Always Exhausted? Why Your Ferritin Level Is Low & Medical Next Steps

If you feel constantly tired—even after a full night's sleep—low ferritin could be part of the problem. Many people assume fatigue is just stress, aging, or a busy schedule. But when exhaustion doesn't improve with rest, it's time to look deeper.

One common and often overlooked cause is low ferritin, a key marker of your body's iron stores. Understanding what ferritin is, why it matters, and what to do next can help you move toward feeling like yourself again.

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What Is Ferritin?

Ferritin is a protein that stores iron inside your cells. Think of it as your body's iron "backup supply."

Iron is essential because it helps your body produce hemoglobin, the protein in red blood cells that carries oxygen. Without enough iron—and therefore low ferritin—your tissues and organs may not get the oxygen they need to function properly.

A simple blood test measures ferritin levels. It's one of the most reliable ways to check your iron stores.

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What Is Considered a Low Ferritin Level?

Normal ferritin ranges vary by lab, age, and sex, but in general:

• Adult women: Often 15–150 ng/mL
• Adult men: Often 30–400 ng/mL

However, many medical professionals consider ferritin below 30 ng/mL to suggest depleted iron stores, even if it falls within a lab's "normal" range.

Some people begin experiencing symptoms when ferritin drops below 50 ng/mL, particularly menstruating women.

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Symptoms of Low Ferritin

Low ferritin can develop slowly. Symptoms may be subtle at first and worsen over time.

Common symptoms include:

• Persistent fatigue
• Weakness
• Shortness of breath with mild activity
• Dizziness or lightheadedness
• Headaches
• Pale skin
• Cold hands and feet
• Brittle nails
• Hair thinning or hair loss
• Brain fog or difficulty concentrating
• Restless legs at night

When ferritin drops far enough to affect hemoglobin levels, it can lead to iron deficiency anemia, a more serious condition.

If you're experiencing several of these symptoms and want to understand whether they could be related to Anemia, a free AI-powered symptom checker can help you identify patterns and prepare informed questions for your doctor.

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Why Is Your Ferritin Low?

Low ferritin does not happen randomly. There is always a cause, and identifying it is essential.

1. Blood Loss (Most Common Cause)

Chronic blood loss is the leading cause of low ferritin.

Common sources include:

• Heavy menstrual periods
• Gastrointestinal bleeding (ulcers, polyps, hemorrhoids)
• Colon conditions, including cancer
• Frequent blood donation
• Recent surgery or injury

In adults—especially men and postmenopausal women—unexplained low ferritin requires evaluation for internal bleeding, often in the gastrointestinal tract.

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2. Inadequate Iron Intake

You may not be getting enough iron from food, particularly if you:

• Follow a vegetarian or vegan diet without careful planning
• Have a highly restricted diet
• Experience food insecurity

Iron from animal sources (heme iron) is more easily absorbed than iron from plant sources (non-heme iron).

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3. Poor Iron Absorption

Even if you consume enough iron, your body may not absorb it properly.

Conditions that affect absorption include:

• Celiac disease
• Inflammatory bowel disease (Crohn's disease, ulcerative colitis)
• Gastric bypass surgery
• Chronic stomach inflammation
• Long-term use of acid-reducing medications

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4. Increased Iron Needs

Some life stages increase iron demand:

• Pregnancy
• Breastfeeding
• Adolescence
• Endurance athletic training

If intake doesn't keep up with demand, ferritin drops.

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Why Low Ferritin Should Not Be Ignored

Low ferritin is not just about feeling tired.

If untreated, iron deficiency can:

• Progress to anemia
• Strain your heart (as it works harder to deliver oxygen)
• Impair cognitive performance
• Increase infection susceptibility
• Complicate pregnancy

In severe cases, untreated anemia can become dangerous. While most cases are manageable, identifying the root cause is essential.

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Medical Next Steps

If you suspect low ferritin, here's what to do:

1. Get Proper Blood Testing

Ask your doctor about:

• Serum ferritin
• Hemoglobin
• Hematocrit
• Serum iron
• Total iron-binding capacity (TIBC)
• Transferrin saturation

Ferritin alone doesn't always tell the whole story. For example, ferritin can appear normal during inflammation, even if iron stores are low.

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2. Identify the Underlying Cause

This step is critical.

Your doctor may:

• Review menstrual history
• Ask about digestive symptoms
• Order stool tests for hidden blood
• Recommend endoscopy or colonoscopy (especially for adults over 45 or anyone with risk factors)
• Screen for celiac disease

Treating low ferritin without finding the cause can delay diagnosis of serious conditions.

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3. Iron Supplementation (If Needed)

If iron deficiency is confirmed, treatment usually involves iron supplements.

Common recommendations:

• Oral iron tablets (often ferrous sulfate, ferrous gluconate, or ferrous fumarate)
• Taken on an empty stomach for better absorption
• Paired with vitamin C to enhance absorption

Possible side effects:

• Constipation
• Nausea
• Dark stools
• Stomach discomfort

If oral iron isn't tolerated or absorbed, intravenous (IV) iron may be recommended.

Do not start high-dose iron without medical guidance. Too much iron can be harmful.

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4. Dietary Improvements

In addition to supplementation, dietary changes help restore ferritin.

Iron-rich foods include:

• Red meat
• Poultry
• Fish
• Lentils
• Beans
• Tofu
• Spinach
• Pumpkin seeds
• Iron-fortified cereals

Tips to improve absorption:

• Pair plant-based iron with vitamin C (citrus, bell peppers)
• Avoid tea or coffee with meals (they reduce absorption)
• Avoid taking calcium supplements at the same time as iron

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5. Monitor Progress

Ferritin does not rebound overnight.

• It may take 2–3 months to improve hemoglobin
• It can take 3–6 months (or longer) to fully replenish ferritin stores

Repeat blood tests are usually done after several weeks of treatment.

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When to Seek Urgent Care

While most cases of low ferritin are manageable, seek prompt medical attention if you experience:

• Chest pain
• Severe shortness of breath
• Fainting
• Black or bloody stools
• Vomiting blood
• Sudden, severe weakness

These symptoms could indicate serious blood loss or severe anemia.

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The Bottom Line

Persistent fatigue is not something you should simply "push through." Low ferritin is a common, treatable cause of exhaustion—but it's also a signal that something deeper may be going on.

The key steps are:

• Confirm with proper blood testing
• Identify the root cause
• Treat appropriately
• Monitor until levels are restored

If you're unsure whether your symptoms fit iron deficiency, consider using a free Anemia symptom checker as a starting point to better understand what you're experiencing.

Most importantly, speak to a doctor about ongoing fatigue, abnormal lab results, or any concerning symptoms. Some causes of low ferritin—such as internal bleeding—can be serious or even life-threatening if ignored.

The good news? With the right evaluation and treatment, most people with low ferritin feel significantly better. Getting answers is the first step toward getting your energy back.