Ruth Bradford felt like she had been sedated. Exhausted, dizzy, anxious, and suffering heart palpitations and brain fog, she struggled to get through the day without needing a lie-down.
"It was like looking at life through a fog that wouldn't clear, like when you've taken drowsy medication," the 44-year-old mum-of-two says. "I felt like I'd been tranquillised, a zombie walking through life. It was rock bottom."
Ruth, from Wiltshire, initially put her symptoms down to the stress of running a business and having two kids aged five and nine.
When she eventually saw her GP in 2024, a blood test showed she had low ferritin. "I'd never even heard of ferritin," she remembers.
Ferritin stores iron in the body, releasing it when you need it.
Low levels, therefore, indicate a lack of iron, which can trigger fatigue, hair loss, brain fog, low mood and breathlessness.
More recently, the term ferritin face has featured in viral social media videos that report dull skin, dark circles and cracked lips as tell-tale signs of an iron deficiency.
Government data shows that 13% of UK women aged 35 to 49 have ferritin levels below 15 micrograms per litre, indicating the body's iron stores are severely depleted. Ruth's was even lower, at 8 micrograms per litre.
"This issue affects so many people yet it's so trivialised," she says.
"Thousands of women are blaming their symptoms on age, busy lives and stress, when it's actually physiological and potentially preventable. It feels like there's this black hole of knowledge."
"Iron deficiency is more common in women of childbearing age due to their periods," says Dr Andrew Fletcher, a consultant at NHS Blood And Transplant.
"It can be caused or made worse if you are pregnant, because unborn babies take all their nutrients from their mothers. If you are vegetarian or vegan, your iron intake sometimes cannot meet the demands of your body."
Having coeliac disease is another risk factor. Untreated, iron deficiency can lead to anaemia, which can increase your risk of illness, heart and lung issues and pregnancy complications.
Ferritin levels below 30 micrograms per litre can indicate iron deficiency, while 15 and under suggests severely depleted iron stores.
Ruth, who runs The Little Black and White Book Project, had low ferritin, but her haemoglobin, the protein in red blood cells that carries oxygen, was normal. It meant she was iron deficient, but not anaemic.
Her GP prescribed iron supplements and her ferritin crawled up to 24, but she is considering discussing iron infusions, when liquid iron is delivered to the bloodstream through a drip, with her doctor.
Infusions may be offered when iron tablets cause side effects or don't work.
"I was being a rubbish mum and missing out on so much life," Ruth says.
"There's being a tired parent, and then there's bone-crushing fatigue that makes you feel like you aren't in your own body.
"Women are crawling through their 30s and 40s on their knees. We shouldn't have to hit rock bottom before we get the help we need."
Amanda Ashworth, 43, thought her brain fog and exhaustion were simply part of getting older.
"It developed gradually so it was easy to normalise it, to blame my lifestyle and keep pushing through," the mum of three says.
"I was tired even after sleeping, and I had brain fog, low libido and no motivation.
"From the outside, I probably appeared to be managing normally, but internally, I felt as though I was constantly operating with a depleted battery."
Amanda, who splits her time between Cambridge, Goa and Dubai as founder of Worldschooling Hub Goa, assumed stress and perimenopause were to blame, but a 100 pound private blood test showed her ferritin level was 21, which her doctor said fell within the laboratory's normal range.
Her haemoglobin was also normal.
"It was so frustrating," she says. "I didn't feel well but I wasn't anaemic, so I wasn't given any plan or further investigation. I just had to do my own research."
Benchmarks for what counts as low ferritin can vary between practices and labs, and a blood test won't always tell the full story.
Doctors tend to consider results alongside a patient's symptoms, other tests and overall health.
Amanda subsequently began taking an iron supplement and noticed improvement within a few weeks.
"I'm already feeling so much better," Amanda, whose children are 18, eight and six, says.
"My energy has improved, I feel mentally clearer and far more like myself again. It's vital to listen to your body.
"Don't automatically assume that constant exhaustion is simply part of being a parent, working, ageing, stress or perimenopause."
Hair Loss And Ferritin Face Symptoms
A key symptom of so-called ferritin face is hair loss. This is what Hannah Leathers first faced, losing fistfuls of hair every day. The 47-year-old mum of three from Fulham, west London, would find huge amounts coming out in the shower.
"I was scared to brush it," she says. "It was awful. I genuinely thought I was going bald. I bought hair serums, supplements and even a special brush, but nothing did the trick."
Hannah, who works in PR, began wearing headbands every day to hide her hairline.
"They became my armour," she says. "I felt incredibly vulnerable without them. My self-esteem plummeted and I didn't want to go out.
"I was so embarrassed. Family trips to the beach were horrible as I couldn't wear my headband. I was having nightmares about losing all of my hair. It made me cry a lot."
Like Ruth and Amanda, she had never heard of ferritin before and figured the hair loss was caused by stress or perimenopause.
Her GP said it was just one of those things.
It was only after she paid to see a trichologist and had further tests that she discovered her ferritin was just 12 micrograms per litre.
After being prescribed iron supplements and using a scalp treatment, she noticed a difference within months. Her hair began to grow back, and the nightmares stopped.
"I wish I'd shouted a little louder," Hannah says.
"Not every symptom for women in their 40s means perimenopause. It has become such a cover-all."
The Symptoms To Know About
Speak to a GP if you have these:
- Fatigue
- Hair loss
- Weakness
- Dizziness
- Headaches
- Pale skin
- Poor concentration
- Shortness of breath
- Heart palpitations
- Brittle or spoon-shaped nails
- Restless legs
You'll need supplements to correct a deficiency. "With intravenous iron infusion, people can feel better within two to three weeks," says Dr Sue Pavord, consultant haematologist at Oxford University Hospitals NHS Foundation Trust.
"It can take longer with pills, as the dose is lower. To ensure maximum absorption, take iron tablets in the morning on an empty stomach with water or vitamin C.
"Both tablets and IVs carry side effects, including bone pain and constipation, so always speak to a doctor.
"And don't take more than recommended, as this can cause stomach pain and diarrhoea.
"You can also top up levels with iron-rich foods including red meat, pulses, nuts, dried fruit and green veg.
"Citrus fruits and peppers can improve absorption, but wait two hours to have tea, coffee, dairy products and wholegrain cereals."
