Your ferritin level shows how large your iron store is, and in every menstruating life stage that store is under pressure. Iron is lost with every cycle, and with heavy menstrual bleeding the loss exceeds what diet can replace. Heavy bleeding is the most common cause of iron deficiency in women under fifty. In pregnancy the requirement rises sharply and ferritin falls physiologically in the second and third trimesters. After the menopause the monthly loss disappears and your store shifts towards the male level. One reference figure therefore cannot fit all of those stages at once.
Doctor's Assessment Included
Source: Star-shl Reference population: Nederlandse eerstelijnspopulatie (Star-shl, Roche Cobas e801)
Reference ranges may vary between laboratories. When you order a test, a BIG-registered doctor assesses your personal results in context. For treatment decisions, discuss your results with your GP.
Check your own valueFerritin is the protein that stores iron, and the measured value reflects your reserve. That differs from serum iron, which only shows how much is circulating at that moment and fluctuates considerably across the day. For the question of whether your store keeps pace with what you lose each month, ferritin is the usable value.
The performing laboratory uses 15 to 150 µg/l for women and 30 to 400 µg/l for men. That difference rightly raises a question, and the answer is not that women need less iron. The lower limit sits lower because the reference population it derives from includes menstruating women, who lose iron structurally. The band therefore describes what is common in a group of which a share has a tight store. It is a description, not a standard for what is desirable.
Your life stage shifts what a result means:
| Life stage | Effect on the store |
|---|---|
| Menstruating | Structural monthly loss; the store is under continuous pressure |
| Heavy menstrual bleeding | Loss often exceeds what diet supplies |
| Pregnancy, 2nd and 3rd trimester | Physiological fall; assess against pregnancy-specific values |
| Postpartum | Store often depleted after birth and breastfeeding |
| After menopause | Monthly loss ends; store shifts towards the male level |
Read the result together with haemoglobin and CRP. Reference values differ between laboratories, so your own report takes precedence.
For women the essential point is that the store empties long before the blood count changes. You can have a clearly reduced ferritin alongside an entirely normal haemoglobin, and it is precisely in that phase that complaints arise which are often attributed to a busy life or poor sleep: persistent fatigue, hair loss, restless legs, headache and breathlessness on stairs. The literature often counts an empty store from around 30 µg/l, while anaemia is only established below 15 µg/l. Between those two figures sits a group of women with genuine complaints and a normal blood count.
Heavy menstrual bleeding is the most underestimated cause here. It is the most common explanation for iron deficiency in women under fifty, and many women do not know their blood loss exceeds average, because they have never had a comparison. Flooding through protection, clots larger than a coin and bleeding for more than seven days are signs worth discussing with your doctor.
In pregnancy the same figure changes meaning. Iron requirement rises sharply and plasma volume increases, so ferritin falls physiologically in the second and third trimesters. A value that looks low then should be read against pregnancy-specific references rather than the ordinary band. After birth and during breastfeeding the store often stays tight for a considerable time.
After the menopause the meaning reverses. The monthly loss disappears, so a low ferritin no longer has an obvious explanation. In postmenopausal women a low value always warrants investigation for another source of blood loss. That is a reason to see your doctor, not a reason to worry alone.
Through all of this the main limitation of ferritin applies: it is an acute-phase protein and rises with inflammation or infection. A normal ferritin therefore does not exclude a deficiency while your CRP is raised.
Been ill? Wait a little
RequiredHad a fever, an infection or a vaccination in the past 2 weeks? Wait with the draw until you are fully recovered. These values react to inflammation and would give a distorted picture.
Preferably fasting
RecommendedComing fasting gives a slightly cleaner value, but it is not required. If it suits you, eat nothing from 22:00 the evening before and drink only water.
Ferritin itself is not cycle-dependent. You do not need to wait for a particular cycle day and you do not need to fast. That differs from the sex hormones, where the cycle day determines everything, and it makes a ferritin test practically easy to schedule.
What does matter is not measuring during or shortly after an infection. Because ferritin rises with inflammation, a bout of flu, a urinary infection or recent surgery can lift the value and mask a deficiency. Always request a CRP alongside, and repeat the test if it turns out to be raised.
Good reasons to measure include heavy or prolonged menstrual bleeding, persistent fatigue that sleep does not resolve, hair loss, restless legs, planning a pregnancy or its early stages, the period after giving birth, and menopausal complaints where you want to know whether iron plays a part. A plant-based diet is also a good reason, because the iron in it is less absorbable.
Preferably measure the whole picture at once: ferritin, serum iron, transferrin, transferrin saturation, haemoglobin and CRP. With persistent fatigue, vitamin B12 is a useful addition, because the complaints closely resemble each other and both deficiencies can exist side by side.
A tight iron store causes complaints that are easily attributed to something else. Women mainly report persistent fatigue that sleep does not resolve, hair loss or thinning hair, restless legs that flare in the evening, headache, dizziness on standing up quickly, breathlessness on stairs, cold hands and feet, brittle nails and difficulty concentrating. Because these complaints also fit a busy period, a thyroid condition or the menopause, they prove nothing on their own. They are, however, a good reason to have iron status measured rather than putting it down to tiredness. If this appears after the menopause, discuss it with your doctor: the obvious explanation is then missing.
A raised ferritin level rarely causes symptoms of its own in women, and the cause is usually not that you hold too much iron. Far more often it involves inflammation or infection, fatty liver, excess weight or heavy alcohol use: all situations in which ferritin rises as an acute-phase protein without the iron store having grown. What you notice then belongs to that underlying cause. A single raised result is therefore no reason for concern, but it is a reason to repeat the test at a time when you are not unwell. If the value stays raised, it warrants assessment by your doctor, including transferrin saturation. Hereditary iron overload does occur in women, but usually presents later than in men.
Low ferritin indicates depleted iron stores. Consider iron supplementation and dietary iron increase (red meat, spinach, fortified cereals).
High ferritin may indicate inflammation, hemochromatosis, or liver disease. Consider CRP testing and comprehensive metabolic evaluation.
When you lose iron every month, the absorbability of your source counts for more than the figure on the label. Haem iron from meat, fish and poultry is absorbed considerably better than non-haem iron from pulses, wholegrain products, nuts and dark green leafy vegetables. If you eat little or no meat and bleed heavily, a higher requirement and a less absorbable source run together, and that is the combination in which the store declines fastest.
Two habits shift absorption measurably. Vitamin C alongside a plant-based iron source clearly increases uptake, so peppers, citrus or strawberries with a lentil or spinach meal is an easy gain. The reverse: the tannins in tea and coffee and the calcium in dairy inhibit absorption when taken with the same meal. Move your tea or coffee to an hour before or after eating rather than with it.
Do not start iron tablets on your own. Supplementing without a demonstrated deficiency is harmful, and which form and duration suit you is a decision for your doctor. If you suspect heavy menstrual bleeding is the source, discuss that cause rather than only the replacement: while the loss continues, refilling is mopping with the tap running. With a pregnancy wish or an ongoing pregnancy, guidance belongs with your midwife or doctor in any case.
The laboratory performing our tests uses 15 to 150 µg/l for women. That lower limit derives from a cohort including menstruating women and therefore describes what is common rather than what is optimal. For an empty store the literature often uses around 30 µg/l, clearly higher than the threshold at which anaemia is established.
Your period affects the store itself, not the measurement. Iron is lost with every cycle, and with heavy bleeding that loss often exceeds what your diet supplies. Over months your ferritin falls as a result. The individual test does not fluctuate with your cycle day, so you do not need to time the draw around it.
No. Unlike hormones such as FSH and oestradiol, ferritin has no preferred cycle day, and fasting is not required either. What matters more is not measuring during or shortly after an infection, because ferritin then rises and can conceal a deficiency. Always request a CRP alongside it.
Iron requirement rises sharply to cover your baby's growth and the increase in your own blood volume, while the expanded plasma volume simultaneously dilutes the value. Ferritin therefore falls physiologically in the second and third trimesters. Such a result should be read against pregnancy-specific references; your midwife or doctor guides that.
Yes, and this is the most common cause of iron deficiency in women under fifty. Signs your blood loss is above average include flooding through protection, clots larger than a coin and bleeding for more than seven days. Discuss it with your doctor, because while the loss continues, replacement alone remains insufficient.
Yes. The monthly loss disappears, so the store gradually shifts towards the male level. That also changes what a low result means: without menstrual loss the obvious explanation is missing, and a low ferritin after the menopause therefore always warrants investigation for another source of blood loss.
Hair loss is regularly reported with a low iron store, including without anaemia. It is not proof, however: thyroid problems, hormonal changes, stress and the period after childbirth produce the same picture. It is a good reason to have your ferritin measured, since this is one of the simplest explanations to check.
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This marker is included in the following test panels.
Measure your ferritin, your body's iron store and a common cause of fatigue. No referral needed.
Iron panel: commonly relevant for menstruating women.
Key nutrients at risk on a plant-based diet: Ferritin, CBC, B12, Vitamin D, Zinc, Magnesium.
Anemia workup: hemoglobin, iron, transferrin, CBC, and B12.
Articles that explain this value in context.
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Dr. Naimi oversees the medical standards behind our content and assessments.
Medical policyDoctor's Assessment Included
Every result includes a professional assessment from a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
Ferritin
€28,-
