Low ferritin levels

[RhinestoneCowgirl]

I started HRT patches 3 months ago, GP arranged a blood test at the time to make sure there wasn't anything else up with me and it came back with iron reserves of 30. She said this was low and prescribed iron tablets for 3 months. I dutifully took these and just had a repeat test, whereupon my ferritin levels have fallen to 14. 3 months of black shit for nothing...

Just what is going on with my body?! I do have mostly vegetarian diet.

How annoying! Do you have heavy periods?

Sounds like the iron tablets aren’t being taken optimally/ absorbed… when do you take them (time of day, frequency) and what with? Sure you’re aware calcium and tannins in tea/coffee inhibits absorption.

did your GP offer any advice?

GP text just said to talk to a pharmacist.

I've been taking the iron supplement with orange juice, trying to avoid it being close to coffee/tea (which I don't drink too much of anyway). My periods are fairly light, only a few mooncupfuls over two or three days.

What a seriously unhelpful response from
your GP!!! I’d be booking in with a different one asap as rapidly declining ferritin despite taking iron should not be taken lightly.

are you very active, keen runner for example? The vege diet won’t be helping but your ferritin shouldn’t be like it is

Mine has been similar - was 14 when it was first noticed and I’ve just had the follow up blood tests. I’m not even vegetarian. I do have very heavy periods though so maybe it’s that?

Thanks @Riprap I'm not currently running, but am fairly active (yoga/pilates) and don't drive so I walk and cycle most places. I have a called booked with the practice pharmacist, which is what GP advised. But I'm thinking that I probably need to try again with a different GP. The trouble is there is no consistency, you always see someone different.

I've never really had much contact with health services (apart from having babies) and finding this a bit of a frustrating experience.

If you're not eating meat or fish the amount of heme iron you're getting even with iron tablets won't be enough.

Is your vegetarianism non-negotiable?

Even if you could eat just one portion of meat a week or a fortnight it would help.

(I say this as a lapsed veggie!)

I think eating more meat and fish than I am is probably the way to go @JinglingSpringbells. I tend to cook mostly veggie as teen DD is vegetarian, plus I was myself for many years so it's what I'm familiar with. Also environmental and cost reasons. Going to add a steak to the shopping order for this week

Hi 👋 Frequently anemone person here. They need to investigate why. It could be heavy periods. Or something else. An iron infusion it an option. Personally I’d push for that. I feel brand new after I have them.
I had a colonoscopy- after a stool test. Had some polyps that can bleed. They were removed.
A 14 I would be pushing for iron infusion and then regular checks on your iron levels. It’s rubbish.
I also get different symptoms each time I am anemic. Hair loss, heavy periods, low mood, very tired, heart palpitations. It’s never the same.
cealic disease can also be a cause.
But who needs to be investigated.
Feel free to ask any questions. Been anemic on and off for about 8 years

And you need to take your iron with vitamin c for it to be absorbed properly. And not with certain foods. Were you told that?

Thanks for your post @Candlesandmatches , that must be exhausting. GP said not anaemic, just that reserves were low. I have been taking the iron supplement with orange juice, and trying not to take it too close to coffee (tend to just have one cup first thing). I do often feel tired, but it's difficult to know what's a normal level of tiredness for a middle aged woman, and life has been pretty stressful for past couple of years, mainly teen DC related

I’m sorry OP. I’ve been on iron tablets for about six months and ferritin has gone up from 14-18. Periods are v heavy so started on something to reduce that. All my bloods point to anemia, according to AI, but GP note says no action (it also said that when ferritin was at 14). I’ve had long covid for a few years, but feel if I can get iron sorted a bit, I might get a semblance of my life back.

What was your haemaglobin level three months ago and now if that was tested? NHS Doctors say anemia is sub 110 so may tell you you are not anemic but WHO says anemia is sub 120 and you may feel ill and tired at levels over 120. How do you feel in terms of energy, anxiety etc? Any hair loss or other physical symptoms? Do you take other supplements or just the iron? How much iron were you taking for three months?

I have been taking 150mg a day of iron for three months as well as high doses of B12 and Vit D as was feeling unwell with a haemaglobin level of 123. I am waiting for repeat blood test results to see how my levels have shifted but I started feeling better after 2 weeks of supplements. My ferritin was ok (79 which is not deficient but sub optimal as ideally it should be 100) but my B12 was low. As I understand it, to make haemaglobin you need iron, B12 and folate. I had some iron stores (ferritin) but was low in B12 so couldn’t make enough haemaglobin and my levels were dropping. By giving my body B12 I can then make haemaglobin and feel better but it would use up my ferritin stores hence why I still took high doses of iron to try to stop my ferritin depleting and try to get my ferritin up to 100. Could something similar have happened to you making your ferritin drop?

Forgot to say my GP also gave me a FIT test (bowel sample) to check I wasn’t bleeding from my colon.

@RhinestoneCowgirl There's a lot of new research showing that being vegetarian can impact on bone health, especially with young girls who are veggie during their teenage years.

This is one of the articles but there are many more.

www.theguardian.com/science/2022/aug/11/vegetarian-women-fracture-hips-study-bone-health

@choux,where do I find that ferritin should be at 100? My GP says they’re normal if 15. I’d like to push for some help in increasing my iron.

The NICE guidelines say “In all people, a serum ferritin level of less than 30 micrograms/L confirms a diagnosis of iron deficiency.“
https://cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/investigations/#interpreting-ferritin-levels

This NHS Bristol page says
Adult females:
<15 ug/L: Consistent with absolute iron deficiency;
15-29 ug/L: Indicative of low body iron stores;
30-99 ug/L: Indeterminate ferritin;
100-310 ug/L: Normal ferritin;
>310 ug/L: High ferritin.

https://www.nbt.nhs.uk/severn-pathology/requesting/test-information/ferritin

Thank you so much.

That NICE guideline tells you what tests and treatments your GP should be offering. But you can buy ferrous fumerate from the chemist yourself without a prescription. Mine charges £4.99 for 84 tablets of 210mg.

i have been taking 2-3 a day with a high strength vit c tablet to aid absorption. The elemental iron in a 210mg tablet is roughly 65mg which is why I said I was taking 150mg iron in a previous post. Menstruating women need about 14mg iron a day and non menstruating women (me) and men need about 8mg a day so I am taking about 20 times what my body needs to try and up my haemaglobin and ferritin levels. I had another blood test this morning so should get the results next week. But I already feel better energy wise and my hair has stopped falling out as much when washing it. Plus I feel less anxious.

Jumping in because I'm on a mission to increase my ferritin too (5 when I was first tested last November, up to 50 at the last test 2 months ago.) I've been on ferrous fumarate all that time but taking one tablet with a vitamin c supplement every other day as evidence suggests absorption is better that way.

I'm largely vegetarian because of vegetarians in the family but have been buying M&S minute steaks (£6 for 3) and having one at least once a week, which I think might have made a significant difference between my first and second test when ferritin jumped from 16 to 50. I'm currently trying to get another test but you'd think I was asking for the moon on a stick!

Does ferrous fumerate work better than ferrous sulphate?

They have different elemental iron levels so you need a higher mg tablet of sulphate to get the same amount of elemental iron. Some people might be more sensitive to one than the other but other than that I think they are the same.

You could make a few dietary changes to get more iron too. If you like black pudding you are golden! Unfortunately I don’t but have switched from muesli to grape nuts cereal (not listed here but has 12.5mg per serving) and I now use spinach as my salad leaves of choice and sprinkle pine nuts on them.

https://www.mkuh.nhs.uk/patient-information-leaflet/good-sources-of-iron

very hard to get 49 points in a day!

They didn't test haemoglobin so don't know that. 3 months ago folate and B12 were both fine. Don't have noticeable hairloss but some fatigue, I had been putting this down to a stressful year. I haven't been able to work much as my teen DD had a MH crisis and has been out of school. This has messed with my sleeping. I have a nap in the afternoon a couple of times a week.

The supplement have been taking is ferrous sulphate 200mg. I take vit D and sometimes magnesium. One possible culprit could be dairy, I have muesli with kefir most mornings and this could have been too close to supplement time. I wondered about taking iron in the evenings (with orange juice) to see if that makes a difference.