The Complete Anemia Guide

(For Hashimoto’s, Heavy Periods, Perimenopause, and Low Energy)

Most women are walking around tired, cold, losing hair, bloated, inflamed, and blaming their thyroid — when the real issue underneath it all is iron metabolism.

Iron affects everything - your thyroid… your hormones… your energy… your mood… your bleeding patterns… even your detox pathways.

And the crazy part? The majority of women have iron patterns their doctor never catches.

This guide breaks it all down simply so you understand EXACTLY what your labs mean and what to do about them.

1. Why Most Women Should NOT Take Oral Iron

“Just take an iron pill” sounds simple — but for many women, it backfires.

A. Oral iron feeds gut pathogens

Unabsorbed iron fuels SIBO, H. pylori, and other “bad bugs.”
This can increase bloating, constipation, gas, and inflammation.

B. Oral iron is poorly absorbed when stomach acid is low

Iron must be converted to its absorbable form using:
• adequate stomach acid (HCl)
• vitamin C

Low HCl is extremely common in: Hashimoto’s, chronic stress, perimenopause, menopause, SIBO, H. pylori, and after having babies.

So most women swallow iron… and absorb almost none of it.

C. Oral iron increases oxidative stress

If iron isn’t stored as ferritin, “free iron” builds up and causes oxidative damage — especially harmful in Hashimoto’s.

D. Oral iron causes stomach issues

• nausea
  • constipation
  • stomach burning
  • bloating

Iron pills often create more symptoms instead of fixing the problem.

Better Options (gentler + safer):

• Iron patches → bypass the gut
• Lactoferrin → improves iron absorption safely
• Biotin → supports iron storage as ferritin
• Stomach acid support → improves absorption of iron from food

2. Why Iron Is CRITICAL for Hashimoto’s

If you have Hashimoto’s or hypothyroidism, healthy iron levels are NON-NEGOTIABLE.

Here’s why:

Iron turns into “heme,” which your thyroid needs to make T4 and T3.

TPO — the enzyme that builds thyroid hormone — requires heme.

When ferritin or heme is low:

• thyroid hormone production drops
• fatigue increases
• metabolism slows
• hair loss and thinning worsen
• detox slows
• TPO antibodies may rise because of oxidative stress

You cannot optimize thyroid function if iron is low.

3. Why Ferritin Must Be Higher in Women Who Menstruate

Ferritin is your iron storage tank.

Every month, women lose iron through menstrual blood.
This is why so many women sit at ferritin 10–40 for YEARS and feel awful.

Optimal ferritin for menstruating women is ABOVE 60.

Below 60, your body literally cannot:

• make enough thyroid hormone
• grow healthy hair
• maintain energy
• repair tissues
• detox efficiently
• balance hormones

And it doesn’t matter how well you eat — if you bleed monthly, you have to rebuild what you lose.

4. Low Iron Causes Heavier Periods (YES — Low, Not High!)

This surprises almost every woman:

Low iron → heavier bleeding.

Iron is required for:

• blood vessel constriction
• uterine lining shedding
• clotting regulation
  
  

When iron is low:

• the uterine lining gets thicker
• the uterus struggles to contract
• periods become heavier, longer, and more painful

This creates a cycle of heavier bleeding → more iron loss → even heavier bleeding.

5. Iron Needs Shift in Perimenopause and Menopause

Perimenopause (late 30s–50s):

Hormones fluctuate →

• heavier cycles
• shorter cycles
• flooding
• thicker uterine lining
• more blood loss
• lower ferritin

Iron deficiency skyrockets here.

Menopause:

Periods stop — but… years of depletion mean many women still have low ferritin, low stomach acid, and poor absorption.

It does NOT “reset” automatically.

6. Key Iron Markers Defined Simply 

These markers tell the REAL story behind your iron status:

Ferritin -  Functional Range: 50–150 ng/mL

Your storage tank.
Low = depleted.
High = inflammation.

Serum Iron - Functional Range: 85–130 µg/dL

Iron floating in your blood.

Transferrin - Functional Range: 200–350 mg/dL

Your iron “Uber driver.”
High = your body is trying to move more iron.

Iron Saturation (%Sat) - Functional Range: 35–45%

How much iron is actually getting delivered to your cells.
Low = deficiency or inflammation.

TIBC - Functional Range: 250–400 µg/dL or UIBC - Functional Range: 150–300 µg/dL

How many “open seats” your body has for iron.
Lots of open seats = deficiency.
Few open seats = inflammation or overload.

7. The Two Most Common Patterns in Women

PATTERN A — TRUE Iron Deficiency

(You are actually depleted)

Lab pattern:

• Low ferritin
• Low serum iron
• Low saturation
• High transferrin
• High TIBC
• High UIBC

This is the woman who is:

• exhausted
• cold
• lightheaded
• hair is falling out
• out of breath
• wiped out by exercise

She needs real iron support — but done safely.

PATTERN B — Low Ferritin ONLY

(Your iron is fine; your storage is broken)

This is extremely common in Hashimoto’s, SIBO, H. pylori, postpartum, heavy cycles, or chronic stress.

Lab pattern:

• Low ferritin
• Normal serum iron
• Normal or mildly low saturation
• TIBC or transferrin not significantly elevated
  
  

This is NOT true deficiency. It is poor ferritin conversion caused by:

1. Low biotin

You can’t convert iron → ferritin without biotin. 10,000-20,000mcg daily to support ferritin synthesis, protect thyroid tissue from oxidative damage, and optimize heme production. Needs to be halted one week before thyroid hormone recheck, and generally hormone and immune function tests due to interference of biotin with lab equipment.

2. Low stomach acid

Iron won’t absorb if HCl is low.

This woman needs:

• biotin
• stomach acid support
• vitamin C
• lactoferrin
• iron patch only if ferritin is very low

NOT oral iron

8. Other Anemia Patterns + The Exact Markers to Look For

Not all anemia is iron anemia.
Here are the three other patterns women commonly show — and the exact markers that identify each one.

1. B12/Folate Anemia (Macrocytic Anemia)

Your red blood cells become too big, but there aren’t enough of them.

This is NOT caused by iron deficiency. It’s caused by low B12, low folate, or poor absorption.

Markers that match this pattern:

Clues clients notice:

• Fatigue
• brain fog
• tingling hands/feet
• memory issues
• mood swings
• feeling “weak” or “off”
• MCV on labs creeping above 95
  

Key idea:
You have iron — but inflammation traps it in tissues, so it can’t be used.

This is common with autoimmunity, Hashimoto’s, infections, chronic inflammation, and chronic illness.

Markers that match this pattern:

Clues clients notice:

• Fatigue
• inflammation symptoms
• flares
• normal ferritin but still very low energy
• iron supplements don’t help (and often make them worse)
  
  

Important:
This is not an iron deficiency.
This is an inflammation problem — not an iron problem.
Oral iron will not fix it.

3. Normocytic Normochromic Anemia

Your red blood cells look normal, but there aren’t enough of them.

This often happens with:

• chronic inflammation
• autoimmune disease
• kidney issues (low EPO)
• chronic illness
• early anemia of chronic disease
  
  

Markers that match this pattern:

Clues clients notice:

• fatigue
• weakness
• exercise intolerance
• “normal iron labs but I still feel awful”
• history of chronic illness or kidney issues

9. WHAT TO DO NEXT?

SIMPLE DECISION TREE:

STEP 1: Is ferritin below 50?

→ Go to Step 2

STEP 1B: Is ferritin above 60?

→ Jump to Step 4

**STEP 2 — Ferritin is LOW

Check serum iron + saturation**

A. Serum iron LOW or saturation LOW (<35%)

➡ TRUE iron deficiency

Next steps:

• Iron patch daily
• Lactoferrin with meals
• Vitamin C
• Stomach acid support

➡ Low ferritin ONLY

Next steps:

• Biotin 10,000–20,000 mcg
• HCl support
• Vitamin C
• Treat H. pylori/SIBO if present
• Iron patch 2–3x/week if ferritin <20
  
  

STEP 4 — Ferritin normal or high, but iron + saturation low

➡ Anemia of chronic disease

Next steps:

• Lower inflammation
• Support detox
• Treat infections
• DO NOT take oral iron
• Consider lactoferrin
  
  

STEP 5 — MCV HIGH (big red blood cells)

➡ B12/folate deficiency
NOT iron.

STEP 6 — RBC, Hgb, Hct low but cell size normal

➡ Normocytic anemia
Check inflammation + kidney function

Quick Summary 

✔ Hashimoto’s absolutely requires healthy iron for thyroid hormone production.
✔ Menstruating women need ferritin above 60 to feel well.
✔ Low iron CAUSES heavier periods.
✔ Perimenopause increases iron loss.
✔ Menopause does NOT fix low ferritin — you still have to rebuild it.
✔ Oral iron is often the worst treatment for women with gut issues.
✔ Lactoferrin + biotin + HCl support are game-changers for many women.