Does iron help with anxiety during perimenopause?

The connection between iron and anxiety is real and biologically grounded, but it only applies if you are actually iron deficient. Iron does not reduce anxiety in women with adequate iron levels. The key question is whether low iron is contributing to your anxiety, and during perimenopause, iron deficiency is more common and more underdiagnosed than most women realize.

Iron is a critical cofactor in the synthesis of dopamine, serotonin, and norepinephrine, the neurotransmitters most directly linked to mood regulation and anxiety. The enzyme tyrosine hydroxylase, which converts tyrosine into dopamine (and eventually norepinephrine), requires iron to function. The enzyme tryptophan hydroxylase, which converts tryptophan into serotonin, also depends on iron. When iron stores are low, these neurotransmitter pathways run below capacity. The result can look strikingly like an anxiety or mood disorder: restlessness, irritability, difficulty concentrating, low stress tolerance, and a feeling of internal agitation.

Iron is also essential for mitochondrial energy production through the electron transport chain, for oxygen transport via hemoglobin, and for thyroid hormone metabolism. Any of these deficits, when severe enough, can amplify symptoms that overlap with anxiety.

During perimenopause, iron deficiency becomes more likely for a specific reason. Many women experience heavier and more irregular periods in the years before menopause. Anovulatory cycles often produce prolonged or heavy bleeding, which accelerates iron loss. At the same time, declining estrogen reduces the body's efficiency at absorbing dietary iron. Ferritin, the stored form of iron, can fall into a gray zone that standard blood tests may flag as normal but that researchers increasingly recognize as suboptimal. A ferritin below 50 to 70 ng/mL can impair neurotransmitter synthesis and cause symptoms even when hemoglobin and red blood cells are still technically in range.

Never supplement with iron without confirmed deficiency from a blood test. Iron toxicity from unnecessary supplementation is dangerous. Excess iron generates oxidative stress, damages tissues, and can interfere with absorption of other minerals including zinc and copper. Before considering iron supplementation, ask your provider for a full iron panel: ferritin, serum iron, total iron binding capacity (TIBC), transferrin saturation, and a complete blood count (CBC). This gives a complete picture rather than relying on any single marker.

If deficiency is confirmed, iron supplements commonly cause constipation, nausea, and GI upset. Taking iron with vitamin C (such as a glass of orange juice or a vitamin C supplement) significantly improves absorption. Avoid taking iron with calcium supplements, green tea, coffee, or dairy, all of which reduce iron absorption. Ferrous bisglycinate is generally better tolerated than ferrous sulfate. Talk to your healthcare provider about the right dose for your situation.

If you take any medications, check with your provider before starting iron. Iron interacts with many drugs, including thyroid medication (levothyroxine), antibiotics (quinolones, tetracyclines), and bisphosphonates for bone density. The timing of iron relative to these medications matters significantly.

Direct evidence linking iron supplementation specifically to anxiety reduction in perimenopausal women is limited. Most of the research in this area comes from studies on iron deficiency in adolescents, athletes, and women of reproductive age more broadly. These consistently show that correcting iron deficiency improves mood, cognitive function, and fatigue, symptoms that overlap substantially with anxiety. Extrapolating to perimenopausal women with confirmed deficiency is reasonable, but this is not the same as a well-powered randomized trial in this specific population. Be honest with yourself about the evidence quality: it is mechanistically sound but not conclusively proven for anxiety as an isolated target.

Timeline: correcting iron deficiency takes time. Even with optimal supplementation, ferritin stores typically take two to four months to rebuild fully. Early improvements in energy and cognitive clarity may appear before that, but give it at least eight weeks before evaluating results.

See a doctor if anxiety is significantly impairing your daily function, if you have symptoms of moderate to severe iron deficiency anemia such as marked fatigue, shortness of breath, or pale skin, or if anxiety symptoms persist after iron levels are confirmed as adequate. Anxiety in perimenopause is often multifactorial, and iron is one piece, not the whole picture. Talk to your healthcare provider about the right approach for your specific situation.

This content is for informational purposes only and does not replace medical advice. Always consult your healthcare provider about your specific situation.