Does iron help with headaches during perimenopause?

Iron may be a contributing factor in some perimenopausal headaches, particularly those tied to heavy periods, poor sleep, or significant fatigue, but it is not a standard headache treatment. Whether iron is relevant to your headaches depends entirely on whether your stores are actually low. Testing comes first.

Iron deficiency can contribute to headaches through several biological pathways. The most direct is reduced oxygen delivery to the brain. Iron is the core of hemoglobin, the protein in red blood cells that transports oxygen throughout the body. When iron stores are depleted, hemoglobin production may fall, and brain tissue receives less oxygen. Even before full anemia develops, research suggests that reduced oxygen delivery can trigger vascular changes in the brain that may provoke headaches. Iron is also required for synthesizing dopamine, serotonin, and norepinephrine. Disruptions in these neurotransmitters are specifically linked to migraine and tension-type headaches in women, making iron's role in their production relevant.

There is a second, indirect pathway that is also well supported. Iron deficiency is the most common correctable cause of restless legs syndrome (RLS), a condition involving uncomfortable sensations in the legs that worsen at rest and severely disrupt sleep. Research by Earley and colleagues (2004) documented a strong connection between low ferritin and RLS, with ferritin below 50 ng/mL as a key risk factor. Poor sleep from RLS is itself a well-recognized headache trigger. If iron deficiency is disrupting your sleep, correcting it may reduce headaches indirectly by restoring sleep quality.

Perimenopause adds specific complexity to this picture. Hormonal headaches, particularly those tied to estrogen fluctuations around menstruation, are extremely common in this phase. When periods become heavy and erratic, as they frequently do in perimenopause, iron loss increases with each cycle. A woman losing more blood each period is also losing more iron, which may lower ferritin to the point where it adds to the headache burden on top of the existing hormonal trigger. The two mechanisms can compound each other in ways that make headaches more frequent or more severe.

The research on iron supplementation specifically for headaches is limited and largely indirect. There are no large randomized trials using iron as a primary headache treatment. The evidence for its role is mostly mechanistic and observational, meaning it makes sound biological sense and has been noted clinically, but has not been rigorously tested in the same way as established headache therapies. If you have confirmed low ferritin and frequent headaches, discussing iron correction with your provider as part of a broader management plan is reasonable, but iron alone is unlikely to fully resolve a headache disorder.

To evaluate whether iron is relevant, ask for ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation, and a complete blood count (CBC). Standard lab normal ranges for ferritin often underestimate what is needed for optimal function. Many clinicians consider 50-100 ng/mL a more practical functional target in symptomatic women, not just the absence of overt anemia. Studies examining iron in women with fatigue-related and sleep-disruption-related headaches have used doses guided by individual lab results and degree of deficiency.

Never supplement with iron without a confirmed deficiency from a blood test (ferritin, serum iron, complete blood count). Iron toxicity from unnecessary supplementation is dangerous.

Iron supplements commonly cause constipation, nausea, and GI discomfort. Taking iron with vitamin C improves absorption. Avoid taking iron at the same time as calcium supplements, dairy, green tea, or coffee as these reduce absorption.

Iron interacts with many medications including thyroid medications, certain antibiotics (quinolones, tetracyclines), and bisphosphonates. Tell your provider about all medications before starting iron.

If iron deficiency is confirmed and you begin supplementation, be patient. Ferritin levels rise slowly, typically over 3-6 months of consistent treatment. Any reduction in headache frequency tied to iron correction would follow after ferritin reaches a functional level, not within the first week or two. Retesting ferritin at 8-12 weeks confirms that levels are heading in the right direction. Tracking headache frequency and severity over this same period helps you and your provider evaluate whether the approach is contributing.

See your doctor promptly if a headache is sudden-onset and severe, or unlike any headache you have experienced before. New headaches with fever, neck stiffness, vision changes, weakness, speech changes, or confusion require urgent evaluation. Headaches accompanied by pallor, shortness of breath, or a racing heart may signal iron-deficiency anemia serious enough to need prompt medical attention. Any new or changing headache pattern in perimenopause is worth discussing with your provider.

Logging your headache frequency and intensity alongside your cycle and iron supplement use helps reveal meaningful patterns. The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log headaches daily so you can spot whether patterns shift over time.

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