Does iron help with mood swings during perimenopause?

If your iron stores are low, correcting the deficiency may reduce mood instability during perimenopause. The link between iron and mood is well-established at a biological level, and it runs through the same neurotransmitter systems that estrogen also supports. However, iron will not improve mood if your levels are already normal, and taking it without a confirmed deficiency can cause serious harm. A blood test before any supplementation is the non-negotiable first step.

Iron is a required cofactor for producing three neurotransmitters that are central to emotional regulation: serotonin, dopamine, and norepinephrine. Serotonin influences overall mood tone, patience, and the ability to handle frustration without tipping into distress. Dopamine underlies motivation, reward, and emotional resilience. Norepinephrine helps calibrate the stress response. When iron is depleted, the enzymes that synthesize these chemicals do not work at full capacity. The result can look like mood swings, irritability, sudden crying, low mood, and a sense of being emotionally on a hair-trigger, symptoms that overlap significantly with what perimenopause produces through hormonal routes.

Perimenopause creates a double vulnerability. Fluctuating estrogen directly affects serotonin and dopamine signaling. In the years leading up to menopause, estrogen does not simply decline in a straight line. It spikes and crashes unpredictably, and each crash pulls serotonin and dopamine availability down with it. If iron deficiency is also present, those same neurotransmitter systems face pressure from two separate directions at once. The result is often mood instability that feels disproportionate and hard to explain. Research suggests ferritin below 50 to 70 ng/mL can impair mood and cognitive function even without technically meeting the diagnostic threshold for anemia. Standard hemoglobin-only testing misses this. Ask your provider specifically for serum ferritin, serum iron, and a complete blood count.

Never supplement with iron without a confirmed deficiency from a blood test (ferritin, serum iron, complete blood count). If a deficiency is confirmed, your provider will advise on form and duration. Heme iron from red meat, organ meats, and fish is absorbed considerably more efficiently than non-heme iron from plant sources or standalone supplements. Pairing non-heme sources with vitamin C, such as a handful of spinach with strawberries or lentils with lemon juice, improves absorption substantially. Avoid taking iron at the same time as calcium supplements, dairy products, green tea, or coffee, all of which reduce how much iron your body absorbs.

Iron supplements commonly cause GI side effects including constipation, nausea, and dark stools. Take with vitamin C. Avoid taking with calcium, dairy, green tea, or coffee. Iron interacts with thyroid medications, antibiotics (quinolones, tetracyclines), and bisphosphonates. Space iron at least two to four hours away from these medications. Because iron accumulates in tissues and organs when taken in excess, supplementing without medical supervision and periodic retesting is not safe. Iron toxicity is a real risk.

Mood improvement from restoring iron is gradual rather than immediate. Ferritin rebuilds over weeks to months, and most women need eight to twelve weeks before noticing a meaningful emotional shift. Energy typically improves first, and emotional stability often follows two to three weeks later as neurotransmitter production recovers. Track your experience over that period so you can evaluate honestly whether the change is meaningful.

Iron is one layer of the mood picture during perimenopause. Hormonal fluctuations, chronic sleep disruption, thyroid dysfunction, vitamin D deficiency, and unaddressed psychosocial stressors all contribute to mood instability independently. If iron levels test as adequate and mood swings remain significantly disruptive, your provider can explore these other contributors. Hormone therapy has solid evidence for mood stabilization in perimenopausal women and is worth discussing if symptoms are affecting your daily life or relationships.

See a doctor if mood swings are severe enough to affect your relationships, your job, or your ability to function in daily life, if you experience thoughts of harming yourself, or if emotional symptoms came on suddenly rather than gradually over months. These all warrant prompt clinical evaluation, not watchful waiting.

The PeriPlan app (https://apps.apple.com/app/periplan/id6740066498) lets you log mood swings daily so you can spot whether patterns shift over time and bring organized data to your provider conversations.

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