Here's a scenario I hear constantly, almost word for word.
A woman with heavy shedding finally gets her bloods done. Her ferritin comes back at 15, or 18, or 22. She's told everything is normal. She leaves the appointment with no answers, no plan, and hair still coming out in handfuls.
The problem isn't her results. It's the gap between "not anaemic" and "enough iron to grow hair", and that gap is where an enormous number of women get lost.
What ferritin actually measures
Ferritin is your body's iron storage protein. A blood ferritin test is essentially a read on your iron reserves: the savings account rather than the current account.
Here's why that distinction matters so much. Haemoglobin measures the iron actively circulating in your red blood cells. You can have perfectly normal haemoglobin, meaning you're not anaemic by any clinical definition, while your ferritin reserves are running on fumes. Your body will keep haemoglobin propped up for a long time by quietly draining stores. Which means you can be significantly iron-depleted and still be told your blood count is fine, because technically it is.
Why hair is the first thing to suffer
Hair is metabolically expensive and biologically non-essential. Your body doesn't need it to survive, and it costs a great deal of resource to produce: hair follicles are among the most rapidly dividing cells you have.
So when iron reserves run low, your body triages. Red blood cells and vital organs get what's available. Hair follicles get cut off early, quietly, and without consultation. The result is increased shedding and slower regrowth, frequently long before any classic anaemia symptom like breathlessness or dizziness ever shows up.
Hair is, in effect, an early warning system that most of us never learn to read.
The numbers that matter
Lab reference ranges for ferritin typically begin somewhere around 13 to 30 µg/L depending on the lab. That lower bound exists to catch anaemia. It was never designed as a threshold for optimal hair growth, and it isn't one.
Research and clinical practice in trichology suggest hair growth may be compromised at levels many labs class as perfectly normal. Many hair specialists prefer to see ferritin considerably above the bottom of the range, often quoted in the region of 40 to 70 µg/L, in patients with active shedding. The evidence here is debated and not uniform, and I'd rather say that plainly than pretend there's a single agreed number. But the practical point stands: a ferritin of 18 may be fine for avoiding anaemia and still be low for your hair.
Which is why the single most useful thing you can do is ask for the actual number. "Normal" is a verdict. The figure is data.
Why midlife women are especially vulnerable
Perimenopause is almost designed to drain iron. Cycles often become heavier and more erratic, sometimes considerably so, and each heavy period takes iron with it. Add the fact that many women eat less red meat than they used to, that plant-based iron is less readily absorbed, and that absorption declines with certain common medications, and depleted reserves become the default rather than the exception.
Then layer that on top of the hormonal shift already thinning your hair, and you have two problems compounding each other. Low iron makes hormonal shedding worse. Hormonal shedding makes you scrutinise every hair you lose to low iron. It's a genuinely miserable combination, and it's extremely common.
What to do
Get the number, not the verdict. Ask for your ferritin figure and the lab's reference range. If it's at the bottom of the range and you're actively shedding, that's a conversation worth having rather than a box ticked.
Talk to your GP before supplementing iron. I want to be firm about this one. Iron is not a supplement to self-prescribe at high doses. Excess iron accumulates and is genuinely harmful, some people have conditions that make supplementation dangerous, and the right dose and form depend on your actual levels. Your GP can advise appropriately and recheck in around three months to see whether it's working.
Support intake through food. Red meat is the most readily absorbed source. For plant sources such as lentils, beans, tofu, spinach and fortified cereals, pair them with vitamin C (a squeeze of lemon, peppers, tomatoes) which meaningfully improves absorption. Tea and coffee alongside meals inhibit iron absorption, so shift them away from your main iron-containing meals if you can.
Give it time. Rebuilding ferritin stores takes months, not weeks, and hair responds after the stores recover rather than alongside them. Expect a lag.
Address the hormonal side in parallel. This is the piece women most often miss. For most menopausal women, low iron is an amplifier rather than the whole story. Correct the ferritin and you remove a significant aggravating factor: you don't remove the hormonal mechanism underneath. DHT's increasing influence on sensitive follicles as oestrogen declines is still there, still miniaturising follicles, still needing to be addressed. That's where research-backed ingredients come in: saw palmetto has been shown to help reduce DHT levels by up to 30%, and pumpkin seed oil was linked to a 40% increase in mean hair count over 24 weeks at 400mg daily in a 2014 study. Both sit in our Hair Growth Softgels at research-matched doses.
The pattern I see again and again
Women who fix only the iron often see shedding improve and then plateau, because the hormonal driver was never touched. Women who address only the hormones sometimes see slower progress than they should, because their follicles are being asked to grow hair without the raw materials.
It's when both are handled together that shedding tends to settle properly. Hair loss at midlife is rarely one single villain. It's usually two, working comfortably together, and the reason so many women feel they've "tried everything" is that they've tried each thing separately.