Why Iron Deficiency Is So Common In Female Athletes

Imagine training six times a week, sleeping early, eating healthy and yet constantly feeling exhausted halfway into practice. Many athletes think they need to work harder. The more they try and push themselves, the more tired they end up feeling. However, the problem has nothing to do with fitness or motivation, it could be entirely related to iron deficiency.

Iron deficiency is one of the most common nutritional deficiencies in the world, with female athletes at a higher risk of developing it. 15–35% of female athletes develop an iron deficiency. Despite how common it is, it is often ignored until it starts to affect performance.

Some people may ask: What does iron have anything to do with sports performance?

In simple words, iron helps produce haemoglobin. Haemoglobin carries oxygen from the lungs to the muscles. Without a sufficient amount of iron, the body cannot produce enough red blood cells, decreasing the amount of oxygen sent to the body. As a result, athletes may experience fatigue, slower recovery, decreased endurance, and reduced performance.

Why Female Athletes Are More Vulnerable

During menstruation, female athletes lose anywhere from ’10 mg to 40mg of iron. While trying to make up for this monthly loss, they have to simultaenously meet the high iron demands of intense athletic training. Research suggests that up to one-third of exercising women experience heavy menstrual bleeding, substantially increasing their risk of iron deficiency and, in some cases, iron-deficiency anemia. The challenge is that many athletes don’t realise their menstrual cycle can have such a significant impact on their performance. They may dismiss persistent fatigue as a result of tough training, when in reality their bodies are struggling to replenish the iron they’ve lost. However, menstruation isn’t the only reason female athletes are at risk.

Training Increases Iron Demand

Another cause of lack of iron can be increased iron demand from training. Although the amount of iron lost is relatively small, athletes who train more frequently gradually lose more iron over time. Additionally, strenuous exercise like running causes small bits of gastrointestinal bleeding and the breaking down of red blood cells. Over months of training, these individual, small losses add up to a larger, total loss of iron, making it harder for athletes to maintain the recommended amount of iron stores. As these changes occur gradually, athletes don’t notice a problem until they see a decline in performance, making an iron deficiency hard to spot in its early stages.

When a Healthy Diet Isn’t Enough

A common assumption made by many athletes is having a healthy diet automatically protects them from iron deficiency. In reality, this is not the case at all. Even healthy diets do not provide enough absorbable iron to match the increased demands of an athlete. There are two main types of iron. Heme iron is a highly absorbable type of iron which comes from animal flesh like meat and fish. Non-heme iron is absorbed less efficiently, found primarily in plant-based foods such as beans, lentils, spinach, tofu, etc, although it is also present in smaller amounts in many animal food. The absorption rate for heme is between 15–35% whereas non-heme is between 2–20%. Eating food containing non-heme iron is important for athletes who are vegetarian or vegan. While these foods often provide adequate iron, the body may require extra amounts of iron which is not fully fulfilled with non-heme food. Fortunately, iron absorption can be increased while pairing it with vitamin C food such as oranges, strawberries, or bell peppers. For athletes, the main focus is about making sure the body absorbs and utilizes the iron in the best way possible.

The Symptoms Many Athletes Overlook

One of the biggest issues with iron deficiency is where the symptons are rarely recognised. Instead, they develop gradually, making it easy to miss until it becomes a larger, recognizable problem. They are often dismissed as lack of sleep, intense training week and everyday stress. An athlete may notice workouts getting harder, recovery taking longer and endurance decreasing. Importantly, athletes can experience many of these symptoms even before they develop iron-deficiency anaemia, highlighting the importance of recognising the signs early and seeking appropriate medical advice if they continue.

The Bigger Picture

Iron deficiency isn’t just about decreasing stamina or being able to lift less weight. It’s about how it affects an athletes confidence, motivation and overall ability to enjoy a sport. When an athletes puts in constant effort, and despite this, training begins to become tougher, they begin to question their own abilities rather than consider an underlying health issue. Forunately, iron deficiency is something that can be easily prevented and treated. Awareness among athletes, coaches and parents is necessary for early diagnosis, so that it is managed and treated properly. Athletes are often advised to push through pain and discomfort, but not all pain should go unnoticed. Listening to the body is as important as pushing through its limits. Recovery time is as important as training time. By recognising the signs of iron deficiency early and prioritising nutrition alongside training, female athletes can protect both their health and their performance. No athlete should have to choose between reaching their potential and taking care of their health.