How to Optimise Iron Levels for Energy, Hormones & Fertility

Iron deficiency is one of the most common issues I see in clinic, particularly in women navigating fatigue, hair loss, hormonal imbalance, endometriosis, and fertility challenges.

Many women are told their iron levels are “normal” yet still experience symptoms. This is where an integrative and functional approach becomes important. Rather than looking at what is simply “adequate,” we focus on what is optimal for your physiology, energy, and reproductive health.

Drawing on clinical experience and frameworks, there are three key reasons iron levels may be low,and understanding these is essential to restoring balance.

The Three Reasons Iron May Be Low

1. You Are Losing Too Much Iron

This is one of the most common drivers of low iron in women.

Heavy or prolonged menstrual bleeding, often seen in:

• Endometriosis

• Fibroids

• Hormonal imbalance (particularly estrogen dominance)

…can lead to ongoing iron depletion.

Even if your diet is sufficient, chronic loss will outpace intake.

This is why addressing iron levels is not just about supplementation — it requires understanding why the loss is occurring and supporting the menstrual cycle itself.

2. You Are Not Absorbing Iron Properly

Iron absorption is influenced by a number of factors, including:

• Gut health and digestive function

• Stomach acid levels

• Inflammation

• Nutrient cofactors

One of the most important regulators here is hepcidin — a hormone produced by the liver.

Hepcidin controls how much iron is absorbed from the gut and released into circulation. When hepcidin levels are elevated (often due to inflammation or stress), iron absorption is reduced.

This means:
👉 You can be eating iron-rich foods — or even taking supplements — but not absorbing them effectively.

This is particularly relevant in women with:

• Autoimmune disease

• Chronic inflammation

• Gut dysfunction

3. You Are Not Getting Enough Iron or Cofactors

While intake is not always the primary issue, it still matters.

Iron-rich foods include:

• Red meat (heme iron — most bioavailable)

• Liver

• Lentils and legumes

• Dark leafy greens

However, iron does not work in isolation. It requires key cofactors for absorption and utilisation:

• Vitamin C → enhances absorption

• Vitamin A → supports mobilisation of iron

• Copper → required for iron metabolism

• B vitamins → support red blood cell production

Dr Libby often emphasises that it’s not just about iron intake, but whether your body has the nutritional environment to use it effectively.

The Role of Hepcidin, Inflammation & Stress

One of the most overlooked aspects of iron deficiency is the role of inflammation and the nervous system.

When the body is under chronic stress — whether physical, emotional, or inflammatory — it produces signals that increase hepcidin.

This creates a protective mechanism:
The body essentially “locks away” iron

While this can be helpful in acute illness, chronically elevated hepcidin leads to:

• Reduced iron absorption

• Limited iron availability for cells

• Ongoing fatigue despite normal intake

This is why addressing:

• Stress

• Gut health

• Inflammation

…is essential for restoring iron levels.

What Optimal Iron Looks Like (Not Just “Normal”)

Standard blood tests often focus on whether your levels fall within a reference range.

However, optimal ranges for function and fertility are often higher than minimum lab ranges.

A comprehensive iron panel should include:

• Ferritin (iron stores)

• Serum iron

• Transferrin

• Transferrin saturation

From a functional perspective, ferritin levels are often ideally:
Above 50–80 µg/L (context-dependent)

Low or borderline levels may still contribute to:

• Fatigue

• Hair loss

• Poor exercise tolerance

• Suboptimal fertility outcomes

This is particularly important for women preparing for pregnancy or IVF, where iron plays a role in oxygen delivery and cellular energy.

How to Optimise Iron Levels

An integrative approach focuses on all contributing factors:

1. Address Underlying Loss

• Support menstrual health

• Investigate heavy bleeding

• Balance hormones

  2. Improve Absorption

• Support gut health

• Reduce inflammation

• Space iron away from inhibitors (coffee, tea, calcium)

3. Optimise Nutrition

• Include bioavailable iron sources

• Pair iron with vitamin C-rich foods

• Ensure adequate cofactors

4. Support the Nervous System

• Reduce chronic stress

• Support sleep and recovery

5. Use Targeted Supplementation (When Needed)

This should be:

• Individualised

• Based on testing

• Monitored over time

Integrative Iron Support with Dr Frances Tobeck

In clinical practice, iron optimisation is approached through a personalised lens.

At the clinic, Dr Frances Tobeck supports women with:

• Iron deficiency and fatigue

• Endometriosis and heavy periods

• Fertility and IVF support

• Hormonal imbalances

• Gut and inflammatory conditions

Treatment may include:

• Acupuncture to regulate the menstrual cycle

• Personalised Chinese herbal medicine

• Nutrition and supplementation strategies

• Functional testing to understand root causes

Final Thoughts

Iron deficiency is rarely just about low intake. It is often a combination of loss, absorption, and underlying physiology.

By understanding the role of hepcidin, inflammation, nutrition, and hormonal health, it becomes possible to restore iron levels in a way that supports long-term energy, resilience, and fertility.

If you’ve been told your iron is “fine” but don’t feel it — there is often more to the picture.

Dr Frances Tobeck
Chinese Medicine Practitioner | Women’s Health, Fertility & Hormonal Support
Melbourne & Ballarat