20/02/2026
If your ferritin isn’t improving despite supplementation, the issue may not be intake.
It may be absorption.
Iron deficiency has three primary drivers:
1️⃣ Blood loss
2️⃣ Inflammatory sequestration
3️⃣ Malabsorption
In clinical practice, I often see women repeatedly prescribed higher doses of iron without investigating the underlying mechanism.
Iron is absorbed primarily in the proximal small intestine. If there is:
• Chronic bloating
• Reflux
• IBS
• Untreated Helicobacter pylori infection
• Small intestinal bacterial overgrowth
• Coeliac disease
• Low stomach acid
Absorption may be compromised.
This impairs iron uptake by affecting stomach acid, mucosal integrity, or inflammatory signalling.
In other cases, ferritin may appear normal, yet serum iron and transferrin saturation are low. This suggests inflammatory blockade — where the hormone hepcidin reduces iron absorption and traps iron in storage.
More supplementation does not override hepcidin.
In fertility and pregnancy care, this matters.
Iron supports:
• Ovulation
• Endometrial oxygenation
• Placental development
• Postpartum recovery
If ferritin won’t rise, the question is not “How much more iron?”
The question is “Why isn’t it being absorbed?”
Iron deficiency is rarely random.
It’s a signal.
