Iron Infusions Are Being Handed Out Too Easily, and the Real Question Is Why You’re Low

Iron Infusions Are Being Handed Out Too Easily, and the Real Question Is Why You’re Low

You’ve had your third iron infusion in three years. Each time, the fog lifts for a few months, your energy comes back and you stop needing to lie down at 3pm. Then it slowly slides again until your ferritin comes back low and another infusion gets booked. Somewhere along the way it stopped feeling like treatment and started feeling like maintenance, like getting the car serviced.

If that’s you, you’ve probably made peace with it. So many of the women we see tell us they’ve been anaemic or low in iron their whole life, that it’s just how they’re built, that their mum was the same. We hear it all the time, and we gently disagree every time. Being low in iron for most of your adult life isn’t normal and it isn’t just your constitution. There’s almost always a reason, and finding it is the difference between topping up the tank every year and fixing the leak.

This matters more now than it did a few years ago. A national study published in August found IV iron use among Australian women aged 18 to 44 rose 17-fold between 2013 and 2024, to around 1 in 20 women a year. The researchers themselves questioned whether it’s always being prescribed appropriately. In September, the US regulator put its strongest safety warning on ferric carboxymaltose, the infusion behind the vast majority of those treatments here, and the TGA says it’s evaluating the US decision.

Iron infusions are being handed out too easily

In our view, the bar for an iron infusion has quietly dropped. Infusions are quick, they work fast and most women feel the difference within weeks, so it’s easy to see why they’ve become the go-to. But an infusion delivers a large dose of iron straight into the bloodstream and bypasses the gut, which is your body’s main gatekeeper for how much iron gets in. That’s exactly what you want in the right situation, and it’s why infusions should be kept for the right situation.

We’d like to see a much more refined set of criteria applied every time a woman is offered one: oral iron tried properly first, in a form she can tolerate and taken the right way; the reason she’s low actually investigated; and her phosphate checked, especially if she’s having repeat infusions. Australian guidelines already put oral iron first for most people. Infusions are meant for when oral iron isn’t tolerated, isn’t working or can’t be absorbed, or when levels need to come up quickly, such as before surgery, later in pregnancy or with inflammatory bowel disease. In clinic, we regularly meet women who went straight past that first step.

Why more iron isn’t better

Iron is essential. It carries oxygen around your body and fuels your energy, your thyroid and your brain, but it’s also highly reactive. In high amounts it’s toxic, and when it builds up in the body it drives oxidative stress and inflammation that damage cells over time. That’s why your body guards iron so tightly, and why it has no real way to get rid of the excess once it’s in.

A single, correctly calculated infusion is designed to refill your stores, not overload them. What concerns us is the pattern: infusion after infusion, year after year, with the cause still unfound and nobody stepping back to look at the whole picture. Enough is the goal, and enough looks different for every woman.

The side effects worth knowing

Most women are told about the short-lived reactions, and they’re worth knowing:

• Flu-like reactions: headache, nausea, flushing, and muscle or joint aches in the day or two after, which usually settle on their own.
• Dizziness or a drop in blood pressure: which is why you’re monitored during and after the infusion.
• Skin staining: if iron leaks out of the vein it can leave a brown mark at the site that, for some women, is permanent. If the drip site starts to sting or burn, speak up straight away.
• Allergic reactions: rare but serious, which is why infusions are only given where emergency equipment is on hand.

The one most women aren’t warned about is low phosphate. Ferric carboxymaltose (sold as Ferinject) can cause your kidneys to waste phosphate, which your muscles, nerves and bones rely on. When it drops you can feel exhausted, weak, breathless and headachy, often a few days to two weeks after the infusion. Those symptoms look almost exactly like the iron deficiency you were treating, so many women assume the infusion just hasn’t kicked in and wait it out. The risk is higher with repeat infusions, which is one more reason the every-year pattern worries us.

What’s actually draining your iron

When iron keeps running low, something is either taking it out faster than you can replace it, or stopping you absorbing it in the first place. These are the drivers we look for most:

• Heavy periods: the most common reason we see and the least talked about. Many women have no idea their periods are heavy because they’ve always been that way. Flooding, changing protection overnight or bleeding for more than seven days all count.
• Poor absorption in the gut: iron is absorbed in the upper part of your small intestine, and it needs a healthy gut lining and enough stomach acid to get in. Low stomach acid, gut inflammation or an irritated gut lining can all quietly block it.
• Coeliac disease: often missed for years, especially when the main sign is low iron rather than obvious gut symptoms. It’s always worth ruling out properly with your GP.
• How and when you’re eating: tea and coffee with meals, a low intake of iron-rich foods, or a diet that’s become very restricted over time can all add up.
• Missing cofactors: iron doesn’t work alone. Your body needs other nutrients to absorb and use it, so low levels of these can keep your iron stubbornly low even when you’re taking it.

It’s never just one thing, and for a lot of women it’s two or three of these working together.

Why the investigation gets missed

This isn’t about blaming GPs, who are often the ones who picked up the low iron in the first place. A standard appointment is short, and an infusion referral is set up to refill your iron, not to find out why it ran low. One Victorian infusion service says as much on its own referral page. So the investigation falls into a gap, and that gap is where naturopaths, nutritionists and other allied health practitioners do some of their most useful work. We have the time to sit with the whole story, and we work alongside your GP to get the right tests done.

How we’d investigate this in clinic

When a woman comes to us with iron that keeps dropping, we start with a full history: her periods in detail, what she eats across a normal week, what she drinks with meals, any gut symptoms (even mild ones she’s stopped noticing), how she’s responded to iron before, and how many infusions she’s had. Then we look at her bloods properly. Ferritin on its own can mislead, as inflammation pushes it up and can make stores look better than they are, so we read it alongside her full iron studies, full blood count and inflammatory markers. Depending on the picture, we’ll ask her GP to check for coeliac disease or refer on if her periods need investigating, and we bring in functional testing only where it would change the plan. Test, don’t guess.

What treatment actually looks like

It’s individualised, and it depends on what’s draining the tank. For some women the main work is getting heavy periods investigated and managed with their GP or gynaecologist. For others it’s the gut: calming inflammation, supporting digestion and absorption, or finally getting a diagnosis that was missed. Food matters too, including how iron-rich meals are put together and what you’re drinking with them. Where iron is needed, we look at which form you can actually tolerate and how and when you’re taking it, so oral iron gets a fair trial. If an infusion genuinely is the right call for you, we’ll support that and help you go in with the right questions.

Practical things you can try at home

• Track your period for one full cycle. Note how many days it lasts and how often you’re changing pads or tampons. Changing every one to two hours, or flooding overnight, is important information for your GP.
• Move tea and coffee away from meals. Both reduce how much iron you absorb, so have them between meals instead.
• Ask for copies of your iron studies. Seeing your numbers over time shows you whether things are moving or just being topped up.
• Count your infusions. If you’ve had more than one, write down when, and how long you felt better each time. That pattern says a lot.
• Take three questions to your GP: Have we tried oral iron properly first? Will you check my phosphate before and after? Have we found out why I’m low?

When to seek help

If you feel more exhausted, weak or breathless, or notice a racing heart or bone pain in the weeks after an infusion, contact your GP and ask specifically about checking your phosphate. If you have trouble breathing, chest pain, or swelling of your face, lips or throat during or after an infusion, call 000. Don’t stop or change any treatment without talking to the doctor who prescribed it.

If you’ve been low in iron for years, or you’re on your second or third infusion and nobody has found out why, that’s the sign the cause is still there. Book a 15-minute Acute Care call with one of our naturopaths, available Australia-wide by telehealth. We’ll help you work out whether your periods, your gut or something else is draining your iron, and where to start.

p.s. If you’re constantly low in iron and also bloated most days, those two problems often share the same root, and the gut is usually where we’d look first.

This article is general education, not medical advice. Please see your GP about any new, severe or worrying symptoms. Naturopathy works alongside your medical care, not instead of it.