Iron, Hypermobility & Perimenopause: The Women's Health Connection No-One Is Talking About
Have you ever wondered why so many women in their late 30s and 40s suddenly start feeling exhausted, dizzy, anxious and like their body is falling apart?
Perhaps your joints ache more than they used to. You struggle with brain fog, your heart races when you stand up, your periods have become heavier, and no matter how much you sleep, you never seem to feel rested.
Many women are told it's "just stress," "just hormones," or simply part of getting older. But there may be more to the story.
An emerging area of interest in women's health is the overlap between iron deficiency, hypermobility and perimenopause. While research into this relationship is still evolving, many practitioners are recognising patterns that help explain why symptoms can become significantly worse during midlife.
Rather than being three separate issues, these factors can interact to create a perfect storm of fatigue, pain, dizziness and poor quality of life.
What is hypermobility?
Hypermobility means your joints move beyond the normal range of motion due to more flexible connective tissue. Some people are naturally flexible and experience no problems, while others have symptoms that affect their daily lives.
Conditions such as Hypermobility Spectrum Disorder (HSD) and Hypermobile Ehlers-Danlos Syndrome (hEDS) don't just affect the joints. Because connective tissue is found throughout the body, hypermobility can also influence the digestive system, blood vessels, bladder, pelvic floor and nervous system.
Common symptoms include:
Joint pain and instability
Chronic fatigue
Headaches and migraines
IBS, reflux or constipation
Easy bruising
Poor recovery from exercise
Dizziness or feeling faint
Anxiety and brain fog
Many women aren't diagnosed until adulthood, particularly if their symptoms have been attributed to anxiety, stress or other unrelated conditions.
Why does perimenopause make everything worse?
Perimenopause is a time of significant hormonal change, with oestrogen levels fluctuating before gradually declining.
Most people know oestrogen is important for reproduction, but it also plays a key role in maintaining collagen, muscle strength, connective tissue and blood vessel health.
For women with hypermobility, these hormonal changes may reduce joint stability and make existing symptoms more noticeable. Many women report worsening joint pain, pelvic floor symptoms, fatigue, headaches and slower recovery during perimenopause.
At the same time, menstrual cycles often become heavier or more irregular. This brings us to another important piece of the puzzle, iron.
Where iron fits into the picture
Iron deficiency is one of the most common nutritional deficiencies in women, yet it is frequently overlooked, particularly when haemoglobin remains within the laboratory reference range.
Many women enter perimenopause after years of:
Heavy menstrual bleeding
Pregnancy and breastfeeding
Restrictive dieting
Vegetarian or low red meat diets
Digestive issues affecting absorption
Chronic inflammation
Iron is essential for much more than preventing anaemia. It supports oxygen transport, energy production, thyroid function, neurotransmitter production, immune health and healthy collagen formation.
This means women can experience significant symptoms even before they develop anaemia.
Why these three create a "perfect storm"
One reason this connection often goes unnoticed is because the symptoms overlap so closely.
Both iron deficiency and hypermobility can cause fatigue, dizziness, headaches, exercise intolerance and brain fog. Perimenopause can contribute many of these same symptoms through hormonal fluctuations, poor sleep and heavier menstrual bleeding.
For women with hypermobility, there may also be changes in how the autonomic nervous system regulates heart rate and blood pressure. This can contribute to symptoms such as dizziness, heart palpitations and feeling faint when standing.
If iron stores are also low, oxygen delivery throughout the body becomes less efficient. This means the cardiovascular system has to work harder to meet the body's needs. The result can be worsening fatigue, poor exercise tolerance and a racing heart.
Many women simply assume they're getting older when, in reality, several contributing factors may be occurring at the same time.
The collagen connection
One of the lesser-known roles of iron is its involvement in collagen production.
Collagen is the body's most abundant structural protein and provides strength to connective tissue, tendons, ligaments and blood vessels.
Producing healthy collagen requires adequate protein, vitamin C, copper, zinc and iron. While iron deficiency doesn't cause hypermobility, low iron may reduce the efficiency of collagen formation and tissue repair.
For someone whose connective tissue is already more fragile, optimising nutrient status becomes even more important.
Don't forget the gut
Many people with hypermobility also experience digestive symptoms such as bloating, constipation, reflux or IBS.
Poor gut health can reduce iron absorption, while chronic inflammation may increase levels of hepcidin, a hormone that blocks the body's ability to absorb and recycle iron effectively.
This means some women continue to struggle with low iron despite eating well or taking supplements.
Addressing gut health is often just as important as replacing iron itself.
Looking beyond "normal" blood tests
One of the biggest frustrations I see in clinic is women being told their iron is "normal" despite experiencing significant symptoms.
Laboratory reference ranges are designed to identify disease, not necessarily optimal wellbeing.
This is why it's important to assess pathology alongside symptoms, menstrual history, digestive health, thyroid function and overall health rather than relying on a single number in isolation.
Low iron stores, even without anaemia, may contribute to fatigue, poor concentration, reduced exercise capacity and decreased quality of life in some women.
Supporting the whole picture
If you recognise yourself in this article, it's worth taking a broader look at your health rather than focusing on one symptom alone.
A holistic assessment may include:
Iron studies, including ferritin
Full blood count
Vitamin B12 and folate
Vitamin D
Thyroid function
Inflammatory markers
Menstrual health
Gut health and nutrient absorption
Diet, sleep and stress
Supporting the body often involves more than simply taking an iron supplement. Identifying why iron became depleted, improving digestion and absorption, supporting hormone health and strengthening the body's foundations can make a significant difference.
Simple strategies such as eating iron-rich foods, pairing plant sources with vitamin C, ensuring adequate protein intake, strength training to improve joint stability and prioritising restorative sleep can all play an important role alongside individualised care.
The bottom line
Iron deficiency doesn't cause hypermobility, and perimenopause doesn't cause either condition. However, when these three factors overlap, they can amplify one another and leave women feeling exhausted, overwhelmed and unheard.
While research into this relationship is still developing, it's an area that deserves far more attention. Understanding the connection allows us to look beyond isolated symptoms and appreciate how hormones, nutrition, connective tissue and the nervous system all influence one another.
If you've been experiencing fatigue, heavy periods, dizziness, brain fog, joint pain or simply don't feel like yourself, don't assume it's something you have to live with. A thorough assessment can help identify the contributing factors and create a personalised plan to support your health through every stage of life.
Ready to uncover the root cause?
As a naturopath, I take a holistic approach to women's health by looking beyond individual symptoms to understand the full picture. Through comprehensive pathology review, functional interpretation, nutrition, herbal medicine and lifestyle support, we'll work together to uncover what's driving your symptoms and create a realistic, evidence-informed treatment plan.
Book an initial consultation in North Beach, Glen Forrest or via Telehealth Australia-wide and let's start connecting the dots in your health.
