BURSTMy doctor first suggested I take iron pills in 2018. My bloodwork revealed I had a low red blood cell count and hemoglobin (a protein in red blood cells that carries oxygen). In fact, it was far lower than what’s considered healthy for a woman in her late 30s.
I can’t say I was entirely surprised. Just a few weeks before my bloodwork, I’d had my second miscarriage in six months, which caused me to lose a lot of blood. I was drained, but I couldn’t tell if it was from the blood loss or emotional exhaustion of what I’d been through.
Instead of taking iron pills, I continued to take my prenatal vitamins, which contained some iron. I never scheduled a follow-up appointment to check my levels, but I did get my blood drawn weekly at my fertility treatments, so I figured if there was a problem with my iron, someone would tell me, right?
No one did. Instead, a few years later (after a successful and healthy pregnancy and birth!) I wound up with the same exhaustion. This time, my bloodwork revealed I was anemic: my red blood cell count, hemoglobin, and ferritin (a protein that stores iron) were all below the “normal” range. Again, my doctor suggested over-the-counter (OTC) iron pills, so I gave them a try. I’d been warned about constipation (a common iron side effect) but was hit with debilitating nausea. So I quit taking them and instead vowed to eat more steak and spinach and explore homeopathic options.
By the summer of 2024, I wasn’t just exhausted—I was depleted. I started falling asleep during work, getting winded while climbing up the stairs, and dealing with dizzy spells and tightness in my chest. It was time to stop ignoring the symptoms and finally get the help I needed to restore my iron levels.
A few friends of mine who struggled with anemia told me about iron infusions—i.e., getting iron supplementation through an IV drip. I was curious, so I sought care from a hematologist (a doctor who specializes in blood disorders) to see if I was a good candidate. Turns out I am.
Here’s my experience with getting iron infusions, how they’ve worked for me so far, and why iron infusions are still largely under-prescribed.
First, what are iron infusions?
Iron infusions are medically supervised treatments where doctors administer supplemental iron through an IV (intravenous) drip at a medical lab or in your doctor’s office. The treatment is often reserved for those with chronic kidney disease or severe iron deficiency anemia—a condition that affects about 34 percent of women between the ages of 18 and 50 in the U.S, according to a recent survey published in JAMA Network Open.
“There are two main reasons that we would give IV iron,” says Ariela Marshall, MD, an American Society of Hematology expert and associate professor of medicine at the University of Minnesota. “One is that somebody tried taking iron pills and just couldn’t tolerate them because of the side effects.” The other is because the person’s body is not able to absorb iron, she adds. This can happen to people with underlying health conditions like celiac disease and inflammatory bowel disease or to people who’ve had gastrointestinal surgery.
According to Dr. Marshall, there are several different formulations of IV iron, the most common being iron sucrose and ferric gluconate. Your exact dosage will also vary from person to person and the level of your deficiency. For example, one person may need a lower dose, which can be administered in less than an hour, while another person may need a higher dose, which requires a three-hour infusion session.
The number and frequency of iron infusions you need can also vary. Some people may only need one or two infusions, while others may need multiple or ongoing treatment, Dr. Marshall explains.
My experience getting iron infusions
I received my first iron infusion within 30 minutes of my first appointment with Rachel Kramer, MD, a hematologist at American Infusion Centers in New York City. After Dr. Kramer reviewed my labs and health history, she performed a brief consultation and recommended I start Venofer (a low-dose form of iron sucrose) right away. She suspected that my heavy periods were keeping my ferritin low and wondered if I could even stomach oral iron (few of her patients could). She also told me they wouldn’t likely be effective at treating my deficiency.
I asked whether my dietary and lifestyle changes (e.g., eating more red meat and cooking with a cast iron skillet) did anything to improve my levels. “I’ve never seen that work,” Dr. Kramer says. This mirrored Dr. Marshall’s response when I asked the same question. She compared low iron levels to a nearly empty fuel tank. “The tank is running low, so to speak, but the car is still running,” she adds. “It’s very hard to refill a tank just by eating a lot of iron in your diet.”
Treatment was fast and simple
After my initial questions were answered, I was led to a room where other people were hooked up to IVs for treatment. I found an open recliner, the nurse sterilized the skin on the inside of my left elbow, and then she placed the needle. Before the infusion, the nurse drew two vials of blood for some lab work. Then, she connected the IV bag filled with a brown liquid mixture—iron, water, and other stabilizing ingredients like saline.
The infusion itself was quick, only about 35 minutes. I didn’t have any side effects except for dark urine, which the doctor told me was normal. (For context, some people can experience side effects like nausea, headaches, or allergic reactions from iron infusions. If you have an allergic reaction, your doctor may suggest taking Benadryl before your appointment.)
My doctor ordered three more infusions, each one to two weeks apart from the last, with the understanding that we would add or cancel appointments based on my bloodwork and how I was feeling.
I started feeling better after one week
Dr. Kramer warned it could take a while to notice any symptom improvement, but I felt a difference within a week of my first appointment. I started sleeping better (I’d been dealing with restless leg syndrome, a common side effect of iron deficiency), and I had more energy. While running, my legs felt lighter, and my breathing was more steady—a welcome change after adjusting my training to accommodate fatigue.
My labs, while still “not award-winning,” according to Dr. Kramer, were also heading in the right direction. My ferritin, red blood cell count, and hemoglobin were higher than they’d been in years.
This brought up the question: Why hadn’t doctors suggested iron infusions before? Turns out the treatment is largely under-prescribed.
Why are iron infusions under-prescribed?
Dr. Kramer says physicians who don’t specialize in hematology can have misconceptions about iron infusions. “Some people think there’s something ‘extreme’ or ‘drastic’ about IV iron,” she adds. “They think, ‘Why would you do something so drastic if you can just take oral iron?'” Here are a few other reasons why it’s under-prescribed:
There are misconceptions about its safety
Some healthcare professionals may have misconceptions about the safety of iron infusions, Dr. Marshall notes. “Thirty-plus years ago, there were a couple of formulations of IV iron (read: iron dextran) that caused pretty serious cases of anaphylaxis (aka very severe allergic actions). Because of that, IV iron got a bad rap,” she adds.
But it was discovered that the additives in the formulations caused the problem, not necessarily the infusions themselves. Since then, the formulations have been fixed, and according to Dr. Marshall, “someone would rarely have a true, serious reaction.”
Some people still do have adverse reactions to iron infusions—ranging from hypersensitivity to more serious allergic reactions—so new patients are closely monitored, and staff are trained to recognize and treat these symptoms promptly.
Cost is a barrier
Money is also an issue. Apart from office and administration fees, the cost of iron alone can range from hundreds to thousands of dollars per infusion. Insurance can often cover a portion of the cost, but each person’s bill will vary widely depending on their insurance provider.
Iron deficiency can be missed
Lastly, iron deficiency can be missed or dismissed altogether. The range for a “normal” ferritin level is large, so if your number is teetering on the lower end of the spectrum but still technically within range, a general practitioner will likely tell you you’re fine. Some doctors also don’t include an iron panel in standard bloodwork.
In other cases, doctors may also misdiagnose or downplay iron deficiency in women because symptoms can be vague and closely mimic those of stress, inadequate sleep, and aging.
This happened to Tina Martinez, a New York-based food stylist, who first thought her iron deficiency symptoms were simply perimenopause. She was an avid CrossFitter but couldn’t even get through workouts anymore. None of her doctors flagged low iron levels, even while being treated for heavy periods and fibroids (benign growths on the uterus). Martinez eventually discovered her iron deficiency while trying to donate blood.
Iron pills made Martinez sick. But thankfully, after seeing a hematologist, she started iron infusions, which made her feel better. “It was like night and day,” she says.
What to do if you think you have low iron
If you think you have low iron—maybe you’ve been told your labs were “a little low” in the past, or you’ve been experiencing symptoms like fatigue, breathlessness, and dizziness—see a doctor and ask for bloodwork, including an iron panel. Advocating for yourself is extremely important (and it’s okay if it feels hard at first).
Sometimes, you might feel like your doctor isn’t supporting you the way you hoped. In cases like this, it’s a good idea to try to find a hematologist. Both Martinez and I found specialists we like through friends, so don’t be afraid to ask your network for referrals. (Considering how common iron deficiency is, chances are someone you know has a recommendation.)
Remember that you are your own best advocate. “If you’re not feeling right, you have to trust yourself,” Martinez says. But don’t attempt to play “Dr. Google,” even if you have access to all of your lab results.
“The truth is, patients shouldn’t be on their [medical] portal analyzing [their numbers] on their own,” Dr. Kramer says. Only a trained doctor can accurately interpret test results. And it’s possible to still experience symptoms of iron deficiency even if your labwork indicates that *technically* you’re fine.
Ultimately, whether your doctor prescribes iron infusions or oral supplements, it’s important to get to the root cause of your deficiency. Otherwise, you could be missing a serious health issue, getting stuck in a never-ending cycle of “maintenance” with pills or infusions.
“That’s like a leaky bucket that you’re pouring water into,” Dr. Marshall says. “What you need to do is fix the leak.”