Is It Perimenopause or Low Ferritin? The Top 100 Symptoms

If you’re experiencing brain fog, fatigue, hair loss, or irregular periods, you may assume that perimenopause is the culprit. However, ferritin deficiency (low iron storage) can cause many of the same symptoms, making it difficult to determine what’s really going on. Perimenopause, the transition leading up to menopause, causes fluctuating estrogen and progesterone levels, leading to widespread changes in mood, metabolism, and overall health. Meanwhile, ferritin deficiency can impair oxygen transport, weaken immunity, and disrupt hormone function, creating a nearly identical set of symptoms.

Because both conditions can coexist or be mistaken for each other, it’s essential to understand how they overlap, how to differentiate them, and what tests can provide clarity. In this article, we’ll break down 100 symptoms that could be caused by either perimenopause or low ferritin, explore the best diagnostic tests, and provide strategies to help you take control of your health. Whether you’re navigating midlife changes or suspect an iron deficiency, this guide will help you pinpoint the root cause of your symptoms and find the right path to relief.

1. Fatigue – Perimenopause can cause chronic fatigue due to fluctuating estrogen and progesterone, leading to poor sleep and energy crashes. Low ferritin reduces oxygen transport in the blood, leading to exhaustion even after a full night’s sleep.

2. Brain fog – Estrogen fluctuations in perimenopause affect cognitive function, making it harder to focus or remember details. Low ferritin can impair brain function because the brain requires iron for proper neurotransmitter balance and oxygen delivery.

3. Weakness – Perimenopause can lead to muscle loss and reduced stamina, making daily activities feel more exhausting. Ferritin deficiency causes weakness due to insufficient oxygen reaching the muscles, leading to faster fatigue.

4. Dizziness – Hormonal changes in perimenopause can cause sudden drops in blood pressure, leading to dizziness or feeling lightheaded. Low ferritin means less oxygenated blood is circulating, making dizziness more frequent, especially when standing up quickly.

5. Lightheadedness – Fluctuating hormones can disrupt blood sugar levels and circulation, leading to episodes of lightheadedness. Iron deficiency can exacerbate this by reducing oxygen supply to the brain, making you feel faint.

6. Poor concentration – Perimenopause can make it difficult to focus due to declining estrogen levels that affect neurotransmitter function. Ferritin deficiency reduces mental clarity because iron is essential for dopamine production and oxygenation of brain tissues.

7. Memory issues – Estrogen supports memory and cognition, so perimenopause can bring noticeable forgetfulness. Low ferritin starves the brain of oxygen, leading to lapses in memory and reduced cognitive processing speed.

8. Depression – Perimenopausal hormonal shifts impact serotonin levels, increasing the risk of depression. Iron deficiency also contributes to depression by reducing dopamine and serotonin production, which are crucial for mood regulation.

9. Anxiety – Progesterone has a calming effect on the nervous system, so its decline in perimenopause can increase anxiety. Iron deficiency worsens anxiety by impairing oxygen flow to the brain and disrupting neurotransmitter function.

10. Mood swings – Fluctuations in estrogen and progesterone during perimenopause can lead to rapid emotional changes. Low ferritin can also cause mood instability due to its role in neurotransmitter regulation and brain function.

Sleep Issues

11. Insomnia – Declining progesterone makes it harder to fall and stay asleep, increasing nighttime wakefulness. Ferritin deficiency can cause restless sleep due to poor oxygen delivery to the brain and muscles.

12. Waking up in the middle of the night – Perimenopausal hormonal shifts disrupt deep sleep, often causing frequent wake-ups. Iron deficiency can lead to nighttime waking due to increased heart palpitations and body temperature regulation issues.

13. Restless legs at night – Perimenopause can cause restless legs due to nerve sensitivity and muscle discomfort. Low ferritin is a primary cause of restless legs syndrome, as iron is essential for dopamine production in the brain.

14. Vivid dreams or nightmares – Hormonal fluctuations can intensify dreams and make them more emotionally charged. Low ferritin disrupts brain oxygenation, leading to erratic sleep patterns and disturbing dreams.

15. Feeling unrefreshed after sleep – Perimenopausal sleep disturbances prevent deep, restorative sleep. Ferritin deficiency means your body isn’t getting enough oxygen overnight, making you wake up feeling exhausted.

    Skin & Hair Symptoms

    16. Dry skin – Estrogen helps retain moisture in the skin, so declining levels in perimenopause can lead to dryness and irritation. Low ferritin reduces oxygen delivery to the skin, making it appear dull, flaky, and prone to dehydration.

    17. Itchy skin – Hormonal fluctuations can cause increased skin sensitivity and itchiness, even without a rash. Iron deficiency contributes to itchy skin due to reduced circulation and potential histamine intolerance.

    18. Eczema or rashes – Perimenopause can worsen existing eczema due to changes in immune response and inflammation. Ferritin deficiency weakens skin repair mechanisms, making rashes more persistent or prone to flare-ups.

    19. Hair thinning – Estrogen helps keep hair thick and strong, so declining levels in perimenopause can cause shedding and thinning. Ferritin is essential for hair growth, and deficiency often leads to excessive hair loss, especially around the hairline and crown.

    20. Hair loss (especially at the crown or temples) – Androgen dominance in perimenopause can lead to female pattern hair loss. Low ferritin levels prevent proper hair follicle function, leading to increased shedding and slowed regrowth.

    21. Brittle nails – Decreased estrogen can weaken nails, making them more prone to splitting. Ferritin deficiency reduces keratin production, leading to brittle, ridged, or slow-growing nails.

    22. Slow-growing nails – As metabolism slows during perimenopause, nail growth can become noticeably slower. Iron deficiency limits cell regeneration, which includes the growth of nails.

    23. Premature graying of hair – Hormonal changes affect melanin production, leading to earlier graying in some women. Ferritin deficiency contributes to graying by reducing melanin synthesis in hair follicles.

    24. Scalp pain or tenderness – Perimenopause can cause scalp sensitivity due to fluctuating blood flow and inflammation. Iron deficiency can exacerbate this by causing increased nerve sensitivity and reduced scalp circulation.

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    Temperature Regulation & Sweating

    25. Night sweats – Perimenopause-related estrogen fluctuations disrupt the body’s ability to regulate temperature. Low ferritin can also cause night sweats due to increased heart rate and metabolic instability.

    26. Hot flashes – Sudden temperature spikes are a hallmark of perimenopause, caused by hormonal imbalances. Ferritin deficiency can make these worse due to poor circulation and impaired thermoregulation.

    27. Feeling cold all the time – Perimenopause affects blood circulation, making some women feel colder than usual. Low ferritin reduces heat production and circulation, leading to persistent cold hands and feet.

    28. Cold hands and feet – Decreased estrogen can slow blood flow to extremities, causing chilly hands and feet. Ferritin deficiency is one of the most common causes of cold extremities due to reduced oxygen in the blood.

    29. Sensitivity to temperature changes – Perimenopausal hormonal shifts can make it harder to adapt to sudden temperature changes. Ferritin deficiency makes the body struggle with temperature regulation, leading to hot-cold sensitivity.

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    Heart & Circulatory Symptoms

    30. Heart palpitations – Estrogen helps regulate heart rhythm, so perimenopause can bring irregular heartbeats or palpitations. Low ferritin can also cause palpitations because the heart works harder to compensate for oxygen deficiency.

    31. Increased heart rate – A common perimenopausal symptom due to hormonal fluctuations affecting cardiovascular function. Ferritin deficiency forces the heart to beat faster to maintain oxygen levels in tissues.

    32. Low blood pressure – Estrogen influences blood vessel tone, and its decline can contribute to occasional low blood pressure episodes. Iron deficiency can cause chronic low blood pressure due to reduced blood volume.

    33. High blood pressure – Some women experience increased blood pressure in perimenopause due to a drop in estrogen’s vasodilatory effects. Iron deficiency can paradoxically cause high blood pressure by making the heart work harder.

    34. Shortness of breath – Perimenopause can cause breathlessness due to anxiety and cardiovascular changes. Ferritin deficiency reduces red blood cell efficiency, leading to frequent breathlessness even with minimal exertion.

    35. Chest discomfort – Some perimenopausal women experience chest tightness due to hormonal changes affecting circulation. Ferritin deficiency can mimic this by causing heart strain and occasional chest pains.

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    Gastrointestinal Symptoms

    36. Bloating – Hormonal fluctuations slow digestion, leading to increased bloating during perimenopause. Low ferritin can cause bloating as the digestive system struggles to break down food efficiently.

    37. Constipation – Perimenopause slows gut motility due to declining estrogen levels. Iron deficiency contributes to constipation due to altered muscle function in the intestines.

    38. Diarrhea – Some women experience perimenopausal diarrhea due to shifting hormone levels affecting the gut microbiome. Iron deficiency can also cause loose stools as the digestive system struggles with nutrient absorption.

    39. Nausea – Hormonal shifts during perimenopause can cause nausea, especially around ovulation or before a period. Low ferritin leads to nausea due to poor oxygenation and sluggish digestion.

    40. Loss of appetite – Perimenopause may disrupt hunger signals, leading to fluctuating appetite levels. Ferritin deficiency reduces appetite due to metabolic slowing and fatigue.

    41. Cravings for ice or non-food items (pica) – Perimenopause-related nutritional imbalances can trigger odd cravings. Pica is a classic sign of iron deficiency, especially cravings for ice (pagophagia).

    42. Acid reflux or GERD – Hormonal fluctuations relax the esophageal sphincter, increasing reflux in perimenopause. Iron deficiency weakens digestive function, leading to increased stomach acid production.

    43. Abdominal pain – Perimenopause can cause digestive discomfort due to slowed gut motility. Ferritin deficiency may contribute by reducing digestive efficiency and increasing cramping.

    44. Irregular periods – Perimenopause disrupts ovulation, leading to unpredictable cycles with varying lengths. Low ferritin can contribute to irregular periods due to its role in maintaining proper hormonal function.

    45. Heavy periods – Estrogen dominance in perimenopause often results in heavier, prolonged bleeding. Ferritin deficiency can exacerbate heavy periods because low iron weakens blood vessel integrity and clotting ability.

    46. Light or skipped periods – As estrogen and progesterone fluctuate, some cycles may be lighter or skipped altogether. Low ferritin can also cause menstrual irregularities by impairing hormone production.

    47. Worsened PMS symptoms – Mood swings, bloating, and breast tenderness often intensify during perimenopause due to erratic hormone levels. Iron deficiency contributes to PMS by affecting serotonin production and blood flow.

    48. Increased menstrual cramping – Lower progesterone levels in perimenopause can make uterine contractions more intense. Low ferritin worsens cramps due to poor oxygen delivery to the muscles.

    49. Spotting between periods – Estrogen fluctuations in perimenopause can cause intermittent spotting. Low ferritin can contribute by weakening blood vessels, making them more prone to breakage.

    50. Lowered libido – Perimenopause reduces testosterone and estrogen, leading to decreased sexual desire. Ferritin deficiency affects energy levels and mood, further diminishing libido.

    51. Vaginal dryness – Declining estrogen in perimenopause leads to reduced lubrication and thinning vaginal tissues. Iron deficiency can cause dehydration and poor circulation, worsening vaginal dryness.

    52. Painful intercourse – Lower estrogen levels make vaginal tissues less elastic and more sensitive. Low ferritin may contribute by causing poor tissue repair and decreased blood flow.

        Muscle & Joint Symptoms

        53. Muscle weakness – Perimenopause leads to gradual muscle loss due to reduced estrogen, affecting strength. Ferritin deficiency causes muscle fatigue because oxygen delivery is impaired.

        54. Muscle pain – Declining hormones in perimenopause make muscles more prone to stiffness and discomfort. Low ferritin contributes to muscle pain due to poor oxygenation and increased inflammation.

        55. Joint pain – Estrogen has an anti-inflammatory effect, so its decline can lead to joint aches. Ferritin deficiency reduces collagen production and circulation, making joints feel stiff and sore.

        56. Stiffness, especially in the morning – Perimenopausal inflammation can cause morning stiffness that improves with movement. Low ferritin contributes by slowing tissue repair overnight.

        57. Cramping or spasms – Perimenopause can lead to muscle cramping due to changes in calcium and magnesium metabolism. Iron deficiency causes frequent cramps because muscles struggle without adequate oxygen.

        58. Aching legs – Estrogen loss in perimenopause affects circulation, leading to leg discomfort. Ferritin deficiency can cause leg aching due to poor oxygen supply to muscle tissues.

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        Nervous System & Neurological Symptoms

        59. Tingling or numbness in hands and feet – Perimenopause can cause nerve irritation due to fluctuating hormones. Ferritin deficiency leads to similar symptoms because iron is essential for nerve function.

        60. Burning sensations in extremities – Hormonal shifts can cause increased nerve sensitivity and burning sensations. Iron deficiency may contribute by impairing nerve signaling and circulation.

        61. Headaches – Perimenopause-related estrogen fluctuations often trigger headaches and migraines. Ferritin deficiency can also cause headaches due to reduced oxygen flow to the brain.

        62. Migraines – Declining estrogen levels are a known trigger for increased migraine frequency. Low ferritin exacerbates migraines by reducing brain oxygenation and increasing inflammation.

        63. Ringing in the ears (tinnitus) – Perimenopause affects inner ear fluid balance, causing ringing or buzzing sounds. Iron deficiency can also cause tinnitus due to impaired oxygenation of the auditory nerves.

        64. Blurred vision – Hormonal shifts can alter eye moisture levels and lead to occasional blurriness. Ferritin deficiency reduces oxygen supply to the optic nerve, contributing to vision issues.

        65. Sensitivity to light – Estrogen fluctuations can make the eyes more sensitive to bright light. Low ferritin may also contribute by affecting nerve and brain function.

        66. Feeling faint when standing up – Perimenopause can cause postural hypotension, leading to dizziness upon standing. Low ferritin exacerbates this by reducing overall blood volume and oxygen supply.

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        Metabolism & Weight Changes

        67. Sudden weight gain – Lower estrogen levels slow metabolism and increase fat storage, especially around the abdomen. Low ferritin contributes to weight gain by causing sluggishness and reduced physical activity.

        68. Sudden weight loss – Some women experience weight loss during perimenopause due to changes in appetite and metabolism. Ferritin deficiency may lead to unexplained weight loss due to chronic fatigue and muscle wasting.

        69. Difficulty losing weight – Perimenopause slows metabolism, making weight loss more challenging. Iron deficiency reduces energy levels, making it harder to stay active and burn calories.

        70. Sugar cravings – Fluctuating hormones increase sugar cravings in perimenopause. Low ferritin also contributes because iron plays a role in blood sugar regulation.

        71. Blood sugar fluctuations – Perimenopausal insulin resistance can cause erratic blood sugar levels. Low ferritin can mimic this by impairing glucose metabolism.

        72. Increased belly fat – Declining estrogen promotes fat storage in the abdominal area. Ferritin deficiency indirectly contributes by lowering energy levels and reducing metabolism.

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        Immune System & Inflammation

        73. Increased susceptibility to colds and infections – Estrogen supports immune function, so perimenopause can weaken immunity. Ferritin deficiency impairs the production of white blood cells, making infections more likely.

        74. Slow wound healing – Perimenopausal changes affect skin elasticity and collagen production, delaying healing. Low ferritin reduces oxygen delivery to tissues, further slowing recovery.

        75. Chronic inflammation – Estrogen has anti-inflammatory properties, so its decline increases overall inflammation. Iron deficiency contributes to chronic inflammation due to oxidative stress and poor circulation.

        76. Autoimmune symptoms worsening – Hormonal changes can trigger autoimmune flare-ups in perimenopause. Ferritin deficiency is common in autoimmune disorders and may worsen symptoms.

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        Emotional & Psychological Symptoms

        77. Increased irritability – Perimenopausal hormone fluctuations can lead to mood instability. Low ferritin can worsen irritability due to its role in neurotransmitter production.

        78. Feeling overwhelmed easily – Estrogen supports stress resilience, so its decline can increase emotional overload. Ferritin deficiency causes mental exhaustion, making everyday tasks feel more difficult.

        79. Loss of motivation – Perimenopause can impact dopamine levels, reducing drive and motivation. Low ferritin contributes by impairing oxygen delivery to the brain, leading to apathy.

        80. Difficulty handling stress – Lower progesterone levels make stress feel more intense during perimenopause. Iron deficiency amplifies stress responses by impairing nervous system regulation.

        81. Social withdrawal – Perimenopausal mood swings and fatigue can make socializing less appealing. Low ferritin contributes by causing exhaustion and low mood.

        82. Low self-esteem – Changes in body composition, mood, and cognitive function during perimenopause can affect confidence. Ferritin deficiency can amplify self-doubt by worsening mental clarity and energy levels.

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        Urinary & Bladder Symptoms

        83. Increased frequency of urination – Estrogen supports bladder function, so its decline can lead to more frequent trips to the bathroom. Low ferritin affects muscle control, potentially worsening bladder sensitivity.

        84. Urinary urgency – Perimenopause weakens pelvic floor muscles, leading to sudden urges to urinate. Iron deficiency can increase urgency by irritating bladder tissues.

        85. Urinary tract infections (UTIs) – Reduced estrogen makes the urinary tract more vulnerable to infections. Low ferritin weakens immune function, increasing the risk of recurrent UTIs.Sensitivity to noise – Perimenopausal hormonal changes can make sounds feel louder or more irritating than usual. Low ferritin may also increase noise sensitivity due to heightened nervous system activity and anxiety.

        86. Loss of taste or changes in taste perception – Estrogen influences taste receptors, so declining levels can alter how food tastes. Iron deficiency can cause a metallic taste in the mouth or reduce taste sensitivity.

        87. Dry eyes – Perimenopause reduces tear production, leading to dry, irritated eyes. Low ferritin contributes to dry eyes by impairing circulation to the eye tissues.

        88. Eye twitching – Hormonal fluctuations can make eye muscles more prone to twitching. Iron deficiency can cause frequent eye twitches due to poor nerve function and low electrolyte balance.

        89. Ear pressure or fullness – Perimenopause can affect fluid balance in the inner ear, causing a sensation of fullness. Low ferritin may contribute to ear pressure due to reduced oxygenation of inner ear tissues.

            Miscellaneous Symptoms

            91. Swollen  hands and feet – Estrogen plays a role in fluid retention, so perimenopause can lead to swelling. Iron deficiency may cause swelling due to poor circulation and reduced blood volume.

            92. Chronic fatigue even after resting – Perimenopause disrupts sleep quality, leading to non-refreshing rest. Ferritin deficiency causes fatigue because oxygen delivery to muscles and the brain is impaired.

            93. Increased bruising – Estrogen helps maintain blood vessel integrity, so its decline can lead to easier bruising. Low ferritin contributes to bruising by impairing collagen production and platelet function.

            94. Loss of endurance during exercise – Perimenopause reduces muscle recovery time, making workouts feel harder. Ferritin deficiency severely impacts endurance due to reduced oxygen transport to muscles.

            95. Increased sensitivity to alcohol or caffeine – Hormonal changes can alter how the liver metabolizes substances, making alcohol or caffeine feel stronger. Low ferritin exacerbates this by impairing liver detoxification processes.

            96. Reduced stamina for daily tasks – Perimenopause slows metabolism and energy production, making daily activities feel more tiring. Low ferritin contributes by limiting oxygen supply to organs and muscles.

            97. Feeling unsteady or off-balance – Hormonal fluctuations can affect the vestibular system, leading to dizziness and poor balance. Low ferritin may cause similar symptoms by reducing oxygen flow to the inner ear and brain.

            98. Generalized discomfort with no clear cause – Perimenopause can make the body feel generally “off” due to shifting hormone levels. Iron deficiency can cause a vague sense of discomfort due to low oxygenation and mild inflammation.

            99. Muscle twitching or spasms – Perimenopause affects nerve signaling, leading to random muscle twitches. Low ferritin can worsen this by impairing nerve conduction and electrolyte balance.

            100. Increased risk of headaches in the morning – Sleep disturbances in perimenopause can lead to morning headaches. Low ferritin contributes to morning headaches due to oxygen deprivation overnight.

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            How to Differentiate Between Perimenopause & Ferritin Deficiency

            Because many of these symptoms overlap, the best way to determine the root cause is through testing and symptom tracking. Here’s how:

            1. Get Bloodwork Done

            Ask your doctor for the following lab tests:
            ✅ Ferritin – The most important test to check iron storage levels. (Optimal range: 50-100 ng/mL for women, even though the lab’s “normal” range is often lower.) I have a whole rant about dumb this is right over here. 
            ✅ Iron Panel (Serum Iron, TIBC, and Transferrin Saturation) – Helps assess overall iron status.
            ✅ CBC (Complete Blood Count) – Checks for anemia.
            ✅ Hormone Panel (FSH, LH, Estradiol, Progesterone, and Testosterone) – Determines if you are in perimenopause.
            ✅ Vitamin B12, Folate, and Magnesium – Deficiencies in these can mimic perimenopause and iron deficiency.

            2. Track Your Symptoms Over Time

            • Perimenopause symptoms tend to come in waves—some days are better, while others are worse. Symptoms may intensify during certain parts of your cycle.
            • Ferritin deficiency symptoms are usually constant and get worse over time if left untreated.

            3. Consider Response to Supplements

            • If you take an iron supplement (such as ferrous bisglycinate) and symptoms improve within 4-6 weeks, low ferritin was likely the cause.
            • If symptoms persist despite improving ferritin, perimenopause may be the bigger factor.

            4. Compare Menstrual Changes

            • If your periods are becoming longer, heavier, irregular, or skipping, perimenopause is the likely culprit.
            • If your periods are lighter than usual or disappearing altogether, ferritin deficiency may also be involved, since iron is necessary for proper hormone function.