A Letter To… The Woman Who’s Been Told She’s “Just Tired”, Written By Dr Libby

You’ve finally made time for that doctor’s appointment, but you’ve left feeling deflated – they’ve told you you’re “just tired”. But, it feels deeper than that. You’re feeling flat, exhausted, maybe you’re having trouble sleeping – you feel wired at night, or wake up wired during the night, unable to fall back asleep easily. Maybe you’ve noticed your hair seems to be falling out more than usual. Is it really just that you’re tired?

Welcome to our column, A Letter To… Some of our most well-known Kiwis and everyday heroes pen letters about a topic close to their hearts. Some of their names you will know very well, while other’s are kept anonymous to protect the privacy of the subjects. Whether it is a letter to a specific someone, or a group of people, or simply an open letter to broach a difficult subject, each letter is very different, but all will share one common thread; they will all be written from the heart. You can read our other letters here.

This month Dr Libby has written a letter for every woman who just hasn’t been feeling herself – maybe for a while, but, when she’s finally made time for a doctor’s appointment, she’s heard the words “you’re just tired”…

Dear You,

I don’t know your name, but I’ve met you thousands of times.

You came to see me because something was off and you couldn’t put your finger on it. You’d already been to your GP. They ran some blood tests, told you everything came back normal, and you left feeling faintly silly for making a fuss about “nothing”.

Then you sat down and told me what your life actually looked like. Asleep on the couch by seven. A heart that thumps hard enough climbing the stairs at work that you’ve quietly wondered whether something’s wrong with it. More hair going down the drain with each wash. Awake at three, brain whizzing, anxious feelings bubbling up. A short fuse with your kids that you feel terrible about afterwards. The gym class you used to love and now invent reasons to skip. And underneath all of it, a flat, grey feeling you’ve more or less decided is just your personality now.

And then the sentence among the ones I’ve heard more than any others in 25 years of practice: “I’m just tired.”

Here’s what I’d say if you were sitting across from me right now.

You might be. Life asks an enormous amount of women, and sometimes exhaustion is the honest arithmetic of what you’re carrying. But before you file it under “this is just my life”, I want to encourage you to go and check one number. Not your iron but your ferritin.

The two aren’t the same thing, and that distinction is where so many women fall through the gap. A standard full blood count looks at your haemoglobin, which only goes low in the final stage of iron deficiency. Ferritin is representative of your stored iron, your reserves, your back-up battery, and it isn’t always tested unless someone specifically asks for it. You can have perfectly respectable haemoglobin, be told your blood work is fine, and be running on an almost empty tank underneath.

So ask for the actual number and ask what the range is and where you sit in it, because sitting at the lower end of a range is not the same as sitting comfortably inside it, and plenty of women feel wretched in that lower stretch.

I’m not going to pretend iron status explains everything. Thyroid function, the persistent output of stress hormones, a nervous system that’s been bracing for impact for too long, sleep challenges, grief, an intense feeling of responsibility that won’t shut down… all of these can produce a version of what I’ve described, and some of them need proper medical care that no supplement on earth will replace. If you’re struggling with your mood, please don’t let anyone, me included, talk you out of getting real support for that.

But iron deficiency is the most common nutritional deficiency in the world according to the World Health Organization. Women of reproductive age and children are the most affected groups on the planet, and it is one of the easiest things on that list to rule in or out. It seems nonsensical to me that we so often don’t test for it, particularly when fatigue or mood symptoms have arisen.

Full disclosure, I created OnBlends, a food-sourced supplement company where our number one selling product is our iron supplement, Iconic Iron. But even that fact – that this product is so in demand – shows just how much need there is for this, and how life changing it can be. The reviews speak to that.

Fatigue in women is too often normalised, ignored or dismissed. We’ve been taught to expect it, absorb it and apologise for mentioning it.

So my ask is small. Book the blood test, ask specifically for ferritin to be included, and get the number.

If it comes back healthy, you’ve lost nothing, which means you and your healthcare professional can go looking thoroughly at what else is potentially going on. And if it comes back low, then the thing you’ve been carrying around as a self-diagnosed character flaw for the past three years turns out to be a measurement which can be changed. And when it changes, you will feel the difference.

Aroha nui,
Dr Libby

Dr Libby is a nutritional biochemist and the author of 14 books, including Fix Iron First. She is the co-founder of OnBlends, a Mount Maunganui supplement company.