📣 It's FINALLY happened: the recommended ferritin cutoff for women moved up to 30

It's finally here. Real, evidence-based guidelines raising the cutoff for diagnosing iron deficiency. It took us long enough.

I've written before about being sent home with "normal" blood work while feeling anything but normal. I had my research training to lean on, and went back to the literature myself.

That experience is part of why I started this newsletter and in the end, why I'm building in women's health.

Higher thresholds give clinicians something concrete to act on, and the people advocating for change something to point to. And while these recommendations will take some time to be fully adopted and implemented, there’s finally weighty recommendations in black and white that we can reference.

For women who've been told their iron is "normal" while feeling anything but, this could change that doctor’s office conversation.

On September 16th, the American Society of Hematology (ASH) issued its first evidence-based guidelines for diagnosing iron deficiency.

For menstruating women, the ferritin threshold moved from 15 ng/mL to 30. Not only that, the panel explicitly advised against the old number.

ASH made distinct recommendations by group, with the goal of catching iron deficiency irrespective of the presence of anemia.

Researchers compared ferritin against iron visible in bone marrow. At 15 ng/mL, the test caught only 41% of people who had no stored iron. The rest were missed.

Raising the ferritin cutoff catches more cases of iron deficiency, but also flags more false positives.

Keep in mind that labs and doctors won’t necessarily make updates based on these recommendations, and certainly, these updates won’t be implemented immediately. These things take time.

But it’s a weighty step in the right direction.

🩸 If you have fatigue you can't shake, it's worth getting your ferritin measured.
30 is a better line than 15, but a guideline isn't necessarily a case closed. You can sit above it and still feel off. The point is having a number to track over time instead of guessing.

📄 The race to diagnose anemia without a needle is further along than you'd think: Researchers screened 1,923 papers and analysed 58 attempts to detect anaemia or estimate haemoglobin without drawing blood, most often from photographs of the inner eyelid, the palm, or a fingertip pulse signal, usually running on a smartphone. Most models aim to estimate haemoglobin rather than simply flag anaemia. The authors' own verdict is that real progress has been made but the field is still held back by small, narrow training data.

📄 A hormone-free supplement added 41 minutes of sleep in menopause (in a trial its own maker ran): 128 peri- and postmenopausal women who were sleeping badly but weren't getting hot flashes took either a blend of L-theanine, GABA, magnesium and SAMe or a placebo, every night for three weeks. The supplement group gained 41 minutes of sleep a night. The placebo group lost 15. Nine in ten improved, against fewer than half on placebo. Those numbers are much bigger than sleep supplements usually manage. But most of the authors work for the company that sells the blend, and the trial lasted three weeks. So, could be worth watching for someone independent to repeat it.

🔎 "Ferritin face" — the claim that you can spot low iron in the mirror: Kinda half right. A pale face comes from low hemoglobin, the protein that makes blood red. And your iron stores run down long before hemoglobin drops, and stores are what ferritin measures. About 38% of women of reproductive age have low iron with perfectly normal hemoglobin, compared to 13% who are anemic (JAMA, 2025). That means three out of four women with low iron look completely fine. The trend is right that ferritin is worth checking.