Low Iron Stores are Still a Symptom – Part 2

It’s time to cover testing, and why iron infusions and the mirena do not address the root cause. Catch up on part 1 here if you’re yet to.


In order to fully understand your iron stores, it’s important to test haemoglobin (Hb), full iron studies and hs-CRP every 8-12 weeks. Here are some key takeaways:

  • My first two test priorities are transferrin and transferrin saturation, not just iron or ferritin. I do however, set a minimum ferritin of 50 ug/L for preconception.
  • Without transferrin, you won’t understand your true iron hunger, and supplements could be prescribed unnecessarily. A transferrin of 2-2.5 g/L is ideal, which differs for those on the OCP and in pregnancy.
  • Without Hb, you won’t fully understand if you have low iron stores, iron deficiency or iron deficiency anaemia (IDA). An ideal Hb is >115 g/L.

Note: these tests should be conducted with 5-12 hours of fasting and without supplementation or strenuous exercise in the last 24 hours.

Too often I hear of iron infusions and/or a mirena [🤦🏼‍♀️] being recommended off low ferritin alone, which is a band-aid approach, often unnecessary and extremely counterproductive.

Iron Infusions

I don’t recommend infusions unless IDA has been reached and all other interventions have failed. Not only do they come with potential side effects but they create inflammatory levels of iron in the body and only last for ~6 months. It’s a vicious cycle to not address the root cause, as you’ll be back at square one within a year.


A mirena is a hormone-releasing intrauterine device (IUD) often prescribed for excessive monthly bleeding, as the synthetic progesterone suppresses the response of estrogen to stop the growth of the lining of the womb, which results in a reduction in the volume and duration of menstrual bleeding. Documented side effects include severe headaches, weight gain, mood and libido changes to deep vein thrombosis, pulmonary
embolism and stroke.

This is again a band-aid solution and we must investigate the hormonal cause. Let’s take a closer look.

So how do we get to the root cause, in this case? Via a Dried Urine Test for Comprehensive Hormones, otherwise known as DUTCH.


The DUTCH is a urine steroid hormone profile that measures hormones and hormone metabolites via dried urine sample. The samples are taken from the comfort of your home and sent back to the lab for analysis.

  • Testing for Estrogen Dominance

Simply put, estrogen dominance is when progesterone is low and estrogen is high. This is one of the most common causes of PMS, painful periods, tender breasts, moodiness, fibroids and more. It also makes perimenopausal symptoms significantly worse. This can be easily identified for your DUTCH test so appropriate interventions can be implemented.

Importantly, your results will show how you metabolize estrogen via your liver. This is an essential part of hormonal balance as otherwise hormones are reabsorbed where they increase in potency and cause further symptoms. In addition, if you don’t metabolize estrogen well, your risks of estrogen-related cancers can increase. The ratio of 2-OH, 4-OH and 16α-OH pathways are of particular interest to me.

  • What else?

A DUTCH is extremely comprehensive and also examines all sex hormones, adrenals and melatonin. The cortisol and cortisone rhythms can also be of particular interest as adrenal dysfunction is often associated with hormonal imbalance.

  • Cost

The cost of your test ranges from $350-380 and is available through a qualified practitioner. A small price to pay to get to the root cause of your hormonal balance, and in this case, avoid iron infusions and birth control once and for all?

Learn more here: http://bit.ly/EICDUTCH

I’m curious to know, have you been recommended an infusion and/or Mirena to treat your low iron? Let me help you treat your low iron once and for all in my latest masterclass, Understanding Low Iron.

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