Iron circulates in haemoglobin inside red blood cells. When you lose blood during menstruation, you lose the iron it carries. The average cycle loses around 30 to 40 mL of blood, containing roughly 15 to 20 mg of iron. Heavy menstrual bleeding is one of the most common causes of iron deficiency in women of reproductive age, and can deplete iron stores considerably faster (Munro et al., 2023). Over months, if intake does not keep pace with loss, serum ferritin drops. Ferritin is the storage form of iron; when it falls below about 30 micrograms per litre, fatigue and cognitive symptoms typically appear, even if haemoglobin is still in the normal range.
This is why many women are told their blood tests are "normal" but still feel exhausted. Haemoglobin, the number most doctors check first, drops late. Ferritin drops early. If your doctor has not checked your ferritin specifically, ask for it.
The Australian recommended daily iron intake for women aged 19 to 50 is 18 mg, against 8 mg for men and for women after menopause (NHMRC Nutrient Reference Values), and that gap exists precisely because of this monthly loss. Most women do not reach 18 mg consistently through diet alone, particularly on diets low in red meat, so the shortfall compounds quietly over months and years.