Iron deficiency and bacterial vaginosis, aerobic vaginitis

Iron is required by our immune system (amongst many other uses) to help protect us against invaders. If you are low in iron (not necessarily anaemic – just on the low side) and suffer from recurrent vulvovaginal infections like bacterial vaginosis or aerobic vaginosis, get your bloods done.

Your iron levels may be (one of) the missing links between solving your BV and there being an underlying contributing cause. The study you want is called an iron study, which looks at the various aspects of your iron storage and levels.

Optimal iron and ferritin levels

Iron is carried around your body by ferritin as both transport and storage, so you need both the iron and the ferritin to get iron around your body.

That’s why we test both – you can be high in serum iron, but low in ferritin, which has the same effect in terms of symptoms of low iron. Typical references ranges are:

  • Iron 10 – 30 ng/mL
  • Ferritin 20 – 300 ng/mL

Remember that reference ranges are actually just what most people’s test results were, not any indication of whether your levels are good or bad. The reference ranges use averages of everyone who has been tested, and creates these upper and lower reference ranges. That’s why they differ between pathology labs.

How much iron is not enough?

If you understand the function of iron in your body, you start to realise that just being within the reference ranges is simply not good enough.

Iron allows oxygen to hop onto your red blood cells and be carried around your body, so if you are on the low or even mid-range of the reference range, your ability to carry oxygen around your body is just at that level.

There is an optimal level, and the reference ranges, and it’s important not to dismiss mid-to-low iron levels as ‘healthy’. It’s just not true. You won’t die, sure, but you won’t feel good either.

Anyone who gets their period loses a lot of iron every time you bleed, so if you bleed heavily or frequently, you lose even more. Heavy periods can also, paradoxically, be a result of low iron.

Signs you could have low iron

  • Poor immune system, frequent infections
  • Feel tired a lot or easily
  • Get tired walking or climbing stairs
  • Sleep a lot or loooove sleeping
  • Have low iron intake – don’t eat red meat very often, are vegetarian or vegan, have disordered eating or low food intake overall
  • When you pull your eyelid down to reveal the conjunctiva, it is pale pink (compare with someone you know has good iron stores)
  • Pale
  • Pale conjunctiva of the eye
  • Restless legs
  • Feel the cold a lot more than other people, especially hands and feet
  • Digestive problems that prevent/reduce absorption of nutrients (diarrhoea, IBS, celiac disease)
  • Digestive problems involving bacteria that use the iron before it can be absorbed
  • You are pregnant – you need more iron while you are pregnant, because your blood volume increases
  • Ridged, spoon-shaped or flat nails
  • Brittle hair
  • Memory a bit fuzzy
  • Reduced thyroid function/thyroid problems

How to decipher your iron blood test results

Serum iron

Serum iron is the level of iron in the sample of blood that was taken.

Serum ferritin

Serum ferritin tells you how much iron is stored in your body.


Transferrin is the protein that transports your iron around the body. If you are low in transferrin, but high in iron, the iron can’t get around your body to be used.

You want to have good levels of both transferrin and iron for the system to work. As transferrin goes about its business in your body, about a third of it is carrying iron, with two-thirds of its capacity reserved.

TIBC – total iron-binding capacity

TIBC is the total amount of iron that can be picked up by proteins in your blood. Transferrin is the main iron-binding protein here, so if your transferrin isn’t doing its job properly, this is the test that will tell you that. TIBC tell you how available your transferrin is in your body.

UIBC – unsaturated iron-binding capacity

UIBC tells you what the reserve capacity of your transferrin is, so the portion of your transferrin that is not used up by circulating iron. UIBC also backs up the transferrin level result.

Transferrin saturation

The sum that reflects how much, percentage-wise, of transferrin is saturated with iron (sum being 100 x serum iron / TIBC).

Study into iron and BV

Researchers looked into iron status of women in early pregnancy, when iron is restricted for reasons that are incompletely understood, as a risk factor for developing bacterial vaginosis.

The rationale was that even mild deficiencies in nutrients like iron, critical for our immune response against bacterial colonisation, can reduce our ability to stave off colonisation.

The iron status of the study participants was collected in early pregnancy, with 80 women who had healthy vaginal flora and 18 who had vaginosis-like flora.

Study results – does low iron contribute to susceptibility to BV (at least during early pregnancy)? Yes!

There was no found correlation between vaginal microflora status (healthy or BV-like) and normal iron levels. There was, however, a highly significant difference between the healthy and unhealthy microflora of the women who had iron deficiency, indicating a strong association between iron deficiency and bacterial vaginosis-associated vaginal microflora.

The conclusion by the researchers was that subclinical iron deficiency is strongly and independently associated with vaginosis-like microflora during early pregnancy.


Verstraelen H, Delanghe J, Roelens K, Blot S, Claeys G, Temmerman M. Subclinical iron deficiency is a strong predictor of bacterial vaginosis in early pregnancyBMC Infect Dis. 2005;5:55. Published 2005 Jul 6. doi:10.1186/1471-2334-5-55

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Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)