Fatigue is common among teenage girls and can have a substantial impact on their everyday life, including school attendance and social functioning.

Iron deficiency and anaemia are often considered the most probable explanations for the symptoms of fatigue that teenage girls experience. But our recent findings suggest that the cause is more complicated.

We studied 485 Swedish female high school students. Participants completed questionnaires about fatigue, quality of life, menstrual patterns, diet, nicotine use and dietary supplement use. They also provided blood samples to measure haemoglobin and ferritin – key markers to assess iron status. Low ferritin and low haemoglobin levels typically indicate iron deficiency and anaemia, respectively.

In earlier analyses of the same group, we found iron deficiency was present in 38% of participants. It was strongly associated with both heavy periods (reported by 54% of the participants) and........

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