Understanding Iron Deficiency in Women: A Comprehensive Overview

The Importance of Iron for Women's Health

Inside the cores of stars, iron is forged during the star’s last moments. A supernova scatters the elements contained inside across the universe, and sometime since then, they weaved their way into becoming essential to human life. For something so abundantly created, why is it so scarce in women?

Iron deficiency (ID) is the most common nutrient deficiency in the world, affecting 20-25% of women globally and more than half the population of pregnant women. Left untreated, it can progress to the last stage: iron deficiency anemia (IDA), which affects 1 in 3 women aged 15-49 worldwide. Despite its alarming prevalence, these conditions are routinely dismissed, misdiagnosed, and even entirely overlooked.

Millions of women lose their spark due to this essential mineral, experiencing various negative effects:

Physical and Cognitive Burden

• Impaired Physical Performance: Women with ID often find themselves fatigued and unable to perform daily tasks effectively.

• Delayed Cognitive Development in Children: Iron deficiency can hinder cognitive growth in children, leading to long-term educational challenges.

  
  

Economic Impact of Iron Deficiency Anemia

The global economic burden of IDA is substantial due to its association with:

• Poor Growth: Children may not reach their full growth potential.

• Decreased Productivity: Women may struggle to maintain their work output.

• Increased Healthcare Costs: Treating complications from IDA can be expensive.

• Poor Pregnancy and Infant Health Outcomes: IDA can lead to complications during pregnancy, affecting both mother and child.

  
  

Treatment Challenges

Many women experience low satisfaction with treatments for ID and IDA due to:

• Unpleasant Sensory Changes: Consuming iron-fortified products can be unappealing.

• Adverse Gastrointestinal Side Effects: Many treatments lead to discomfort, which discourages adherence.

• Low Adherence Rates: The combination of side effects and dissatisfaction results in many women not completing their treatment plans.

  
  

The Broader Economic Health Burden

The significant economic health burden of IDA includes:

• Lower Educational Attainment: Especially in children and adolescents, leading to long-term disadvantages.

• Decreased Work Productivity: Women may miss work or perform poorly due to fatigue.

• Lost Earning Potential: Chronic ID can lead to reduced income over a lifetime.

• Increased Healthcare Costs: Ongoing treatment and complications can strain financial resources.

  
  

Misdiagnosis: A Persistent Issue

In this day and age, how is iron deficiency consistently missed for many women, especially with rapidly advancing healthcare technology? The answer lies in the vague methods of diagnosing ID and IDA. Commonly accepted levels of iron, measured in serum ferritin and hemoglobin levels, are based on data from a combined population of both men and women. However, it is widely known that menstruating and pregnant women need more iron than men.

Moreover, growing research indicates that there are differences between males and females regarding how their unique physiologies affect iron absorption. Iron metabolism is influenced by sex hormones such as estrogen, progesterone, and testosterone in:

• Regulation of Blood Cell Formation: Hormones play a crucial role in how blood cells are produced.

• Iron Absorption: Women’s bodies may absorb iron differently than men’s.

• Hemoglobin Concentrations: Hormonal differences can affect hemoglobin levels.

  
  

Therefore, not only do women require more iron, but the hormonal differences also show that men are relatively less susceptible to developing ID and IDA.

Additional Factors Influencing Iron Deficiency

Several factors further complicate the issue of ID and IDA in women:

• Healthcare Accessibility: Limited access to healthcare can hinder diagnosis and treatment.

• Prevalence of Infectious Diseases: Certain diseases can exacerbate iron deficiency.

• Race and Ethnicity: Different populations may experience varying rates of ID.

• Medication Use: Some medications can impact iron absorption.

• Multiple Micronutrient Deficiencies: A lack of other essential nutrients can worsen iron deficiency.

  
  

Social Factors

• Gender Inequity: Women often receive lower food quality and nutritional intake than men.

  
  

Geographic and Socioeconomic Factors

• Regional Disparities: The highest prevalence of ID and IDA is reported in Southeast Asia and Central and West Africa.

  
  

Dietary Factors

• Dietary Choices: Women often consume significantly less meat than men in many countries and are more likely to follow a vegetarian or vegan diet. Plant-based iron has lower bioavailability and absorption compared to iron in meat.

  
  

Treatments: Addressing Iron Deficiency Anemia

Commonly accepted treatments for ID and IDA also have flaws in their effectiveness. The most widely given treatment is ferrous sulfate, which is cost-efficient and works well for most patients, provided they adhere to their treatment plan.

However, low levels of satisfaction have been consistently reported with these treatments. Unpleasant sensory changes and adverse gastrointestinal side effects lead to low adherence rates. Research on poor patient adherence remains limited, stalling progress in reducing ID and IDA prevalence.

Exploring Alternative Treatments

To improve treatment outcomes, it is essential to explore alternative therapies that may offer better tolerability and effectiveness. This could include:

• Dietary Changes: Increasing the intake of iron-rich foods, such as leafy greens, legumes, and fortified cereals.

• Iron Supplements: Considering different forms of iron supplements that may cause fewer side effects.

• Education and Awareness: Raising awareness about the importance of iron and the symptoms of deficiency can empower women to seek help sooner.

  
  

Conclusion: The Path Forward

The consequences of untreated ID and IDA, particularly the sex differences associated with them, will continue to burden women. These conditions impact their physical, cognitive, and economic well-being. Instead of seeking temporary relief, it is crucial to pursue solutions and treatments that will create a lasting impact on women who continue to experience the effects of iron deficiency in their daily lives.

By addressing the underlying issues and improving diagnostic methods, we can help ensure that women receive the care they need. Empowering women with knowledge about their health and the importance of iron can lead to better outcomes for themselves and their families.

References

Burns, J. L., Miller, C. H., FontaineBisson, B., & Connor, K. L. (2025). Iron deficiency and iron deficiency anaemia in women of reproductive age: Sexand genderbased risk factors and inequities. Journal of Trace Elements in Medicine and Biology, 90, 127684. https://doi.org/10.1016/j.jtemb.2025.127684

Peoc’h, K., Manceau, H., Joly, F., & Treton, X. (2021). Iron deficiency in chronic inflammatory bowel diseases: An update. Journal of Laboratory and Precision Medicine, 6(0). https://doi.org/10.21037/jlpm-21-49