Health

Study Highlights Need For Iron Deficiency Screening In Women, Particularly Those Experiencing Symptoms

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A recent study sheds light on the overlooked importance of iron deficiency screening for women of reproductive age, suggesting that widespread testing could be a cost-effective measure to address this common but underdiagnosed condition.

The widespread problem of iron deficiency

Iron deficiency, which can lead to debilitating symptoms such as fatigue, brain fog, and hair loss, remains largely undiagnosed in women, despite its high prevalence. According to a new study presented at the American Society of Hematology‘s annual meeting, iron deficiency screening could be an effective strategy to identify and treat this condition, especially in women who exhibit symptoms.

As Ariela Marshall, MD, a hematologist and associate professor at the University of Minnesota, explains, “We currently do not screen women at all. There is no recommended screening for iron deficiency for women, or for anyone, the way we recommend screening for cervical cancer or breast cancer.” This lack of a clear guideline for screening has contributed to the widespread underdiagnosis of iron deficiency, particularly among women.

While the study’s findings are still preliminary and have not undergone independent peer review, they raise serious questions about current practices. Previous studies suggest that nearly 1 in 3 Americans may be unaware they have an iron deficiency, with women under 50 being particularly vulnerable—up to 20 times more likely to be affected than men.

How to identify iron deficiency

Iron deficiency can be diagnosed with a straightforward blood test that measures ferritin levels, a protein that indicates the body’s iron stores. In this study, researchers compared the cost-effectiveness of screening for iron deficiency at different ferritin thresholds—either at 25 micrograms per liter (µg/L) or 15 µg/L—and evaluated the potential benefits of treatment with both oral and intravenous iron supplements.

The cost-effectiveness of screening was evaluated using the concept of quality-adjusted life years (QALY), a metric that considers both the quality of life and life expectancy when assessing the value of a medical intervention. Interestingly, the study found that, over a lifetime, the differences in cost-effectiveness between screening and not screening were negligible. This remained true regardless of the ferritin threshold used or whether oral or intravenous iron supplementation was prescribed.

The dangers of missed diagnoses

The lack of iron deficiency screening means many women with the condition are going undiagnosed. Iron deficiency symptoms are often mistaken for other issues, which complicates diagnosis. “The issue is that there are many symptoms and many of them can be seen outside of iron deficiency,” says George Goshua, MD, senior author of the study. He lists symptoms like “restless legs, cravings for ice, cognitive fog, shortness of breath, and fatigue” as common signs that are not exclusive to iron deficiency.

Due to this symptom overlap, many women remain unaware of their condition. Leo Buckley, PharmD, MPH, a clinical pharmacy specialist at Brigham and Women’s Hospital, notes that “the question then becomes what are the pros and cons of screening all women for iron deficiency.” The potential drawbacks include the costs of testing, as well as the side effects from iron supplements, which may cause stomach discomfort or, in rarer cases, reactions to intravenous iron treatments such as difficulty breathing or low blood pressure.

The case for symptomatic screening

While universal screening for iron deficiency in all women remains a topic of debate, it’s clear that women exhibiting symptoms should be tested. Sant-Rayn Pasricha, MBBS, PhD, an expert in anemia research at the Walter and Eliza Hall Institute of Medical Research, emphasizes that “current evidence does not suggest that all women with iron deficiency benefit from iron supplementation in terms of symptoms—rather, if women have symptoms and are then tested for iron deficiency, they do experience benefit.” This suggests that women with noticeable symptoms of iron deficiency can find significant relief from iron supplements, improving their quality of life.

A simple solution for a widespread issue

While the study’s findings are still being reviewed, they highlight the importance of addressing iron deficiency in women, particularly those who present with symptoms. As the prevalence of iron deficiency remains alarmingly high, screening could offer a straightforward and cost-effective way to improve women’s health. For those already showing symptoms, testing and subsequent supplementation could provide meaningful relief, making the case for further exploration of iron deficiency screening both urgent and necessary.