Iron deficiency is finally getting the attention it deserves. Especially in reproductive-age women (which is anyone from 15 - 49). Important because the amount of iron in your body affects your energy, mood, focus, physical endurance, immunity, and more, and one study found that nearly 40% of young women are likely iron deficient. For the first time in history, according to the New York Times, the International Federation of Gynecology and Obstetrics (FIGO) is recommending that women get their iron levels checked regularly.
What causes anemia or iron deficiency?
First, iron deficiency and anemia aren’t the same. The key role of iron is to make hemoglobin (a protein in red blood cells that helps transport oxygenated blood throughout the body), which is necessary for survival.
Roughly 70% of the iron in your body is found in hemoglobin. The rest is either stored for later as a protein called ferritin or used for other functions, including producing serotonin and dopamine and maintaining your immune system, according to Angela Weyand, MD, a pediatric hematologist and oncologist at C.S. Mott Children’s Hospital.
When you don’t have enough available iron, the body uses reserved ferritin to maintain hemoglobin production. If the problem persists, and you’re scraping the bottom of the iron storage barrel, you’ll lessen the production of hemoglobin and reduce the number of healthy red blood cells traveling throughout the body. This is considered iron-deficiency anemia.
Why iron deficiency matters
Even before it reaches the level of anemia, iron deficiency can cause fatigue, difficulty exercising, poor focus, and irritability, according to Weyand. “We know that iron is required for many different processes in the body outside of making red blood cells, so any amount of iron deficiency may cause symptoms,” says Weyand. Anemia comes with additional problems, such as “heart palpitations, shortness of breath, headache, lightheadedness, cold intolerance, brittle nails, and cravings for nonfood substances such as ice or dirt,” she says. Both iron deficiency and anemia are linked to generally higher rates of illness and death, she adds.
Despite the health consequences of iron deficiency, alarm bells don’t seem to ring for healthcare providers unless anemia is involved. This could be because the symptoms are common and nonspecific or that iron deficiency is “neglected and understudied, and people have not recognized how prevalent it truly is,” says Weyand.
A consequence of this lack of attention is that there’s no universal consensus for defining iron deficiency, she says. For example, the Mount Sinai network of hospitals considers 12 to 150 micrograms of ferritin per liter of blood as a normal level of iron in the body for the average woman. Whereas, the World Health Organization defines iron deficiency in adults as a ferritin level under 15 micrograms per liter of blood. Even more confusing, studies show that iron deficiency can be present even with ferritin levels as high as 30–50 micrograms per liter, according to Weyand. It’s easy to see how assessing the severity of a deficiency can be complex.
Who should get tested for iron?
In line with the new guidelines from FIGO, some researchers are calling for regular iron-deficiency testing in young women who menstruate, though “we don’t yet know the optimal timing or frequency of this testing,” says Weyand. Screening is particularly crucial for those who have heavy periods or an iron-deficient diet (i.e., vegans or vegetarians), she adds.
Plus, if you’re experiencing any potential symptoms, that’s reason enough to ask about a test. “If you're feeling tired all the time, you have to figure out why,” says Hope Ricciotti, MD, an OB-GYN at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. There are “readily available diagnostic tests and effective treatment for iron deficiency, and women should not have to deal with the many problems that iron deficiency causes,” says Weyand.
If you’re curious or concerned about your iron levels, specify that you’d like a ferritin test at your next checkup. A ferritin test measures the amount of iron-storing protein in your blood and is the best way to look for iron deficiency, according to FIGO. (But heads up: your insurance may or may not cover it.) If test results reveal a deficiency, your doctor might suggest options to lighten your flow, such as birth control pills. Discuss iron supplementation and tricks to boost how much iron you absorb from the foods you eat, according to Ricciotti.
Iron deficiency is a neglected problem, leaving many women low on a mineral that is quite literally necessary for survival, while also struggling to live with symptoms like exhaustion that have been normalized at the cost of well-being. If you’re concerned, know that there are easy and effective testing and treatment options you can ask about — or, frankly, demand — with your doctor.
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