The clinical way forward for iron deficiency in peri-menopausal women

Dr Sachin Pawar, Head Medical Affairs-India Cluster, Procter & Gamble Health stresses that unfortunately, there is not enough clinical awareness about iron deficiency in peri-menopausal women in India as the symptoms of ID/IDA can be misinterpreted or overlooked in this phase

Iron deficiency or anemia is a common clinical condition with a disproportionate prevalence in women which usually occurs during or after pregnancy. Anemia has been a clinical concern for women’s health, irrespective of their age¹. Peri-menopause is the natural transition period from menstruation to menopause. Empirical evidence has suggested how such women are at an increased risk of iron deficiency as the symptoms experienced are often overlooked or misinterpreted. The National Family Health Survey (NFHS-5) data revealed that 1 in every 2 women in India is anemic and the prevalence is around 57 per cent in non-pregnant women & 52 per cent in pregnant women². Unfortunately, there is not enough clinical awareness about iron deficiency in peri-menopausal women in India as the symptoms of ID/IDA can be misinterpreted or overlooked in this phase.

In an attempt to bridge this gap, notable practitioners from the space of gynaecology & endocrinology in India published ‘Iron Deficiency in Peri-menopausal women: Clinical considerations from an Expert Consensus’. Worked on by a group of 9 accomplished doctors, the expert consensus aimed to recognise symptoms, understand risks and the clinical way forward for the issue.

How and why is iron deficiency a growing concern

Insufficient iron storage and inconsistent haemoglobin production in the body often lead to iron deficiency which results in impaired cognitive function and mood swings in women. We know monthly blood loss during menstruation in the peri-menopausal phase is one of the main reasons for iron deficiency in women. There are some studies conducted in certain states of India (including Rajasthan, North India & West Bengal) which outpace (range from 78 to 88 per cent) prevalence of iron deficiency in peri-menopausal women³

As per the expert consensus, clinical evidence shows that 93 per cent of pre and peri-menopausal women have lower than recommended dietary iron intake which results in iron deficiency.

Iron deficiency in peri-menopausal women leads to poor results in tests of learning, attention and memory compared to women with sufficient iron stores in their body⁴. The study further found that Irregular menstruations, HMB (Heavy Menstrual Bleeding), inadequate iron intake, inflammatory bowel diseases, obesity, malabsorption of iron, these risk factors put women of peri-menopausal age group at risk of developing iron deficiency or iron deficiency anaemia. Hence, the identification of iron deficiency before it results in iron deficiency anemia is important.

What was achieved from the consensus?

Through discussions, consensus was achieved on multiple statements – establishing their importance in recognising and treating iron deficiency in peri-menopausal women. For starters, an agreement was reached on the prevalence of iron deficiency anemia in peri-menopausal women being between 30-60 per cent. Agreement was also reached on how zinc and iron supplementation can provide therapeutic response in the management of iron deficiency in pre-menopausal/menopausal/peri-menopausal women.

The way forward

Spreading awareness about iron deficiency in the peri-menopausal age group and encouraging them to consult their doctors. Also spreading awareness amongst doctors to help them diagnose better. Doctors too, need to be cognizant of this condition and diagnose accordingly. Additionally, women need to be conscious of their transition into the peri-menopausal phase, understand the symptoms and visit their doctors often to know about their iron stores to evade iron deficiency and iron deficiency anemia. If you develop any of the symptoms and signs, you should visit a doctor and seek advice.

The most natural way of getting enough iron is through a diet with adequate iron content, which includes foods like red meat, seafood, green leafy vegetables such as spinach, dried nuts like raisins, apricots and iron fortified food. Another effective way of managing iron deficiency is through iron supplements, which can be prescribed by your doctor both as a preventive measure or to manage already existing iron deficiency. Together with the right diet, iron supplements can provide huge benefits for overall health.

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