Iron Supplements for Women: Boosting Health and Vitality

Introduction

Iron deficiency is a global health concern, affecting over 1 billion people worldwide, with women of reproductive age and pregnant women being at higher risk (Camaschella, 2015). Iron plays a crucial role in various bodily functions, including oxygen transport, energy production, and cognitive development. When iron levels are low, it can lead to iron deficiency anaemia, characterised by fatigue, weakness, and impaired immune function.

For many women, meeting the recommended dietary allowance (RDA) of 18 mg/day for ages 19-50 and 27 mg/day during pregnancy (Institute of Medicine, 2001) through diet alone can be challenging. This is where iron supplements for women come into play. Supplementation has been shown to effectively prevent and treat iron deficiency, offering numerous health benefits such as reducing anaemia risk, improving exercise performance, and supporting healthy pregnancy outcomes (Low et al., 2016; Pasricha et al., 2014; Peña-Rosas et al., 2015).

In this comprehensive article, we will delve into the importance of iron supplementation for women, exploring the various benefits, types of supplements available, dosage recommendations, and safety considerations. By understanding the role of iron in women’s health and how to effectively incorporate supplements into your routine, you can take proactive steps towards optimising your well-being and vitality.

Understanding Iron Deficiency in Women

Iron deficiency is the most common nutritional deficiency worldwide, affecting over 1 billion people, with women of reproductive age and pregnant women being at higher risk (Camaschella, 2015). The progression of iron deficiency occurs in three stages: depletion, deficiency, and finally, iron deficiency anaemia (IDA). In the depletion stage, iron stores in the body are diminished, but haemoglobin levels remain normal. As the deficiency progresses, iron stores become exhausted, leading to a decrease in serum ferritin concentration, which is the most efficient test for diagnosing iron deficiency (Camaschella, 2015). Ferritin levels below 30 mcg/L indicate iron deficiency, while levels below 10 mcg/L suggest IDA (Camaschella, 2015).

Women are particularly susceptible to iron deficiency due to increased iron requirements during menstruation, pregnancy, and lactation. The recommended dietary allowance (RDA) for iron is 18 mg/day for women aged 19-50 and 27 mg/day for pregnant women (Institute of Medicine, 2001). However, many women struggle to meet these requirements through diet alone, especially those following vegetarian or vegan diets, as iron from plant sources (non-heme iron) is less bioavailable than iron from animal sources (heme iron) (Pawlak et al., 2016). Consequently, iron supplements are often necessary to prevent and treat iron deficiency in women (National Institutes of Health, 2023).

Symptoms and Consequences of Iron Deficiency

The symptoms of iron deficiency can be subtle in the early stages but become more pronounced as the deficiency worsens. Common signs and symptoms include fatigue, weakness, pale skin, headaches, dizziness, cold hands and feet, brittle nails, and unusual cravings for non-food items like ice or dirt (pica) (National Institutes of Health, 2023). If left untreated, iron deficiency can progress to IDA, which is characterised by low haemoglobin levels and decreased red blood cell size (microcytic anaemia) (Camaschella, 2015).

The consequences of iron deficiency extend beyond anaemia. Iron is essential for cognitive development, and deficiency during pregnancy can lead to impaired fetal growth and low birthweight (Peña-Rosas et al., 2015). In children, iron deficiency can cause developmental delays and behavioural problems (Jáuregui-Lobera, 2014). For women of reproductive age, iron deficiency can negatively impact work productivity, exercise performance, and overall quality of life (Pasricha et al., 2014).

Diagnosing Iron Deficiency

Diagnosing iron deficiency involves a combination of clinical assessment and laboratory tests. A complete blood count (CBC) can reveal low haemoglobin and haematocrit levels, as well as changes in red blood cell size and colour. However, these findings are not specific to iron deficiency and can occur in other types of anaemia (Camaschella, 2015).

The most reliable indicator of iron deficiency is serum ferritin concentration, which reflects the body’s iron stores. Ferritin levels below 30 mcg/L are diagnostic of iron deficiency, while levels below 10 mcg/L indicate IDA (Camaschella, 2015). Other laboratory tests that can help assess iron status include serum iron, total iron-binding capacity (TIBC), and transferrin saturation (National Institutes of Health, 2023).

In some cases, additional tests may be necessary to determine the underlying cause of iron deficiency, such as tests for coeliac disease, inflammatory bowel disease, or occult blood loss (Camaschella, 2015). Identifying and addressing the root cause of iron deficiency is crucial for effective long-term management.

Recommended Iron Intake for Women

The recommended dietary allowance (RDA) for iron varies by age, sex, and life stage. For women, the RDA is highest during pregnancy due to the increased demands of fetal growth and development. The following table summarises the RDA for iron in women (Institute of Medicine, 2001):

| Age/Life Stage | RDA (mg/day) |
|—————-|————–|
| 14-18 years | 15 |
| 19-50 years | 18 |
| 51+ years | 8 |
| Pregnancy | 27 |
| Lactation | 9-10 |

Despite these recommendations, many women struggle to meet their iron needs through diet alone. The Australian Health Survey found that 23% of women aged 19-50 had inadequate iron intakes, compared to only 3% of men in the same age group (Australian Bureau of Statistics, 2015). This disparity can be attributed to factors such as menstrual blood loss, pregnancy, and lower consumption of iron-rich foods like red meat.

Dietary Sources of Iron

Iron is found in a variety of foods, both animal and plant-based. However, the bioavailability of iron differs depending on the source. Heme iron, found in animal products like red meat, poultry, and fish, is more readily absorbed by the body than non-heme iron, which is found in plant foods such as legumes, nuts, and fortified cereals (Pawlak et al., 2016).

Some of the best dietary sources of iron include (National Institutes of Health, 2023):

• Red meat (beef, lamb, pork)
• Poultry (chicken, turkey)
• Fish (tuna, sardines, haddock)
• Shellfish (oysters, clams, mussels)
• Organ meats (liver, kidney)
• Legumes (beans, lentils, tofu)
• Nuts and seeds (pumpkin seeds, cashews, almonds)
• Fortified cereals and bread
• Dark green leafy vegetables (spinach, kale, broccoli)
• Dried fruit (apricots, raisins, prunes)

To enhance the absorption of non-heme iron, it is recommended to consume these foods along with vitamin C-rich sources like citrus fruits, berries, and bell peppers (Hallberg et al., 1989). Conversely, certain compounds found in tea, coffee, and calcium-rich foods can inhibit iron absorption, so it is best to consume these separately from iron-rich meals (Zijp et al., 2000).

The Role of Iron Supplements

While a balanced diet is the foundation of good nutrition, many women may require iron supplements to meet their increased needs and prevent deficiency. The National Institutes of Health (2023) recommends iron supplements for the following groups:

• Pregnant women
• Preterm and low birth weight infants
• Older infants and toddlers
• Teenage girls
• Women with heavy menstrual periods
• Women following a vegetarian or vegan diet
• People with certain gastrointestinal disorders (e.g., coeliac disease, inflammatory bowel disease)
• People undergoing certain cancer treatments

Iron supplements are available in various forms, including ferrous sulfate, ferrous gluconate, and ferrous fumarate. The recommended dosage depends on the individual’s age, sex, and iron status, but typically ranges from 30-60 mg of elemental iron per day for women (National Institutes of Health, 2023). Higher doses may be necessary for the treatment of diagnosed iron deficiency anaemia, as determined by a healthcare provider.

It is important to note that iron supplements can cause side effects such as nausea, constipation, and gastrointestinal discomfort. Taking supplements with food, starting with lower doses, or using slow-release formulations may help alleviate these symptoms (Tolkien et al., 2015). However, if side effects persist or worsen, it is advisable to consult a healthcare professional to discuss alternative options.

Benefits of Iron Supplementation for Women

Iron supplementation has been extensively studied for its potential benefits in various aspects of women’s health. From reducing the risk of anaemia to improving exercise performance and supporting healthy pregnancy outcomes, the evidence suggests that iron supplements can play a crucial role in optimising the well-being of women across different life stages.

Reducing Anaemia Risk

One of the most well-established benefits of iron supplementation is its ability to reduce the risk of anaemia in women. A 2016 Cochrane review analysed 67 trials involving over 8,500 menstruating women and found that daily iron supplementation reduced the risk of anaemia by 61% (RR 0.39, 95% CI 0.25 to 0.60) and the risk of iron deficiency by 38% (RR 0.62, 95% CI 0.50 to 0.76) compared to no intervention (Low et al., 2016). The effect was even more pronounced in women with baseline anaemia, with a 70% reduction in risk (RR 0.30, 95% CI 0.19 to 0.46) (Low et al., 2016).

Similarly, in pregnant women, a Cochrane review of 61 trials found that daily iron supplementation reduced the risk of maternal anaemia at term by 70% (RR 0.30, 95% CI 0.19 to 0.46) and the risk of iron deficiency at term by 57% (RR 0.43, 95% CI 0.27 to 0.66) compared to no supplementation (Peña-Rosas et al., 2015). These findings highlight the efficacy of iron supplements in preventing and treating anaemia in women of reproductive age.

Improving Exercise Performance

Iron plays a crucial role in oxygen transport and energy production, making it essential for optimal athletic performance. In women, iron deficiency can impair exercise capacity and endurance, even in the absence of anaemia (Pasricha et al., 2014). A systematic review and meta-analysis of 22 randomised controlled trials found that iron supplementation significantly improved both absolute and relative VO2 max in women of reproductive age, with a mean difference of 2.35 mL/kg/min (95% CI 1.34 to 3.36) and 2.33 mL/kg/min (95% CI 0.86 to 3.80), respectively (Pasricha et al., 2014).

Furthermore, iron supplementation has been shown to enhance endurance capacity and reduce fatigue in female athletes. A randomised controlled trial of 40 iron-deficient, non-anaemic female rowers found that four weeks of iron supplementation (100 mg ferrous sulfate daily) significantly improved time to complete a 2-km simulated race compared to placebo (mean difference -4.3 seconds, 95% CI -8.4 to -0.3) (DellaValle & Haas, 2011). These findings suggest that iron supplementation can provide performance benefits for women engaging in regular exercise, particularly those with suboptimal iron status.

Reducing Fatigue

Fatigue is a common symptom of iron deficiency, and supplementation has been shown to improve fatigue in women with low iron stores. The 2016 Cochrane review by Low et al. found that daily iron supplementation reduced the risk of fatigue by 29% (RR 0.71, 95% CI 0.52 to 0.96) in menstruating women compared to no intervention. The effect was more pronounced in women with baseline fatigue, with a 47% reduction in risk (RR 0.53, 95% CI 0.37 to 0.76) (Low et al., 2016).

A randomised controlled trial of 198 women with unexplained fatigue and ferritin levels <50 mcg/L found that 80 mg of elemental iron daily for 12 weeks significantly improved fatigue scores compared to placebo (mean difference -1.49, 95% CI -2.25 to -0.73) (Vaucher et al., 2012). These results suggest that iron supplementation can be an effective strategy for managing fatigue in women with low iron stores, even in the absence of anaemia.

Preventing Low Birthweight in Pregnancy

Adequate iron status during pregnancy is crucial for fetal growth and development. The 2015 Cochrane review by Peña-Rosas et al. found that daily iron supplementation during pregnancy reduced the risk of low birthweight (<2500 g) by 16% (RR 0.84, 95% CI 0.69 to 1.03) compared to no supplementation. The effect was more pronounced in women with baseline anaemia, with a 28% reduction in risk (RR 0.72, 95% CI 0.51 to 1.01) (Peña-Rosas et al., 2015).

A meta-analysis of 48 randomised controlled trials and 44 cohort studies found that prenatal iron use was associated with a significantly higher mean birthweight (mean difference 41.2 g, 95% CI 1.2 to 81.2) and a lower risk of low birthweight (RR 0.81, 95% CI 0.71 to 0.93) compared to no iron use (Haider et al., 2013). These findings underscore the importance of iron supplementation during pregnancy for optimising fetal growth and reducing the risk of adverse birth outcomes.

Choosing the Right Iron Supplement

With the wide array of iron supplements available on the market, selecting the most appropriate option can be overwhelming. Factors to consider when choosing an iron supplement include the form of iron, dosage, absorption, tolerability, and quality. Understanding these aspects can help women make informed decisions about their supplementation regimen.

Common Iron Supplement Forms

Iron supplements come in various forms, each with different characteristics and benefits. The most common forms include (National Institutes of Health, 2023):

• Ferrous sulfate: This is the most widely used and economical form of iron supplement. It contains 20% elemental iron and is available in both tablet and liquid form. However, it is known to cause gastrointestinal side effects in some people.

• Ferrous gluconate: Containing 12% elemental iron, ferrous gluconate is considered more bioavailable and gentler on the stomach than ferrous sulfate. It is a good option for those who experience side effects with ferrous sulfate.

• Ferrous fumarate: With 33% elemental iron, ferrous fumarate is a highly bioavailable form of iron that is often used in prenatal vitamins. It is generally well-tolerated and has a lower risk of gastrointestinal side effects compared to ferrous sulfate.

• Iron bisglycinate: This is a chelated form of iron that is bound to the amino acid glycine. It has superior absorption and tolerability compared to other forms of iron, with fewer gastrointestinal side effects (Milman et al., 2014). However, it is typically more expensive than the ferrous forms.

Dosage Recommendations

The recommended dosage of iron supplements varies depending on the individual’s age, sex, and iron status. The World Health Organization (2023) provides the following general guidelines for iron supplementation in women:

• Menstruating women: 30-60 mg of elemental iron daily for three months, followed by a three-month period of no supplementation, in a cyclical manner.

• Pregnant women: 30-60 mg of elemental iron daily throughout pregnancy, starting as early as possible.

• Postpartum women: 30-60 mg of elemental iron daily for at least three months after delivery.

Higher doses may be necessary for the treatment of diagnosed iron deficiency anaemia, as determined by a healthcare provider. It is essential to follow the recommended dosage instructions and not exceed the upper limit of 45 mg of elemental iron per day for adults, as excessive iron intake can lead to adverse effects (National Institutes of Health, 2023).

Considering Absorption and Tolerability

The absorption and tolerability of iron supplements can vary depending on the form of iron and individual factors. Heme iron, found in animal-based foods, is more readily absorbed by the body than non-heme iron, which is found in plant-based foods and most iron supplements (Hurrell & Egli, 2010). However, certain dietary factors can enhance or inhibit iron absorption from supplements.

Vitamin C is known to enhance iron absorption by reducing ferric iron (Fe3+) to the more soluble ferrous form (Fe2+) (Teucher et al., 2004). Taking iron supplements with vitamin C-rich foods or beverages, such as citrus fruits or juice, can improve absorption. Conversely, calcium can inhibit iron absorption by competing for the same transport pathway (Hallberg et al., 1991). It is recommended to take iron supplements separately from calcium-rich foods or supplements to maximise absorption.

Gastrointestinal side effects, such as nausea, constipation, and abdominal discomfort, are common with iron supplements, particularly ferrous sulfate. A systematic review and meta-analysis found that ferrous sulfate supplementation increased the risk of gastrointestinal side effects by 2.32 times compared to placebo (95% CI 1.74 to 3.08) (Tolkien et al., 2015). Strategies to improve tolerability include taking supplements with food, using lower doses, or switching to a different form of iron, such as iron bisglycinate, which has been shown to have fewer gastrointestinal side effects (Milman et al., 2014).

Quality and Purity

Conclusion

Iron supplementation is a safe and effective strategy for preventing and treating iron deficiency in women when taken as directed. Women of reproductive age, especially those who are pregnant or have heavy menstrual periods, are at a higher risk of iron deficiency and can benefit greatly from supplementation. The benefits of iron supplements for women are well-established, including reducing the risk of anaemia, improving exercise performance, decreasing fatigue, and supporting healthy pregnancy outcomes.

Choosing a high-quality iron supplement that meets individual needs is crucial for optimal results. Women should consider factors such as the form of iron, elemental iron content, and potential for gastrointestinal side effects when selecting a supplement. Ferrous sulfate, ferrous gluconate, and ferrous fumarate are common forms of iron supplements, while newer formulations like iron bisglycinate may offer better absorption and fewer side effects. Following recommended dosages and instructions is essential for safety and effectiveness.

While iron supplements are generally safe when used appropriately, they can cause side effects such as constipation, nausea, and gastrointestinal discomfort in some individuals. These side effects can often be managed by taking supplements with food, using lower doses, or switching to a different form of iron. However, it is crucial to keep iron supplements out of reach of children to prevent accidental overdose. Women with pre-existing conditions such as hereditary hemochromatosis should consult their healthcare provider before starting iron supplementation. By understanding the importance of iron for women’s health and how to effectively incorporate supplements into a balanced diet and lifestyle, women can take proactive steps towards optimising their well-being and vitality at every stage of life.

Key Highlights and Actionable Tips

• Maltofer is an iron supplement used for the treatment and prevention of iron deficiency in adults and adolescents aged 12 years and over
• Maltofer contains 100mg of elemental iron per dose in the form of iron polymaltose, providing an adequate amount of iron to treat iron deficiency when taken as directed
• The absorption of iron from Maltofer takes place by a controlled mechanism, releasing iron gradually to reduce the likelihood of gastrointestinal side effects like constipation
• Always take Maltofer exactly as instructed by your medical practitioner or pharmacist
• For treatment of iron deficiency, take 1-2 tablets or 10-20mL of syrup (100-200mg iron) daily, preferably with food
• For prevention of iron deficiency in high-risk individuals, take 1 tablet or 10mL of syrup (100mg iron) daily, preferably with food
• Maltofer is suitable for vegans and vegetarians, and is lactose-free, gluten-free, dairy-free, soy-free, and yeast-free

How does Maltofer compare to other iron supplements in terms of absorption and side effects?

Maltofer contains iron in the form of iron polymaltose, which is absorbed through a controlled mechanism. This gradual release of iron reduces the likelihood of gastrointestinal side effects, such as constipation, compared to other iron supplements like ferrous sulfate. The unique absorption process of Maltofer allows for better tolerability while still providing an adequate amount of elemental iron to treat iron deficiency.

Can Maltofer be taken by individuals with dietary restrictions or allergies?

Yes, Maltofer is suitable for a wide range of individuals, including those with dietary restrictions or allergies. The supplement is vegan and vegetarian-friendly, as it contains no ingredients of animal origin. Additionally, Maltofer is free from lactose, gluten, dairy, soy, and yeast, making it a suitable choice for people with common food allergies or intolerances.

How much elemental iron is in each dose of Maltofer, and why is this important?

Each dose of Maltofer contains 100mg of elemental iron in the form of iron polymaltose. The amount of elemental iron is crucial when choosing an iron supplement, as it represents the actual amount of iron that is available for absorption by the body. Many other iron supplements contain lower amounts of elemental iron per dose, often less than 24mg, which may not be sufficient for treating iron deficiency. Maltofer’s higher elemental iron content ensures that users receive an adequate amount of iron to address their deficiency when taken as directed.

What are the signs and symptoms of iron deficiency, and who is at higher risk?

Iron deficiency can cause various signs and symptoms, including fatigue, weakness, pale skin, headaches, dizziness, cold hands and feet, and chest pain. Some individuals are at higher risk of developing iron deficiency, such as women of reproductive age, pregnant women, vegetarians and vegans, frequent blood donors, and people with certain gastrointestinal disorders like coeliac disease or inflammatory bowel disease. If you suspect you may have an iron deficiency, consult your healthcare provider for proper diagnosis and treatment.

How long does it typically take to see improvements in iron levels when taking Maltofer as directed?

The time it takes to see improvements in iron levels when taking Maltofer can vary depending on the severity of the deficiency and individual factors. However, most people begin to notice improvements in their symptoms within 1-2 weeks of starting treatment. To assess the effectiveness of the treatment, your healthcare provider may recommend a blood test to check your iron levels after 3-4 months of taking Maltofer as directed. It is important to continue taking the supplement as prescribed, even if you start feeling better, to ensure your iron levels are fully replenished.

References

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Camaschella C. (2015). Iron-deficiency anemia. The New England Journal of Medicine, 372(19), 1832–1843. https://doi.org/10.1056/NEJMra1401038

Institute of Medicine (2001). Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: The National Academies Press. https://doi.org/10.17226/10026

Low, M. S., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S. R. (2016). Daily iron supplementation for improving anaemia, iron status and health in menstruating women. The Cochrane Database of Systematic Reviews, 4(4), CD009747. https://doi.org/10.1002/14651858.CD009747.pub2

National Institutes of Health (2023). Iron: Fact Sheet for Health Professionals. Office of Dietary Supplements. Retrieved June 15, 2023 from https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/

Pasricha, S. R., Low, M., Thompson, J., Farrell, A., & De-Regil, L. M. (2014). Iron supplementation benefits physical performance in women of reproductive age: a systematic review and meta-analysis. The Journal of Nutrition, 144(6), 906–914. https://doi.org/10.3945/jn.113.189589

Peña-Rosas, J. P., De-Regil, L. M., Garcia-Casal, M. N., & Dowswell, T. (2015). Daily oral iron supplementation during pregnancy. The Cochrane Database of Systematic Reviews, 2015(7), CD004736. https://doi.org/10.1002/14651858.CD004736.pub5

Tolkien, Z., Stecher, L., Mander, A. P., Pereira, D. I., & Powell, J. J. (2015). Ferrous sulfate supplementation causes significant gastrointestinal side-effects in adults: a systematic review and meta-analysis. PloS One, 10(2), e0117383. https://doi.org/10.1371/journal.pone.0117383

World Health Organization (2023). Daily iron supplementation in adult women and adolescent girls. e-Library of Evidence for Nutrition Actions (eLENA). Retrieved June 15, 2023 from https://www.who.int/tools/elena/interventions/daily-iron-women