It may be cost-effective to screen U.S. women of reproductive age for iron deficiency, a common condition that can lead to symptoms like brain fog, fatigue, and hair loss, according to a new study presented at the annual meeting of the American Society of Hematology.
“We currently do not screen women at all,” says Ariela Marshall, MD, a hematologist and associate professor of medicine at the University of Minnesota in Minneapolis, who wasn’t involved in the new study. “There is no recommended screening for iron deficiency for women, or for anyone, the way we recommend screening for cervical cancer or breast cancer.”
The study results are preliminary and haven’t been published in a medical journal, a process that typically involves an independent review of the analysis by outside experts.
However, previous research suggests that nearly 1 in 3 Americans have undiagnosed iron deficiency — and that women under 50 years old are up to 20 times more likely to have iron deficiency than men.
How Do You Know if You’re Iron Deficient?
Iron deficiency can be diagnosed with a simple blood test that checks levels of ferritin, a protein in the blood that is more abundant when the body has sufficient stores of iron. The new study compared the cost-effectiveness of not screening at all with screening and diagnosing iron deficiency at a higher ferritin level of 25 micrograms per liter (ug/L) or a lower ferritin level of 15 ug/L.
Researchers estimated the cost-effectiveness of all three options based on what’s known as quality-adjusted life years (QALY), which calculates how much screening and treatment might impact daily life as well as life expectancy. They also factored in the potential costs of treatment with oral iron pills, which are available over the counter, and intravenous iron supplementation, which is more expensive and requires treatment in an infusion center.
Over a lifetime, researchers didn’t find a meaningful difference in the cost-effectiveness of screening for iron deficiency versus not screening. This was true regardless of which ferritin level was used to diagnose iron deficiency — and regardless of whether patients got oral or intravenous iron supplements.
Women Who Are Iron Deficient May Be Going Undiagnosed
The lack of widespread iron-deficiency screening contributes to underdiagnosis, especially because it can be hard for patients to tell which specific symptoms might mean they need to get tested, says senior study author George Goshua, MD, a hematologist-oncologist and assistant professor at Yale Cancer Center and Yale School of Medicine in New Haven, Connecticut.
“The issue is that there are many symptoms and many of them can be seen outside of iron deficiency,” Dr. Goshua says. “These include, but are not limited to, restless legs, cravings for ice, cognitive fog, shortness of breath, and fatigue.”
Based on the prevalence of iron deficiency and the lack of widespread screening, it’s clear many women are going undiagnosed, says Leo Buckley, PharmD, MPH, a clinical pharmacy specialist at Brigham and Women’s Hospital in Boston, who wasn’t involved in the new study.
“The question then becomes what are the pros and cons of screening all women for iron deficiency,” Dr. Buckley says. The tests cost time and money, and there are side effects of treatment such as stomachaches with oral supplements and a risk of relatively rare infusion reactions like difficulty breathing and low blood pressure, Buckley says.
If You’re Having Symptoms, It Makes Sense to Get Tested
Even if the case for universal screening isn’t settled, it does still make sense for clinicians to screen symptomatic women for iron deficiency because supplements can ease their symptoms, says Sant-Rayn Pasricha, MBBS, PhD, acting director of the anemia lab at Walter and Eliza Hall Institute of Medical Research in Melbourne, Australia.
“Note 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,” says Dr. Pasricha, who wasn’t involved in the new study.
Tom Gavin joined Everyday Health as copy chief in 2022 after a lengthy stint as a freelance copy editor. He has a bachelor's degree in psychology from College of the Holy Cross.
Prior to working for Everyday Health, he wrote, edited, copyedited, and fact-checked for books, magazines, and digital content covering a range of topics, including women's health, lifestyle, recipes, restaurant reviews, travel, and more. His clients have included Frommer's, Time-Life, and Google, among others.
He lives in Brooklyn, New York, where he likes to spend his time making music, fixing too-old electronics, and having fun with his family and the dog who has taken up residence in their home.
Lisa Rapaport is a journalist with more than 20 years of experience on the health beat as a writer and editor. She holds a master’s degree from the UC Berkeley Graduate School of Journalism and spent a year as a Knight-Wallace journalism fellow at the University of Michigan. Her work has appeared in dozens of local and national media outlets, including Reuters, Bloomberg, WNYC, The Washington Post,Los Angeles Times, Scientific American, San Jose Mercury News, Oakland Tribune, Huffington Post, Yahoo! News, The Sacramento Bee, and The Buffalo News.
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Resources
Wang D et al. Sex, Lies, and Iron Deficiency in 2024: Cost-Effectiveness of Screening Ferritin Thresholds for the Treatment of Iron Deficiency in Women of Reproductive Age. American Society of Hematology. December 7, 2024.
