Iron deficiency: who is particularly affected

Iron deficiency is not equally likely for everyone. Certain phases of life and lifestyles increase requirements or losses. This page goes through the groups with elevated risk — and explains what this means for a sensible investigation.

Menstruation

Women of childbearing age

With each period, the body loses iron. Over the years this adds up — women of childbearing age are therefore the largest group affected by iron deficiency. Heavy or prolonged menstrual bleeding in particular is one of the most common causes overall.

Even bleeding perceived as normal can tip the balance when iron intake through diet is marginal. Persistent heavy menstrual bleeding is itself a reason to have it medically clarified.

Pregnancy and breastfeeding

Increased requirement for two

During pregnancy, iron requirement rises significantly — for the growing child, the placenta and the mother’s larger blood volume. Iron deficiency is common in pregnancy.

For this reason, checking iron status is part of prenatal care; a higher reference value is usually applied — a ferritin below approximately 30 µg/l is already considered to warrant treatment in pregnancy. Whether and how iron is supplemented is a medically guided decision and should not be undertaken on one’s own.

Endurance sports

Athletes

Those who practise endurance sport intensively have an elevated risk of iron deficiency — women more so than men. Several factors combine: small losses via sweat and the gut, the mechanical strain on red blood cells, and a temporary rise in the regulatory hormone hepcidin after intense exertion, which briefly dampens iron absorption.

Iron deficiency can impair performance and recovery before anaemia develops. In sports medicine, the ferritin value is therefore often assessed with a higher target range in view — a good example that “too low” also depends on life circumstances.

Plant-based nutrition

Vegetarian and vegan nutrition

Iron from plant sources is absorbed less efficiently than iron from animal foods, and some components of plant-based diets reduce absorption further. A vegetarian or vegan diet does not therefore automatically mean deficiency — but it does increase the risk and requires some attention to intake and food combinations.

How iron absorption from plant-based food can be improved is covered on the page about iron-rich nutrition.

When no clear cause is apparent

Iron deficiency without an obvious cause

Iron deficiency always has a cause. If no obvious one can be found — particularly in men and in women after the menopause — the source should be clarified. Iron deficiency can be the first sign of a slow, unnoticed bleeding often from the gastrointestinal tract.

Approach at the practice

What this means for investigation

Belonging to a risk group is a good reason to determine iron status — but not a diagnosis. In the practice we interpret the individual situation, determine a complete status and look into the cause. What these values look like and what they mean is explained on the page about diagnostics; an overview of the entire topic is given on the page iron deficiency.

Frequently asked questions

Questions about risk groups

I eat vegetarian — do I automatically have iron deficiency?

No. A vegetarian or vegan diet increases the risk but does not automatically mean deficiency. It is sensiblet, den Eisenstatus zu bestimmen und auf eine gute Zufuhr zu achten.

Should I take iron during pregnancy?

Iron status is regularly checked during pregnancy. Whether and how iron is supplemented is a medically guided decision — taking it on one’s own is not advisable.

I do a lot of sport and am often tired — could that be the iron?

This is possible. Endurance athletes have an elevated risk, and performance and recovery can decline before anaemia develops. Determining iron values provides clarity.

Why should iron deficiency without a clear cause be investigated further?

Because every iron deficiency has a cause. If no obvious one is present, a slow, unnoticed bleeding — for example from the gastrointestinal tract — should be ruled out.

Medically endorsed by Dr. med. Thomas Ackermann, specialist in anaesthesiology — Private practice Harmony of Aesthetics, Herzogenaurach. This article describes risk groups in general terms and does not replace individual medical consultation.