Iron Deficiency Anemia in Young Women

Primary Causes and Risk Factors

Menstrual blood loss, particularly menorrhagia, is a leading cause of iron deficiency anemia in premenopausal women, affecting 5-10% of this population 1, 2
Pregnancy and breastfeeding increase iron demands and are major contributors to iron deficiency anemia in young women 1, 3
Poor dietary iron intake is a significant factor, especially in women of lower socioeconomic status who have decreased access to iron-rich foods 3
Celiac disease, found in 3-5% of all iron deficiency anemia cases, causes malabsorption and must be screened for 3, 4

Serum ferritin is the most specific test for iron deficiency, with levels <15 μg/L confirming iron deficiency and <30 μg/L indicating low stores 4
Celiac serology, such as tissue transglutaminase antibody, should be performed in all premenopausal women with iron deficiency anemia 3, 4, 6
Urinalysis or urine microscopy should be performed to exclude urinary tract bleeding 4

The American Gastroenterological Association recommends screening for celiac disease with antiendomysial antibody in young women with iron deficiency anemia under age 45 without upper GI symptoms 1
The European Society for Gastrointestinal Endoscopy recommends endoscopy and small bowel biopsy in women with upper GI symptoms 1
Failure to respond to iron therapy indicates poor compliance, misdiagnosis, continued blood loss, or malabsorption, and should be investigated further 1, 2, 7