Low Ferritin Levels Can Affect Premenstrual Syndrome (PMS)
Low ferritin levels may worsen premenstrual syndrome symptoms, and iron supplementation should be considered for women with PMS who have ferritin levels below 50 μg/L.
Iron Deficiency and PMS: The Connection
- Iron deficiency, as indicated by low serum ferritin, is common in menstruating women, with studies showing that approximately 17.7% of premenopausal women have depleted iron stores (ferritin <15 μg/L) and 23.1% have small iron stores (ferritin 15-30 μg/L) 1
- Low ferritin levels can contribute to fatigue and mood disturbances, which are common symptoms of PMS 2
- Short-term food restrictions, which are sometimes observed in women attempting weight loss, can decrease iron concentrations in serum and hair, as well as ferritin levels, potentially worsening negative feelings and depression symptoms 3
Diagnostic Considerations
- Absolute iron deficiency is defined as serum ferritin <30 ng/mL in individuals without inflammation 4
- Ferritin <15 μg/L confirms absolute iron deficiency with 98% specificity 4
- In patients with inflammation, ferritin levels between 30-100 ng/mL may still indicate iron deficiency 4
- A comprehensive iron panel including transferrin saturation (<16% suggests inadequate iron availability) provides better diagnostic accuracy 4
Treatment Recommendations
- Iron supplementation should be considered for women with unexplained PMS symptoms who have ferritin levels below 50 μg/L 2
- Low-dose iron supplements (18-20 mg iron/day) can improve iron status in iron-depleted non-anemic women and may be better tolerated than high-dose therapy 5
- Oral ferrous sulfate (80 mg of elemental iron daily) has been shown to significantly reduce fatigue in non-anemic women with low ferritin (<50 μg/L) compared to placebo 2
- Vitamin C should be co-ingested with non-heme iron sources to enhance absorption, and foods or fluids that impair iron absorption (such as tea and coffee) should be avoided around meal times 6
Monitoring Response to Treatment
- Assess efficiency of iron supplementation using blood markers after six weeks of treatment 2
- Regular monitoring of serum ferritin levels is recommended to ensure adequate iron stores 6
- For female athletes or women with heavy menstrual bleeding, more frequent assessment of iron status may be necessary (twice per year) 6
Special Considerations
- Inflammation can elevate ferritin levels, potentially masking iron deficiency 4
- Oral contraceptives can have a marked influence on iron stores; premenopausal women taking oral contraceptives tend to have higher ferritin levels and a lower frequency of depleted iron reserves 1
- Anti-inflammatory supplements like curcumin may help reduce inflammation markers (hsCRP) in women with PMS without negatively affecting iron homeostasis 7
Pitfalls and Caveats
- Iron deficiency may be overlooked in women with PMS if only hemoglobin is measured without assessing ferritin levels 4, 2
- Gastrointestinal side effects of iron supplementation can include constipation and nausea, which may affect compliance 6
- Women with chronic inflammatory conditions may have functional iron deficiency despite normal ferritin levels, requiring additional testing 4
- Excessive iron supplementation should be avoided as it can lead to iron overload in susceptible individuals 6