What are the recommendations for oral iron supplementation in a 45-year-old female (YOF) with iron deficiency in Canada?

Oral Iron Supplementation for a 45-Year-Old Female with Iron Deficiency in Canada

For a 45-year-old female with iron deficiency in Canada, the initial treatment should be with one tablet per day of ferrous sulfate, ferrous fumarate, or ferrous gluconate taken in the fasting state. 1

Initial Treatment Approach

• Start with a single daily dose of 50-100 mg of elemental iron (e.g., one ferrous sulfate 200 mg tablet containing 65 mg elemental iron) 1
• Take the iron supplement in the morning on an empty stomach to maximize absorption 2
• Monitor hemoglobin response after 4 weeks of treatment 1
• Continue iron supplementation for 3 months after normalization of hemoglobin to ensure adequate replenishment of iron stores 1, 3

Specific Iron Preparations Available

• Ferrous sulfate: 200 mg tablet contains 65 mg of elemental iron 4
• Ferrous fumarate: 210 mg tablet contains 69 mg of elemental iron 1
• Ferrous gluconate: 300 mg tablet contains 37 mg of elemental iron 5

Management of Side Effects

• If standard daily dosing is not tolerated, consider:

  • Reduced dose of one tablet every other day 1
  • Alternate-day dosing (may improve absorption and reduce side effects) 2
  • Morning dosing only (avoid afternoon/evening doses which may be less effective due to circadian hepcidin variations) 2
  • Adding ascorbic acid (vitamin C) to enhance iron absorption 1, 2

• For patients with significant intolerance to traditional iron salts:

  • Consider ferric maltol as an alternative oral preparation 1, 6
  • Parenteral iron should be considered when oral iron is contraindicated, ineffective, or not tolerated 1

Monitoring Response

• Check hemoglobin levels after 2-4 weeks of treatment 1
• An absence of hemoglobin rise of at least 10 g/L after 2 weeks of daily oral iron therapy is strongly predictive of subsequent treatment failure (sensitivity 90.1%, specificity 79.3%) 1
• After normalization of hemoglobin, continue monitoring blood counts periodically (every 6 months initially) to detect recurrent iron deficiency anemia 1

Special Considerations for Women of Reproductive Age

• Menstrual blood loss is a common cause of iron deficiency in premenopausal women 3
• For women with menometrorrhagia, addressing the underlying gynecological condition alongside iron supplementation is important 3
• In cases of severe anemia or when oral therapy fails, parenteral iron may be necessary 7

Common Pitfalls to Avoid

• Overdosing: Higher doses (e.g., 200 mg three times daily) are not more effective and may increase side effects 2, 7
• Poor timing: Taking iron with meals significantly reduces absorption but is often recommended to reduce side effects - this represents a trade-off between efficacy and tolerability 2
• Inadequate duration: Stopping treatment once hemoglobin normalizes without continuing for the additional 3 months needed to replenish iron stores 1
• Failure to investigate: Not investigating the underlying cause of iron deficiency in a 45-year-old woman, particularly if not clearly related to menstrual blood loss 1
• Missing non-response: Failing to recognize when oral iron therapy is not working and delaying switch to parenteral iron when appropriate 1