Does ferritin (iron storage protein) level decrease during menstruation?

Ferritin Levels During Menstruation

Yes, ferritin levels typically decrease during menstruation due to blood loss, which contributes to iron depletion in women of reproductive age. 1, 2

Mechanism of Ferritin Reduction During Menstruation

• Menstrual blood loss represents a significant source of iron loss in women of reproductive age, with average menstrual blood loss being approximately 59.3 g per cycle (range 24-110 g) 2
• This blood loss directly impacts iron stores, as reflected by a negative correlation between menstrual blood loss volume and serum ferritin levels 2, 3
• Ferritin serves as the primary storage form of iron in the body, accounting for approximately 70-80% of iron stores in healthy individuals 1
• When menstrual blood loss occurs, the body mobilizes iron from storage (ferritin) to support ongoing erythropoiesis, resulting in decreased ferritin levels 1

Quantifiable Impact on Ferritin Levels

• Recent research has demonstrated that menstrual blood loss accounts for approximately 8% of the explained variance in ferritin levels in premenopausal women, second only to time since last blood donation 3
• Studies show that women with heavy menstrual bleeding (≥80 mL/month) have significantly lower ferritin levels, affecting approximately 10% of women of childbearing age 1
• Among female university students, 22.58% were found to be in the iron reduction phase (serum ferritin <12 ng/mL) primarily due to menstrual blood loss 2

Clinical Implications

• Iron requirements for female adolescents and women are higher (0.35 mg/kg) than for males (0.2 mg/kg) specifically to compensate for menstrual blood loss 1
• Only about one-fourth of adolescent girls and women of childbearing age meet the recommended dietary allowance for iron through diet alone 1
• Without adequate dietary intake or supplementation, ferritin levels continue to decrease with each menstrual cycle, potentially leading to iron deficiency anemia 4
• In women with heavy menstrual bleeding, treatment with tranexamic acid has been shown to significantly increase both hemoglobin and ferritin levels over time 5

Physiological Adaptations

• During adolescence, hepcidin levels (the primary regulator of iron absorption) decrease in response to estrogen and testosterone production, representing a regulatory mechanism to adapt to increased iron demands from both growth and menstrual blood loss 1
• This physiological adaptation helps increase iron absorption but may not be sufficient to prevent iron depletion in women with heavy menstrual periods 1
• Use of hormonal contraceptives, particularly levonorgestrel-releasing intrauterine devices, is associated with decreased risk for iron deficiency by reducing menstrual blood loss 1, 3

Monitoring and Management

• Ferritin is the most sensitive indicator for iron nutritional status and should be monitored regularly in women with heavy menstrual bleeding 2
• Iron supplementation for one month can significantly increase ferritin levels in menstruating women, but levels may fall again after supplementation is discontinued 4
• Dietary factors influencing ferritin levels in menstruating women include meat intake (positive effect) and coffee consumption (negative effect) 6
• For female athletes, monitoring of iron status is recommended twice yearly (compared to once yearly for males) due to the additional iron loss through menstruation 1