Menopause, shall you be worried about iron deficiency?

July 27, 2020

What is menopause?

Women’s lives go through different phases based on the status of female sex hormones. Menarche, reproductive life, the menopausal transition and postmenopausal years. All of these periods have their role on women’s health status. In this article we are going to talk about menopause and its effect on iron deficiency.

Menopause is a natural ageing process during which a woman passes from the reproductive to the non-reproductive years. The most observable physiological change during menopause is the cessation of menstrual periods.

What causes menopause?

According to the NHS, menopause happens when your ovaries stop producing as much of the hormone oestrogen and no longer release an egg each month. Hence, period cycles will not happen.

There is a phase before menopause which is called perimenopause. During perimenopause, fewer eggs exist for the ovaries to stimulate. As a result menstrual periods become irregular. This period of fluctuation can last up to 10 years.

Signs and symptoms of menopause:

Although menopause is a natural process but many women still experience menopausal disturbing symptoms. This contains:

  • Hot flushes
  • Night sweats
  • Vaginal dryness and discomfort during sex
  • Difficulty sleeping
  • Low mood or anxiety
  • Reduced sex drive (libido)
  • Problems with memory and concentration

Due to lack of oestrogen loss of bone density will occur which is a common sign. The latter leads into osteoporosis, causing broken bones. Broken wrist, broken hip, broken spinal bones are among the most common sites of these fractures.

How to relief these symptoms?

Menopause is not pathologic. So it does not need any treatment. However, in some women menopause is disturbing or causes health issues. But there are treatments to reach for.

The main treatment is “hormone replacement therapy” or HRT. In this way of treatment oestrogen hormones are replaced to cover the declined levels of the body’s oestrogen. As a result the annoying signs and symptoms of menopause will relief.

Iron loss and menstrual status:

During childbearing years, because of menstrual cycles, women’s body goes through a chronic blood loss. Therefore, iron deficiency and iron deficiency anaemia are always a threat.

After menopause or during menopausal transition, due to lower or no blood loss, this risk factor will not be as threatening. This is why women are at a lower risk for becoming iron deficient. Because iron is no longer lost through menstruation, it accumulates in the body.

Both iron deficiency and iron overload could cause adverse health effects. Speaking of which, ischemic heart disease, diabetes, infections and cancers are some of these effects. It has been demonstrated that low iron levels in young women is a risk factor for breast cancer recurrence, whereas iron overload in postmenopausal women leads to high breast cancer incidence.

In another study called “NHANES III”, it was found that prevalence of hot flashes are parallel with the amounts of our body iron stores in the form of ferritin. The higher the ferritin levels, the higher the prevalence of hot flashes.

HRT and iron stores

There is a hypothesis which says during HRT due to the reproductive hormone replacement, women’s iron status will be different from those who do not use HRT.

Surprisingly, iron which is stored in our cells is significantly lower in menopausal women who currently use HRT. But why is that?

There is no exact answer to this question. But there are some hypothesis. The first one is that as HRT may lead to bleeding as menstrual periods then the iron levels will be lowered. One of the other hypothesis s that oestrogen controls “hepcidin”. Hepcidin is a component which controls iron absorption. The higher the hepcidin levels the lower the iron absorption. Recently, several non-human models have suggested that oestrogen directly modifies the action of hepcidin. Therefore, oestrogen therapy will increase the hepcidin levels, thus, lower iron absorption and ferritin status.

In conclusion, if you have outweighed the cons and pros of going through HRT, and decided to use it, then you should use iron supplements to prevent iron deficiency. Always start HRT under your doctor’s monitoring and ask him if you can use an iron supplement. Keep in mind that Irofix due to its microencasuolation technology, will not interact with hepcidin levels and you are safe with iron, HRT and hepcidin all at once.

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