By Dr. Stephen G Chaney
It is well known that iron deficiency
anemia is fairly common in women of childbearing age. And one of the major symptoms of
iron deficiency anemia - the symptom that usually brings the women to the doctor's
office in the first place - is fatigue.
But what about women who have fatigue,
but don't have iron deficiency anemia? I came
across a recent article in the Canadian
Medical Association Journal (Vauchor et al, CMAJ, doi: 10.150/cmaj.110950, 2012) that
asked this very question.
A group of clinicians from Geneva
Switzerland and the French National College of General Practitioners did a clinical
study of women with unexplained fatigue. They enrolled 198 women from 44 primary care
physician's offices in France into this study.
All of the women in the study reported
severe fatigue,but their hemoglobin levels were normal and their ferritin levels - a
protein in the blood that binds hemoglobin - was borderline. The ferritin levels were just
below the 50 mcg/L cutoff range for iron deficiency.
Because their hemoglobin
levels were normal and their ferritin levels were not severely deficient these women were
not diagnosed with iron deficiency anemia. So their severe fatigue was considered
"unexplained".
The physicians divided the women into two
groups. One group received 80 mg of an iron
supplement (ferrous sulfate) and the
other group received a placebo. The study was a
randomized, double blind study. Basically
that means that neither the women nor the clinicians knew who was getting the iron
supplement and who was getting the placebo.
After 12 weeks the women were asked to
evaluate their level of fatigue again.
The women receiving the iron supplement
reported a 48% decrease in fatigue, whereas
the women receiving the placebo only
reported a 29% decrease in fatigue.
This was a highly significant difference. The
authors of the paper concluded that in cases of unexplained fatigue in women of
childbearing age iron deficiency should be considered even if there is no evidence of anemia.
The authors went on to point out that
this was an important consideration in the treatment of women with unexplained
fatigue. Specifically, the authors said: "Iron deficiency may be an under
recognized cause of fatigue in women of childbearing age.
If fatigue is not due to secondary
causes, the identification of iron deficiency as a potential cause may prevent inappropriate
attribution of symptoms to putative emotional causes or life stressors, thereby
reducing the unnecessary use of healthcare resources, including inappropriate pharmacological
treatments."
In plain English the authors are saying
that iron supplementation is an inexpensive, low risk intervention in women of
childbearing age, so it should be considered first in cases of severe fatigue – even if hemoglobin
levels are normal. That's because in today's medical system if symptoms like fatigue
persist, physicians will inevitably try to treat those symptoms with drugs which may not
be needed and are certain to have side effects.
To Your Health…..Dr. Stephen G Chaney
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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