Date of Award

Spring 2026

Document Type

Scholarly Project

Degree Name

Master of Physician Assistant Studies (MPAS)

Department

Physician Assistant Studies

First Advisor

Kristen Carr

Second Advisor

Julie Solberg

Keywords

iron supplementation, ferritin, non-anemic, without anemia, iron deficiency, women, premenopausal, menstruating

Abstract

Nonanemic iron deficiency is a common finding amongst premenopausal women. Despite symptoms like fatigue occurring prior to and independent of hemoglobin changes, iron deficiency is often untreated until it results in overt anemia. While there are generally accepted standards for treatment of iron deficiency in anemia, the medical community has yet to establish evidence-based screening and treatment protocols for symptomatic, premenopausal women experiencing nonanemic iron deficiency. Additionally, traditional oral iron treatments are notorious for causing gastrointestinal distress. The purpose of this literature review is to evaluate the efficacy of oral and intravenous iron in reducing fatigue amongst premenopausal women with nonanemic iron deficiency. A literature review was performed using electronic databases PubMed and Embase, yielding 46 studies. Ultimately, seven articles met inclusion criteria and were evaluated, including one pilot study. Current literature suggests oral and IV iron are both safe and effective for nonanemic, iron deficient women with fatigue. While IV administration consistently results in more rapid iron repletion, symptom improvement was similar between the groups. There are also promising preliminary results for low-dose oral iron supplementation, including reduced side effects and better compliance. Future studies could explore dietary controls, personalized iron dosing, and implementation of objective fatigue measurements. Practitioners should maintain a low threshold for checking ferritin in premenopausal women with fatigue.

Comments

Note: this is a corrected draft of the student work, not the final version

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