THE IMPACT OF IRON DEFICIENCY ON QUALITY OF LIFE, PHYSICAL PERFORMANCE, AND COGNITIVE FUNCTION AMONG WOMEN OF REPRODUCTIVE AGE: A REVIEW OF CURRENT LITERATURE
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6447Keywords:
Iron Deficiency, Women’s Health, Fatigue, Cognitive Impairment, Exercise PerformanceAbstract
Background: Iron deficiency is one of the most common nutritional deficiencies worldwide and represents a major public health concern, particularly among women of reproductive age. Although traditionally associated with anemia, increasing evidence indicates that iron deficiency may adversely affect health even in the absence of reduced hemoglobin concentrations.
Objective: This narrative review summarizes current evidence regarding the impact of iron deficiency on quality of life, physical performance, and cognitive function in women of reproductive age.
Methods: A literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Original studies, systematic reviews, and meta-analyses evaluating the clinical consequences of iron deficiency in women of reproductive age were included and qualitatively analyzed.
Results: Iron deficiency was consistently associated with reduced health-related quality of life, persistent fatigue, impaired psychological well-being, and poorer sleep quality. Evidence from systematic reviews and meta-analyses indicates that iron deficiency may impair physical performance by reducing aerobic capacity, exercise tolerance, and recovery after exertion, particularly among physically active women and athletes. Furthermore, inadequate iron availability may negatively affect cognitive function through its impact on neuronal metabolism and neurotransmitter synthesis, contributing to impaired attention, memory, and information processing. Importantly, many of these adverse effects may occur in women with iron deficiency without anemia. Iron supplementation has been shown to improve fatigue, selected cognitive outcomes, iron status, and physiological indicators of exercise capacity.
Conclusions: Iron deficiency should be recognized as a systemic condition affecting multiple dimensions of women's health beyond hematological parameters alone. Early diagnosis and appropriate management may improve quality of life, physical capacity, and cognitive functioning in women of reproductive age. Further research is required to establish standardized diagnostic criteria and optimal management strategies, particularly for iron deficiency without anemia.
References
Al Hinai, M., Jansen, E. C., Song, P. X., Peterson, K. E., & Baylin, A. (2024). Iron deficiency and vitamin D deficiency are associated with sleep in females of reproductive age: An analysis of NHANES 2005–2018 data. The Journal of Nutrition, 154(2), 648–657. https://doi.org/10.1016/j.tjnut.2023.11.030
Åsberg, A., Åsberg, A. E., & Skadberg, Ø. (2026). Divide or subtract: Transferrin saturation versus unbound iron binding capacity (UIBC). Scandinavian Journal of Clinical and Laboratory Investigation, 86(2), 136–140. https://doi.org/10.1080/00365513.2026.2632315
Auerbach, M., DeLoughery, T. G., & Tirnauer, J. S. (2025). Iron deficiency in adults: A review. JAMA, 333(20), 1813–1823. https://doi.org/10.1001/jama.2025.0452
Avery, H., Jackson, P., & Haskell-Ramsay, C. (2020). The effect of iron supplementation on cognition, subjective mood, well-being and fatigue in women of reproductive age: A systematic review. Proceedings of the Nutrition Society, 79(OCE2), E330. https://doi.org/10.1017/S0029665120002785
Beatrix, J., Piales, C., Berland, P., Marchiset, E., Gerbaud, L., & Ruivard, M. (2022). Non-anemic iron deficiency: Correlations between symptoms and iron status parameters. European Journal of Clinical Nutrition, 76(6), 835–840. https://doi.org/10.1038/s41430-021-01047-5
Burns, J. L., Miller, C. H., Fontaine-Bisson, B., & Connor, K. L. (2025). Iron deficiency and iron deficiency anaemia in women of reproductive age: Sex- and gender-based risk factors and inequities. Journal of Trace Elements in Medicine and Biology, 90, 127684. https://doi.org/10.1016/j.jtemb.2025.127684
Cappellini, M. D., Santini, V., Braxs, C., & Shander, A. (2022). Iron metabolism and iron deficiency anemia in women. Fertility and Sterility, 118(4), 607–614. https://doi.org/10.1016/j.fertnstert.2022.08.014
Fiani, D., Chahine, S., Zaboube, M., Solmi, M., Powers, J. M., & Calarge, C. (2025). Psychiatric and cognitive outcomes of iron supplementation in non-anemic children, adolescents, and menstruating adults: A meta-analysis and systematic review. Neuroscience & Biobehavioral Reviews, 178, 106372. https://doi.org/10.1016/j.neubiorev.2025.106372
Georgieff, M. K. (2020). Iron deficiency in pregnancy. American Journal of Obstetrics & Gynecology, 223(4), 516–524. https://doi.org/10.1016/j.ajog.2020.03.006
Greig, A. J., Patterson, A. J., Collins, C. E., & Chalmers, K. A. (2013). Iron deficiency, cognition, mental health and fatigue in women of childbearing age: A systematic review. Journal of Nutritional Science, 2, e14. https://doi.org/10.1017/jns.2013.7
Iolascon, A., Andolfo, I., Russo, R., Sanchez, M., Busti, F., Swinkels, D., Aguilar Martinez, P., Bou-Fakhredin, R., Muckenthaler, M. U., Unal, S., Porto, G., Ganz, T., Kattamis, A., De Franceschi, L., Cappellini, M. D., Munro, M. G., Taher, A., & from EHA-SWG Red Cell and Iron. (2024). Recommendations for diagnosis, treatment, and prevention of iron deficiency and iron deficiency anemia. HemaSphere, 8(7), e108. https://doi.org/10.1002/hem3.108
Kernan, K. F., & Carcillo, J. A. (2017). Hyperferritinemia and inflammation. International Immunology, 29(9), 401–409. https://doi.org/10.1093/intimm/dxx031
Kovalev, A. V., Викторович, К. А., Kovalev, A. V., Tishko, V. V., Владимирович, Т. В., Tishko, V. V., Polyakov, A. S., Сергеевич, П. А., Polyakov, A. S., Glavinskaya, A. M., Михайловна, Г. А., Glavinskaya, A. M., Egorova, E. N., Николаевна, Е. Е., Egorova, E. N., Bulankov, Y. I., Иванович, Б. Ю., & Bulankov, Y. I. (2024). Iron deficiency and daily physical activity in female military personnel. Bulletin of the Russian Military Medical Academy, 26(3), 411–420. https://doi.org/10.17816/brmma623700
Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022a). Iron deficiency anaemia: Pathophysiology, assessment, practical management. BMJ Open Gastroenterology, 9(1). https://doi.org/10.1136/bmjgast-2021-000759
Kumar, A., Sharma, E., Marley, A., Samaan, M. A., & Brookes, M. J. (2022b). Iron deficiency anaemia: Pathophysiology, assessment, practical management. BMJ Open Gastroenterology, 9(1). https://doi.org/10.1136/bmjgast-2021-000759
Kuwabara, A. M., Tenforde, A. S., Finnoff, J. T., & Fredericson, M. (2022). Iron deficiency in athletes: A narrative review. PM & R: The Journal of Injury, Function, and Rehabilitation, 14(5), 620–642. https://doi.org/10.1002/pmrj.12779
Munro, M. G., Mast, A. E., Powers, J. M., Kouides, P. A., O’Brien, S. H., Richards, T., Lavin, M., & Levy, B. S. (2023). The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. American Journal of Obstetrics & Gynecology, 229(1), 1–9. https://doi.org/10.1016/j.ajog.2023.01.017
Musallam, K. M., & Taher, A. T. (2018). Iron deficiency beyond erythropoiesis: Should we be concerned? Current Medical Research and Opinion, 34(1), 81–93. https://doi.org/10.1080/03007995.2017.1394833
Nakamoto, F. P., de Almeida, K. M., Gonçalves, L. C., & dos Santos Quaresma, M. V. L. (2026). Effect of iron supplementation on exercise performance of women with non-anemic iron deficiency or iron deficiency anemia—A systematic review and meta-analysis. Journal of Trace Elements and Minerals, 15, 100275. https://doi.org/10.1016/j.jtemin.2025.100275
Peinado, A. B., Alfaro-Magallanes, V. M., Romero-Parra, N., Barba-Moreno, L., Rael, B., Maestre-Cascales, C., Rojo-Tirado, M. A., Castro, E. A., Benito, P. J., Ortega-Santos, C. P., Santiago, E., Butragueño, J., García-de-Alcaraz, A., Rojo, J. J., Calderón, F. J., García-Bataller, A., & Cupeiro, R. (2021). Methodological approach of the iron and muscular damage: Female metabolism and menstrual cycle during exercise project (IronFEMME study). International Journal of Environmental Research and Public Health, 18(2), 735. https://doi.org/10.3390/ijerph18020735
Pengelly, M., Pumpa, K., Pyne, D. B., & Etxebarria, N. (2024). Iron deficiency, supplementation, and sports performance in female athletes: A systematic review. Journal of Sport and Health Science, 14, 101009. https://doi.org/10.1016/j.jshs.2024.101009
Piskin, E., Cianciosi, D., Gulec, S., Tomas, M., & Capanoglu, E. (2022). Iron absorption: Factors, limitations, and improvement methods. ACS Omega, 7(24), 20441–20456. https://doi.org/10.1021/acsomega.2c01833
Rizo-Téllez, S. A., Sekheri, M., & Filep, J. G. (2023). C-reactive protein: A target for therapy to reduce inflammation. Frontiers in Immunology, 14. https://doi.org/10.3389/fimmu.2023.1237729
Ru, Q., Li, Y., Chen, L., Wu, Y., Min, J., & Wang, F. (2024). Iron homeostasis and ferroptosis in human diseases: Mechanisms and therapeutic prospects. Signal Transduction and Targeted Therapy, 9(1), 271. https://doi.org/10.1038/s41392-024-01969-z
Rusch, J. A., van der Westhuizen, D. J., Gill, R. S., & Louw, V. J. (2023). Diagnosing iron deficiency: Controversies and novel metrics. Best Practice & Research Clinical Anaesthesiology, 37(4), 451–467. https://doi.org/10.1016/j.bpa.2023.11.001
Schaefer, B., Meindl, E., Wagner, S., Tilg, H., & Zoller, H. (2020). Intravenous iron supplementation therapy. Molecular Aspects of Medicine, Iron in Health and Diseases, 75, 100862. https://doi.org/10.1016/j.mam.2020.100862
Sevgi, M., & Mehta, R. P. (2023). Symptomatic iron deficiency without anemia: An underrecognized phenomenon. Blood, 142(Supplement 1), 1092. https://doi.org/10.1182/blood-2023-173737
Sheema, U. K., & Rawekar, A. (2022). P300, a tool for cognitive assessment in women with iron deficiency anemia: A systematic review. Journal of Family Medicine and Primary Care, 11(6), 2320–2326. https://doi.org/10.4103/jfmpc.jfmpc_1151_21
Siebenthal, H. K. von, Gessler, S., Vallelian, F., Steinwendner, J., Kuenzi, U.-M., Moretti, D., Zimmermann, M. B., & Stoffel, N. U. (2023). Alternate day versus consecutive day oral iron supplementation in iron-depleted women: A randomized double-blind placebo-controlled study. eClinicalMedicine, 65. https://doi.org/10.1016/j.eclinm.2023.102286
Skolmowska, D., Głąbska, D., Kołota, A., & Guzek, D. (2022). Effectiveness of dietary interventions to treat iron-deficiency anemia in women: A systematic review of randomized controlled trials. Nutrients, 14(13), 2724. https://doi.org/10.3390/nu14132724
Vinge, F., Stubbendorff, A., Bolmsjö, B. B., Jakobsson, U., Milos Nymberg, V., & Wolff, M. (2026). Screening for iron deficiency in young women: The predictive validity of a five-item screening instrument (IRON-5). Scandinavian Journal of Primary Health Care, 44(1), 2649329. https://doi.org/10.1080/02813432.2026.2649329
Wiafe, M. A., Ayenu, J., & Eli-Cophie, D. (2023). A review of the risk factors for iron deficiency anaemia among adolescents in developing countries. Anemia, 2023(1), 6406286. https://doi.org/10.1155/2023/6406286
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dominika Lewandowska, Katarzyna Otrębska, Aleksandra Szredzka, Magdalena Bukowska, Anna Jastrzębska

This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.

