This document summarizes a review article on iron deficiency in women aged 40-55 years. It discusses how this age period is associated with risks of iron deficiency anemia due to changes in hormone levels, menstrual patterns, and lifestyles. Common symptoms of iron deficiency like fatigue can be misinterpreted as other conditions. Risk factors identified include low iron intake from dieting, vegetarian diets, heavy menstrual bleeding, and gastrointestinal bleeding. The review emphasizes the importance of physicians recognizing iron deficiency in this age group in order to properly diagnose and treat it, thereby improving patients' quality of life.
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A Study of the Prevalence of Cardio-Vascular Diseases and Its Risk Factors (B...inventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
A Descriptive Study to Assess the Knowledge and Attitude Regarding Self Admin...ijtsrd
Diabetes mellitus is characterized by abnormally high levels of sugar glucose in the blood. When the amount of glucose in the blood increases, e.g., after a meal, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates muscle and fat cells to remove glucose from the blood and stimulates the liver to metabolize glucose, causing the blood sugar level to decrease to normal levels. In people with diabetes, blood sugar levels remain high. This may be because insulin is not being produced at all, is not made at sufficient levels, or is not as effective as it should be. The most common forms of diabetes are type 1 diabetes 5 , which is an autoimmune disorder, and type 2 diabetes 95 , which is associated with obesity. Gestational diabetes is a form of diabetes that occurs in pregnancy, and other forms of diabetes are very rare and are caused by a single gene mutation. For many years, scientists have been searching for clues in our genetic makeup that may explain why some people are more likely to get diabetes than others are. The Genetic Landscape of Diabetes introduces some of the genes that have been suggested to play a role in the development of diabetes. Archana | G. Ramalakshmi "A Descriptive Study to Assess the Knowledge and Attitude Regarding Self Administration of Insulin Injection among Diabetes Mellitus Patients in Rural Area at Dehradun" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd35843.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/35843/a-descriptive-study-to-assess-the-knowledge-and-attitude-regarding-self-administration-of-insulin-injection-among-diabetes-mellitus-patients-in-rural-area-at-dehradun/archana
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
Diabetes, commonly referred as diabetes mellitus, in general describes a group of metabolic diseases that are caused by insulin deficiency. In which the person has high blood glucose level (blood sugar), either due to the insufficient production of insulin, or due to the body’s cells does not respond to insulin, or both. As long as the cells cannot take up the available glucose molecules from the blood of patients due to the lack of insulin hormone, it develops the sense of hunger (polyphagia). Kidneys act as a filter and normally reabsorb the blood glucose before it gets excreted in the urine, but when glucose level is high, kidnies cannot reabsorb all of the sugar, hence the excess sugar is dumped into the urine (polyurea). The increased urine production and consequential dehydration leads to the extreme thirst (polydipsia). India being the capital for diabetic world, visible increase of Type 2 diabetes is coupled with increasing age and that imposes a significant burden on the health care system. Hence, this work was therefore designed to assess the gender and age prevalence of type 2 diabetes mellitus (T2DM) patients attending Government Stanley Hospital, Chennai
A Study to Assess the Effectiveness of Structured Teaching Programme on Knowl...ijtsrd
Statement of problem “A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention and Prevalence of Anemia among Adolescent Girls in A Selected areas.â€Material and Methods In the present study one group pre test and post test experimental descriptive research design is used to collect the sample from selected areas of Mohali of 100 adolescent girls. The sample is collected through purposive sampling technique. The data is collected by socio demographic questionnaire and self instructional module.Result Majority 58 58 of the adolescent girls had inadequate knowledge, 40 40 had moderate knowledge and 02 2 had adequate knowledge in pre test before administering structured teaching program. After getting structured teaching program, 15 15 of adolescent girls had moderate knowledge and 85 85 of adolescent girls had reported adequate knowledge. It is significantly shows that there is association between knowledge levels of adolescent girls regarding prevention and prevalence of anemia and demographic variables.Conclusion It was concluded that there is gain in knowledge after teaching program and there is significant association between level of knowledge and demographic variables. Ms. Deepti | Dr. Priyanka Chaudhary | Ms. Ramanpreet Kaur | Ms. P. Chitra "A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention and Prevalence of Anemia among Adolescent Girls in Selected Areas" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd49097.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/49097/a-study-to-assess-the-effectiveness-of-structured-teaching-programme-on-knowledge-regarding-prevention-and-prevalence-of-anemia-among-adolescent-girls-in-selected-areas/ms-deepti
Iron Status Audit Among Women of Reproductive Age Attending a Tertiary Hospital in South- East Region of Nigeria: A Frontier for Achieving Millennium Development Goals
A Descriptive Study to Assess the Knowledge and Attitude Regarding Self Admin...ijtsrd
Diabetes mellitus is characterized by abnormally high levels of sugar glucose in the blood. When the amount of glucose in the blood increases, e.g., after a meal, it triggers the release of the hormone insulin from the pancreas. Insulin stimulates muscle and fat cells to remove glucose from the blood and stimulates the liver to metabolize glucose, causing the blood sugar level to decrease to normal levels. In people with diabetes, blood sugar levels remain high. This may be because insulin is not being produced at all, is not made at sufficient levels, or is not as effective as it should be. The most common forms of diabetes are type 1 diabetes 5 , which is an autoimmune disorder, and type 2 diabetes 95 , which is associated with obesity. Gestational diabetes is a form of diabetes that occurs in pregnancy, and other forms of diabetes are very rare and are caused by a single gene mutation. For many years, scientists have been searching for clues in our genetic makeup that may explain why some people are more likely to get diabetes than others are. The Genetic Landscape of Diabetes introduces some of the genes that have been suggested to play a role in the development of diabetes. Archana | G. Ramalakshmi "A Descriptive Study to Assess the Knowledge and Attitude Regarding Self Administration of Insulin Injection among Diabetes Mellitus Patients in Rural Area at Dehradun" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-1 , December 2020, URL: https://www.ijtsrd.com/papers/ijtsrd35843.pdf Paper URL : https://www.ijtsrd.com/medicine/nursing/35843/a-descriptive-study-to-assess-the-knowledge-and-attitude-regarding-self-administration-of-insulin-injection-among-diabetes-mellitus-patients-in-rural-area-at-dehradun/archana
There has been an increase in the predominance of diabetes mellitus over the past 40 years worldwide. The worldwide occurrence of diabetes in 2000 was approximately 2.8% and is estimated to grow to 4.4% by 2030. This data interprets a projected rise of diabetes from 171 million in 2000 to well over 350 million in 2030. The presence of hypertension in diabetic patients substantially increases the risks of coronary heart disease, stroke, nephropathy and retinopathy. Indeed, when hypertension coexists with diabetes, the risk of CVD is increased by 75%, which further contributes to the overall morbidity and mortality of an already high risk population. Patients with type 2 diabetes mellitus have a considerably higher risk of cardiovascular morbidity and mortality, and are disproportionately affected by cardiovascular disease. Most of this excess risk is associated with high prevalence of well-established risk factors such as hypertension, dyslipidaemia and obesity in these patients. Hypertension plays a major role in the development and progression of microvascular and macrovascular disease in people with diabetes. Lifestyle Modifications and pharmacotherapy are the choice for the Management of Hypertension in Patients with Diabetes.
Diabetes, commonly referred as diabetes mellitus, in general describes a group of metabolic diseases that are caused by insulin deficiency. In which the person has high blood glucose level (blood sugar), either due to the insufficient production of insulin, or due to the body’s cells does not respond to insulin, or both. As long as the cells cannot take up the available glucose molecules from the blood of patients due to the lack of insulin hormone, it develops the sense of hunger (polyphagia). Kidneys act as a filter and normally reabsorb the blood glucose before it gets excreted in the urine, but when glucose level is high, kidnies cannot reabsorb all of the sugar, hence the excess sugar is dumped into the urine (polyurea). The increased urine production and consequential dehydration leads to the extreme thirst (polydipsia). India being the capital for diabetic world, visible increase of Type 2 diabetes is coupled with increasing age and that imposes a significant burden on the health care system. Hence, this work was therefore designed to assess the gender and age prevalence of type 2 diabetes mellitus (T2DM) patients attending Government Stanley Hospital, Chennai
A Study to Assess the Effectiveness of Structured Teaching Programme on Knowl...ijtsrd
Statement of problem “A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention and Prevalence of Anemia among Adolescent Girls in A Selected areas.â€Material and Methods In the present study one group pre test and post test experimental descriptive research design is used to collect the sample from selected areas of Mohali of 100 adolescent girls. The sample is collected through purposive sampling technique. The data is collected by socio demographic questionnaire and self instructional module.Result Majority 58 58 of the adolescent girls had inadequate knowledge, 40 40 had moderate knowledge and 02 2 had adequate knowledge in pre test before administering structured teaching program. After getting structured teaching program, 15 15 of adolescent girls had moderate knowledge and 85 85 of adolescent girls had reported adequate knowledge. It is significantly shows that there is association between knowledge levels of adolescent girls regarding prevention and prevalence of anemia and demographic variables.Conclusion It was concluded that there is gain in knowledge after teaching program and there is significant association between level of knowledge and demographic variables. Ms. Deepti | Dr. Priyanka Chaudhary | Ms. Ramanpreet Kaur | Ms. P. Chitra "A Study to Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention and Prevalence of Anemia among Adolescent Girls in Selected Areas" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-1 , December 2021, URL: https://www.ijtsrd.com/papers/ijtsrd49097.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/49097/a-study-to-assess-the-effectiveness-of-structured-teaching-programme-on-knowledge-regarding-prevention-and-prevalence-of-anemia-among-adolescent-girls-in-selected-areas/ms-deepti
Iron Status Audit Among Women of Reproductive Age Attending a Tertiary Hospital in South- East Region of Nigeria: A Frontier for Achieving Millennium Development Goals
Prediction of the Syndrome Premature Ovarian Insufficiencyijtsrd
Premature ovarian failure syndrome is a symptom complex characterized by hypergonodotropic amenorrhea in women under 40. Known causes include 1. Genetic aberrations that can affect the X chromosome or autosomes. 2. Autoimmune damage to the ovaries, as evidenced by the observed association of POF with other autoimmune disorders. 3. Iatrogenic after surgery, radiotherapy or chemotherapy, as in malignant neoplasms. 4. Environmental factors such as viral infections and toxins, the mechanism of action of which is not known. Tangirova Yulduz Alimovna | Yusupov Shokhruh "Prediction of the Syndrome Premature Ovarian Insufficiency" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-6 | Issue-3 , April 2022, URL: https://www.ijtsrd.com/papers/ijtsrd49766.pdf Paper URL: https://www.ijtsrd.com/biological-science/other/49766/prediction-of-the-syndrome-premature-ovarian-insufficiency/tangirova-yulduz-alimovna
A Comparative Study of Anthropometric Characteristics and Blood Pressure betw...ijtsrd
Background Hypertension is a frequently encountered multifactorial disorder and its prevalence is reported to increase in postmenopausal females. Cardiovascular disease is the leading cause of death in women. Furthermore, there is evidence that hormonal changes also leads to anthropometric changes associated with hypertension.Aim - To compare the anthropometric measures and blood pressure of pre and post menopausal women and find the association between anthropometric measures and hypertension.Methodology - A comparative study was conducted on 50 pre and 50 post menopausal women. The sampling method was purposive sampling and conducted in Goyala Vihar of Delhi. The door to door survey was conducted and data was collected using kobo tool. The measurements of BP, weight, height, hip and waist circumference was done following the protocols. The data was analysed using SPSS software.Result and conclusion - The result was significant for all variables Age, Wt, BMI, HC, WC, WHR and BAI except Ht. Independent T test was used to compare. Correlation and regression depicted that age is the predictor for diastolic blood pressure in pre menopausal women and for post menopausal women age, Ht, Wt, BMI, WC and HC are predictor of diastolic blood pressure. Women in post menopausal stage were at high risk of HTN compared to pre menopausal women. Jyoti Yadav "A Comparative Study of Anthropometric Characteristics and Blood Pressure between Pre and Post - Menopausal Women in Poor Urban Area, Goyala Vihar, Delhi" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-4, August 2023, URL: https://www.ijtsrd.com/papers/ijtsrd59641.pdf Paper Url:https://www.ijtsrd.com/other-scientific-research-area/other/59641/a-comparative-study-of-anthropometric-characteristics-and-blood-pressure-between-pre-and-post---menopausal-women-in-poor-urban-area-goyala-vihar-delhi/jyoti-yadav
Introduction: The objective of this work is to study the epidemiological and clinical aspects of erectile dysfunction in a population of diabetic patients in the Thies region.
RunningHead: PICOT Question 1
RunningHead: PICOT Question 7
PICOT Question
Avery Bryan
NRS-433V
Professor Christine Vannelli
May 19, 2019
Clinical Problem
A report from the Center for Disease Control and Prevention in 2015 revealed that (9.4%) 30.3 million Americans are diabetic and 84.1 million have prediabetes. This is a total population of over 100 million is at risk of developing type 2 diabetes which is a growing health problem being the seventh leading cause of death in the U.S. An estimated 1.5 million new cases were among 18-year old bracket and the rates of diagnosed diabetes increased proportionally to age. Below 44 years accounted for 4%, below 64 years at 17 % and 25% for those above 65 years across both genders. One-third of adults in America has prediabetes but sadly, they are unaware despite reports released by The National Diabetes Statistics Report every year. These reports elaborate on prevalence and incidence, prediabetes, long-term complications, risk factors, mortality, and cost. Diabetes poses the risk of serious complications like death, blindness, stroke, kidney disorders, cardiac diseases and health problems that lead to amputation of legs. However, the risks can be mitigated through physical body activities, proper dieting and prescribed use of insulin and other related measures to control the blood sugar levels. Diabetes Prevention Program was funded by NIH to research a yearly evidence-based program to improve healthy weight loss through diet and physical activities. There also efforts to determine the effectiveness of public service campaigns in improving the real-life experience in the diagnosis and treatment of diabetes.
PICOT Question.
The population affected by diabetes cuts across all ages, gender, race, and ethnicity. The prevalence is significantly high from 18 years and it increases with age to about 25% above 65 years. In terms of gender, men are at higher risk accounting for 37% while women are at 30% across races and educational levels. On races, the rates were higher among Indians/Alaska natives at 15%, non-Hispanic blacks at 12.7% and Hispanics at 12%. Among Asians, the rates were lower at 8% and 7.4% for non-Hispanic whites.
Intervention indicator for diabetes shows that individuals who do not observe a healthy diet are more exposed to the disease. Some risk behaviors include lack of exercise and excessive intake of junk foods that lead to obesity and increased blood sugar levels. Diabetes prevalence varied according to education levels were those with less than high school education at 12.6% and 7.2% for those higher than high school education.
Comparison and use of a control group from the popularity of Complementary and Alternative Medicine and Traditional Chinese Medicine showed distinct knowledge of diabetes, blood sugar control, and self-care. The experimental group received education through interactive multimedia for three months while the control group received.
Barriers and facilitators for regular physical exercise among adult females n...Dr. Anees Alyafei
What stimulates and prevents females from regular physical exercise. Updated Comprehensive narrative review.
https://www.researchgate.net/publication/341220204_Citation_AlYafei_A_Albaker_W_2020_Barriers_and_Facilitators_for_Regular_Physical_Exercise_among_Adult_Females_Narrative_Review_2020
Austin Journal of Nephrology and Hypertension is an open access, peer review Journal publishing original research & review articles in all the fields of Nephrology. Nephrology is the study of Kidney problems, diagnosis, treatments and transplantation of Kidney. Austin Journal of Nephrology and Hypertension journal provides a new platform for all researchers, scientists, scholars, students to publish their research work & update the latest research information.
Austin Journal of Nephrology and Hypertension is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.
Austin Journal of Nephrology and Hypertension supports the scientific modernization and enrichment in Nephrology research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Running Head FREE RADICAL THEORY OF AGING 1 .docxjeanettehully
Running Head: FREE RADICAL THEORY OF AGING 1
Research Article Summary:
Free Radical Theory of Aging
University of Maryland Baltimore County
FREE RADICAL THEORY OF AGING 2
Theories of aging are important aspects of understanding the aging process. The
theories give society different methods to understand how and why aging occurs, even
though not all of the theories are accurate. Most theories of aging have some sort of
research that back them, unlike personal experiences or educated guesses. Theories of
aging change our perception of adults and aging by giving us an understanding of the
process of aging. If we are able to better understand how aging occurs and why it occurs,
society is more likely to accept the process and accept elders. Theories of aging are
relevant to those who work with older adults because theories can help workers focus on
specific aspects of aging to increase care. An example is our knowledge of the
immunological theory. As we age our immune system deteriorates leaving elders more
susceptible to disease; workers can attempt to improve sanitation of elder care to decrease
risk of diseases. The quality of programs and services of older adults can be improved by
the theories because they allow for a better understanding of the development of older
adults, which allows caretakers to improve their approaches to care.
The biological theory of free radicals contributes to the physical aspect of aging.
Free radicals are waste products produced by cells, specifically, molecules of ionized
oxygen that have an extra electron (Moody & Sasser, 2014, p. 21). The free radicals
cause damage because they bond with proteins and other structures in the body, which
can inactivate them and make them unable to function. The amount of free radicals in the
body increase as people age. This causes mutations, damage to organs, and ultimately the
symptoms we see as aging. The body does create antioxidants, which are protection
against free radicals; they find and destroy the free radicals, preventing damage of cells
FREE RADICAL THEORY OF AGING 3
(Moody & Sasser, 2014, p. 62). Although it is thought that consuming antioxidants will
slow aging, studies have only shown minimal effects (Moody & Sasser, 2014, p. 62).
Schöttker et al. (2015) studied if free radicals were associated with mortality,
more specifically the association of derivatives of reactive oxygen metabolites (d-ROMs)
and total thiol levels (TTL) with mortality from all causes, cardiovascular disease, and
cancer. The study was conducted on two groups. The first group was Health, Alcohol and
Psychosocial Factors in Eastern Europe (HAPIEE) from Poland, Czech Republic, and
Lithuania. The second group was an eight year follow up from Epidemiologische Studie
zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer
Erkrankungen in d ...
Sanis-Nutrisport 2014 Nutrizione, Integrazione e SportRoberto Conte
Presentazione dello studio: "Prevenzione di disturbi acuti con una formulazione di alimento funzionale, formulato per supportare e mantenere la funzionalità della barriera intestinale durante la performance sportiva". N. Sponsiello - S. Belgeri - R. Conte - D. Carandini - M. Salomone
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Ferrodyn 03 iron gyo
1. Full Terms & Conditions of access and use can be found at
http://www.tandfonline.com/action/journalInformation?journalCode=igye20
Download by: [FU Berlin] Date: 28 March 2017, At: 12:52
Gynecological Endocrinology
ISSN: 0951-3590 (Print) 1473-0766 (Online) Journal homepage: http://www.tandfonline.com/loi/igye20
Forty to fifty-five-year-old women and iron
deficiency: clinical considerations and quality of
life
Anne Firquet, Wolf Kirschner & Johannes Bitzer
To cite this article: Anne Firquet, Wolf Kirschner & Johannes Bitzer (2017): Forty to fifty-five-
year-old women and iron deficiency: clinical considerations and quality of life, Gynecological
Endocrinology, DOI: 10.1080/09513590.2017.1306736
To link to this article: http://dx.doi.org/10.1080/09513590.2017.1306736
Published online: 28 Mar 2017.
Submit your article to this journal
View related articles
View Crossmark data
2. http://informahealthcare.com/gye
ISSN: 0951-3590 (print), 1473-0766 (electronic)
Gynecol Endocrinol, Early Online: 1–7
! 2017 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09513590.2017.1306736
REVIEW ARTICLE
Forty to fifty-five-year-old women and iron deficiency: clinical
considerations and quality of life
Anne Firquet1
, Wolf Kirschner2
, and Johannes Bitzer3
1
Department of Obstetrics and Gynecology, CHR Citadelle, Lie`ge, Belgium, 2
FB + E Forschung, Beratung + Evaluation GmbH c/o Charite´ Frauenklinik
CVK, Berlin, Germany, 3
Basel, Switzerland
Abstract
Between the age of 40 and 55 years, women experience important changes in their lives. This
period, which corresponds to the perimenopause for most women, is associated with the risk of
iron deficiency anemia (IDA). The clinical presentation of anemia can be misleading, and the
underlying cause, particularly bleeding, is frequently treated without concomitant iron
prescription. Iron deficiency (ID) remains a social and economic burden in European countries.
Underdiagnosed and undertreated, this problem has a strong negative impact on women’s
quality of life. The risk factors for ID are well known. The physician’s role is essential in
recognizing the symptoms, identifying the risk factors, detecting IDA by testing hemoglobin,
and evaluating the degree of ID by measuring serum ferritin (SF). Iron therapy treats the anemia
and restores iron stores, thus decreasing symptoms such as fatigue and restoring quality of life.
Among the available forms of iron, evidence is in favor of ferrous sulfate in a slow release
formulation, which is well-tolerated and results in good adherence, a key factor for efficacious
supplementation.
Keywords
Anemia, ferrous sulfate, iron deficiency,
middle-aged women, quality of life
History
Received 8 February 2017
Accepted 11 March 2017
Published online 27 March 2017
Introduction
The period between 40 and 55 years, which covers pre-
menopause, peri-menopause, and for some women, post-meno-
pause, has a great impact on women’s health and quality of life
[1–3]. This natural life stage lasts 4–11 years and is associated
with variations in hormonal levels; menstrual disturbances with
an increased risk of heavy bleeding [4]; an unhealthy life style,
often with restrictive dieting and a lack of exercise; and
subsequent changes in physical and mental well-being, with
fatigue commonly reported [5]. These changes have a negative
impact on quality of life, and many are linked to iron status.
Quality of life is defined by the World Health Organization [6]
as the ‘‘individual’s perception of their position in life, in the
context of the culture and value systems in which they live and in
relation to their goals, expectations, standards and concerns. It is a
broad-ranging concept affected by the person’s health’’.
Worldwide, iron deficiency (ID) is the most prevalent nutri-
tional problem and remains the most common cause of anemia in
both developing and developed countries, including in Western
Europe [7–9]. Anemia affects health and has a strong negative
influence on women’s quality of life [10]. Unfortunately, phys-
icians do not seem to be aware that ID can still be a problem in
women of this age group, as anemia and ID are mainly perceived
as occurring during and after pregnancy. The topic of ID in peri-
menopausal women is rarely addressed in the literature.
The symposium entitled ‘‘Women 40–55 Years Old: Clinical
Considerations and Quality of Life’’, held at the 15th World
Congress of the International Menopause Society in September
2016 in Prague focused on this clinical and public health
problem. This review article reports a summary of the lectures
from the symposium, and is the third in a series on gyneco-
logical care [11,12]. The objectives of the symposium were to
clarify why this transitional period must be carefully monitored
to quantify the level of risk for ID, and to explain how the
treatment of ID can restore the associated impaired quality of
life.
The complexity of a common clinical case
Mrs. X is 45 years old. She is booked in for her yearly checkup.
After asking how she feels and giving her some time to explain
her situation, she responds: ‘‘I think I’m getting old. Everything is
changing. I feel so tired; I have no energy but I still try to exercise.
I’m on a very strict diet, I sometimes feel hot and wake up at night
sweating. I was always positive, now I feel depressed, and I’m not
interested in sex anymore. And then I bleed—it’s so embarrassing.
The first few days I’d rather not go out, and it lasts so long, but it’s
become irregular and unexpected. It’s very disturbing.’’ Her
medical examination was unremarkable, apart from mild symp-
toms of irritable bowel syndrome. Ultrasound did not show any
evidence of abnormalities of the uterus or adnexa.
This typical complex picture raises several questions. Do her
symptoms indicate a climacteric syndrome, burn-out, an
unhealthy lifestyle, depression, chronic fatigue syndrome, sexual
dysfunction, or abnormal uterine bleeding? Laboratory tests
revealed a low hemoglobin (Hb) level of 11.0 g/dL and a low
Address for correspondence: Anne Firquet, Department of Obstetrics and
Gynecology, CHR Citadelle, Boulevard du 12e`me de Ligne, 1, 4000
Lie`ge, Belgium. Tel: +32 477955636. E-mail: annefirquet@hotmail.com
3. serum ferritin (SF) concentration, at 15 mg/L, suggesting IDA,
which explains most of Mrs. X’s symptoms [13,14].
Make iron deficiency part of your differential diagnosis
Recognizing the symptoms
Symptoms of ID/IDA are nonspecific and can be wrongly
interpreted as related to other conditions. The typical picture of
ID/IDA includes fatigue, palpitations, irritability, breathlessness,
paleness, cold intolerance, poor concentration, restless leg
syndrome [15] and susceptibility to infection [16–18]. Among
these, fatigue and cognitive impairment are the most confusing.
Fatigue
Fatigue is a syndrome grouping lack of energy, physical and
mental exhaustion and cognitive impairment. It affects 14–33% of
patients seen in general practice and represents a significant
public health problem. It occurs not only in the context of anemia,
but also in cases of ID [19], and can be remedied by iron
supplementation [2,5,20,21].
Cognition
Iron status has an impact on cognitive performance (including
spatial ability, attention, memory, learning, reasoning ability and
executive functioning) in women of reproductive age [22]. Pre-
menopausal women with ID were found to have poorer results on
tests of attention, learning and memory when compared to iron-
sufficient participants [17]. Iron supplementation improves cog-
nitive function regardless of whether the participant suffers from
ID or IDA [23]; a significant improvement in SF was associated
with a five- to seven-fold improvement in cognitive performance
[24].
How can iron deficiency/iron deficiency anemia (IDA)
explain this wide range of symptoms?
Iron is an essential component of many metabolic enzymes. It
plays an important role in essential cellular functions and can be
responsible for mitochondrial dysfunction, abnormal enzyme
activity, abnormal transport, modified structural proteins, altered
neurotransmitter synthesis and apoptosis, all processes that might
explain fatigue, reduced work efficacy, impaired cognitive
performance, increased morbidity and impaired exercise capacity,
as well as the classical physical manifestations such as glossitis,
koilonychia and pica [10,18,25].
The risk of iron deficiency/iron deficiency anemia
Prevalence
Data on the prevalence of ID/IDA in European women aged 40–
55 years are not readily available in the literature. Therefore, an
internet-based data search was performed, collecting publications
or data on the epidemiology, prevalence, risk factors for anemia,
ID or IDA, in women of this age group, excluding data from
developing countries, where the situation differs.
In the USA, the Center for Disease Control and Prevention
(CDC) [26] reported an ID prevalence rate of 12% in non-
pregnant women aged 20–49 years and 9% in women aged 50–69,
with the IDA prevalence being 4% and 3%, respectively, in the
year 1999–2000. In Germany, Thefeld and Ellert [27] published
the results of the 1990–1992 German National Health survey
showing that latent ID (SF530 mg/L or transferrin saturation
[TSAT]516%) has a prevalence rate of 10.4% in women aged
40–49 years and 9.8% in women aged 50–54 years. In Europe,
Levi et al. [16] recently reported IDA prevalence rates in women
as being 2.2% in Belgium, 2.9% in Italy, 4% in Germany and 4.5%
in Spain.
In France, a major epidemiological study (the SUVIMAX
trial) found that one menstruating woman in five had depleted
iron stores, while 23% of pre-menopausal women had SF 15 mg/
L, and 4% had anemia (Hb512 g/dL) [28,29]. Approximately 5%
of post-menopausal women presented a total depletion of iron
stores, and 1% had IDA [29].
To calculate the prevalence of ID in German women aged 40–
55 years, the age distribution of natural menopause in Norwegian
women reported by Jacobsen et al. [30] and the prevalence rates
of ID and IDA reported in the SUVIMAX study were used, with
the results indicating that around 1.3 million German women in
this age group are iron-deficient, while 190 000 have IDA. Thus,
ID represents an economic burden that deserves the attention of
physicians.
Risk factors and causes of iron deficiency/iron deficiency
anemia in peri-menopausal women
Several conditions have been identified in the literature as risk
factors for ID in women of this age group [27,29,31–48]: low iron
intake and compromised absorption, chronic blood loss (heavy
menstrual bleeding (HMB), GI lesions) and increased iron
requirements, such as athletic activity (Table 1). Pregnancy is
not included, as only 3% of pregnancies occur over the age of 40
[49,50].
Low iron intake
Fasting. Peri-menopausal women are vulnerable to ID due to low
dietary iron intake resulting from restrictive dieting aimed at
losing weight [9]. In the SUVIMAX study, 93% of menstruating
women had dietary iron intakes lower than the recommended
dietary allowance (RDA) [29], at approximately 12 mg/day
instead of the 18 mg/day recommended [28]. Women of this age
may struggle to manage their weight, which often leads to
restrictive dieting and the elimination of meat [10]. Other
slimming diets also lead to insufficient intake of iron; for
example, in 46 healthy women, two-day food restrictions
(5200 kcal/day) every eight days for a period of 48 days
significantly decreased serum iron concentrations as well as SF
(–28%, p50.001) and Hb (–8%, p50.05) [32].
Vegetarian diets. Vegetarians and vegans have a greater risk of
ID as their heme iron intake is almost nil. Vegetarian diets provide
adequate amounts of non-heme iron if a wide variety of fruit,
cereals and vegetables are consumed [51]; however non-heme
iron is poorly absorbed (1 ± 5%) in comparison to heme iron
(25%), which is only found in foods of animal origin [52]. In the
German Vegan study, 40% of vegan women under the age of 50
were considered iron-deficient [31]. The United States/Canadian
Institute of Medicine recommends that the iron requirements for
vegetarians be 1.8 times that of the regular RDA [53]; to reach
this amount requires complex dietary management.
Increased blood loss
Heavy menstrual bleeding. The prevalence of HMB (formerly
called menorrhagia), defined as menstrual periods lasting more
than seven days and/or involving blood loss greater than 80 ml,
ranges from 11 to 13% in the general population and increases
with age, reaching 25% in women older than 41 years [40,54].
Likewise, in 18 000 women who served in the US Armed Forces
from 1998 to 2002, HMB was diagnosed in 23.1% of women aged
40–49 and 9.2% of women aged 50–55 [55]. HMB is an important
cause of anemia in peri-menopausal women. It is a hidden
condition that is underdetected in women aged 40–55 years for
2 A. Firquet et al. Gynecol Endocrinol, Early Online: 1–7
4. various reasons: a cultural perception that menstruation is an
embarrassing topic that should be concealed [56], the belief that
bleeding is a cleansing process good for health, and the difficulty
of quantifying the losses [57]. Several useful tools have been
developed to quantify menstrual bleeding; for example, the
Matteson questionnaire [58] or a 15-question form developed by a
group of experts (Expert group on Heavy Menstrual Bleeding: I
Fraser, D Mansour, A Kaunitz, J Bitzer; unreferenced). The
causes of HMB have been classified using the PALM-COEIN
acronym [59] and the treatment has been detailed in the recent
update of the National Institute for Care and Health Excellence
(NICE) guidelines [3]. For NICE, HMB has ‘‘a major impact on a
woman’s quality of life’’, and ‘‘any intervention should aim to
improve this rather than focusing on menstrual blood loss.’’ The
guidelines recommend a full blood count on all women with
HMB; however, ferritin testing is not mentioned to help to
identify ID. Peuranpa¨a¨ et al. [1] recommend treating all women
with HMB and IDA/ID with an effective iron preparation at
initiation of HMB therapy.
Intrauterine devices. The use of copper UIDs is also a risk
factor; 28% of women using copper IUDs were found to be iron
depleted [29].
GI bleeding. HMB is not the only culprit responsible for iron
loss. In a population of pre-menopausal women with IDA, 82% of
patients had normal menstrual blood loss, but more than 25%
reported GI symptoms and fecal occult blood was detected in
41%. Only 24% of these anemic patients were treated with iron
supplements [41]. GI bleeding is frequently underdiagnosed and
related ID undertreated [60]. Female patients with IDA not
explained by heavy menses, or those with GI symptoms, should
be evaluated by endoscopy or colonoscopy [41,42]. In post-
menopausal women, gut lesions are the main reason for ID,
predominantly due to cancers and coeliac disease [9]. IDA is also
a known consequence of Helicobacter pylori infection due to
chronic occult blood loss, competition for iron by the bacteria,
reduced ascorbic acid concentration and upregulation of hepcidin
[47,50]. The anemia improves after eradication of the pathogen
[9]. The use of proton pump inhibitors seems to reduce the risk of
upper GI bleeding [43]; however, these medications are known to
inhibit iron absorption [61].
Iatrogenic bleeding. Bleeding associated with anticoagulants/
aspirin/non-steroidal anti-inflammatory drugs (NSAIDs) may
contribute to ID. Aspirin or NSAID use was reported by 35% of
patients with IDA [41]. In patients hospitalized for GI bleeding,
the use of anticoagulants, low-dose aspirin, NSAIDs was linked to
upper and/or lower GI bleeding; the risk was two-fold higher for
anticoagulants [43].
Malabsorption and inflammatory conditions
Celiac disease and inflammatory bowel disease (IBD) affect GI
cells. The villous atrophy of the mucosa impairs iron absorption
[9]. Approximately 80% of anemic patients with celiac disease are
iron-deficient due to impaired iron absorption and blood loss
[25,46]. Anemia is common in celiac disease. According to the
British Society of Gastroenterology guidelines [46], all patients
with IDA should be screened for celiac disease by serological
testing for tissue transglutaminase antibody (tTG-IgA) or
endomysial antibody (EMA-IgA), and/or duodenal biopsy.
Anemia in IBD is multifactorial. IDA, the most common cause,
coexists with anemia due to chronic disease, also known as
anemia of inflammation or functional IDA [25,62]. In the case of
inflammation, cytokines induce the production of hepcidin, which
is responsible for iron sequestration in intracellular ferritin. SF
concentrations increase independently of iron status; however, this
increase may mask a deficiency of iron [46]. It is therefore
essential to detect inflammation by concurrently measuring an
inflammatory marker such as C-reactive protein (CRP) [9], which
is increased during inflammation [36]. Strict inflammatory
anemia is refractory to oral iron therapy because the raised
hepcidin levels result in trapping of iron in the enterocytes [9];
however, in case of concomitant ID, there is little justification for
giving parenteral iron when oral therapy is possible. The
intravenous route is indicated only when the patient is intolerant
or unresponsive, in cases of persistent noncompliance, or when
treated by erythropoiesis stimulating agents [13,25,46].
Obesity, a chronic inflammatory condition with an increasing
prevalence, also has the potential to compromise iron status
[9,45]. Obesity can result in iron being retained in the enterocytes
and macrophages. The higher prevalence of ID in obese people is
possibly due to inadequate iron intake or higher blood volume
[51].
Increased iron requirements
Some women, concerned about their weight, begin an obsessive
exercise program. Female athletes, and especially long distance
runners, suffer ID due to insufficient iron intake, menstruation or
increased blood losses due to exercise (sweating, hemolysis,
hematuria or GI bleeding) [48]. In endurance athletes, the RDA for
iron should be increased by 70% [48]. ID can be corrected with
Table 1. Risk factors for iron deficiency and iron deficiency anemia in women aged 40–55 years.
Risk factors for ID/IDA OR/RR Source
Low iron intake, low absorption
Vegetarian, vegan diet, poor diet 1.76 Thefeld and Ellert [27], Waldmann et al. [31]
Fasting N/A Wojciak [32]
Low BMI 1.7–2.97 Contreras-Manzano et al. [33]
Low vitamin C intake 2 Ramakrishnan et al. [34], Peneau et al. [35]
Malabsorption N/A Qamar et al. [36]
High consumption of coffee/tea N/A Fairweather-Tait [37]
Increased blood loss
Use of intrauterine devices (not . . .) 2 Galan [29]
High menstrual blood loss 2.6 Kirschner et al. [38], Milman et al. [39], Janssen et al. [40]
Intestinal bleeding N/A Green and Rockey [41], Bull-Henry and Al-Kawas [42]
Use of NSAIDs, aspirin, anticoagulants 2–4.2 Green and Rockey [41], Lanas et al. [43]
Repeated blood donations 5 Milman et al. [44]
Inflammatory chronic diseases/obesity 2 Aigner et al. [45]
Helicobacter pylori infection 1.38–2.8 Goddard et al. [46], Hudak et al. [47]
Increased needs
Competitive sports 2 Alaunyte et al. [48]
N/A: ratio not available.
DOI: 10.1080/09513590.2017.1306736 ID in women aged 40–50 3
5. iron supplementation [63], and a recent Cochrane review [20]
concluded ‘‘Daily iron supplementation effectively reduces the
prevalence of anemia and ID, raises Hb and iron stores, improves
exercise performance and reduces symptomatic fatigue.’’
Treat iron deficiency/iron deficiency anemia effectively
to restore quality of life
Iron therapy produces a rapid improvement of symptoms
‘‘Anemia control produces an immediate increase in physical
work output, higher productivity outside the workplace, improved
quality of leisure time, increased learning capacity, and a greater
sense of well-being’’ [13].
Quality of life
Patterson et al. confirmed a link between ID and decreased well-
being that was improved by iron treatment [2]. In Finland, 236
women referred for HMB were randomized to two groups: one
treated by hysterectomy and one with a levonorgestrel IUD, and
followed up for five years [1]. At baseline, 27% of women were
found to be anemic, 60% were severely iron-deficient (fer-
ritin515 g/L), with only 8% of the anemic women taking an iron
supplement. Anemia was corrected in the first year after treatment
of HMB in most women, and was associated with an improvement
of health-related quality of life as measured with the RAND 36
questionnaire; however, it took several years to replenish the iron
stores with dietary iron. After five years, the mean ferritin value
was 49.31 g/L (range 7–237) in the initially anemic group and
67.51 g/L (range 5–464 mg/L) in the initially non-anemic group
(p ¼ 0.03), showing that despite reassuring mean values, some of
the women in both groups were still iron-deficient. Surprisingly,
iron supplementation was rare, which probably explains the
persistence of deep ID in some women. A possible explanation is
that clinicians focus on the treatment of HMB itself, and may not
consider the possibility of ID. Many doctors expect that anemia
and ID will spontaneously resolve once HMB is treated.
Choosing the right iron supply
Diet or oral supplementation?
Although theoretically useful, dietary advice is difficult to follow.
It is recommended to avoid inhibitors of iron absorption (e.g.
tannins and phytates in tea or coffee; calcium), to favor efficient
iron absorption [9,64], and to eat iron-rich foods (meat, blood
sausages, lentils, herrings, etc.) [65]. This advice rarely matches
the patient’s dietary choices and is often rapidly abandoned,
despite initial goodwill. If an iron-rich diet is elected as the sole
measure, Hb and SF should be regularly monitored to control the
normalization of iron stores.
Iron supplements are not all the same
From a practical point of view, the oral route is the first choice to
treat IDA and rebuild iron stores. Ferrous sulfate is preferred, as
the bioavailability of ferric iron is 3–4 times lower because of its
poor solubility and the fact that it must be transformed into ferrous
iron before it can be absorbed [66]. Moreover, ID upregulates iron
absorption from ferrous sulfate better than from ferric iron [67].
Iron preparations vary in their bioavailability, efficacy and side
effects. Good tolerability is key, as it guarantees good compliance,
essential for efficacy. The major reason for iron therapy failure is
noncompliance due to side effects. Patients may take the
supplement for a few days and cope with the associated
discomfort, but stop the treatment as soon as they experience an
improvement from the rise in their Hb levels. Unfortunately, this
occurs long before Hb has reached a normal level [13]. To avoid
high amounts of iron being in contact with the GI mucosa, slow
release preparations have been proposed as they improve absorp-
tion and GI tolerance [13].
Slow release ferrous sulfate
Bioavailability and kinetics. Ferrous sulfate in a polymeric
complex (FSPC), TardyferonÕ
(Pierre Fabre Pharma Laboratory,
Castres, France) was tested in non-pregnant women with IDA (Hb
85–105 g/L, SF515 mg/L) taking a single dose of two tablets of
80 mg [68]. Iron was released slowly, with the median time to
reach the peak concentration around 4 h. At 12 post-dose, the
mean iron concentration was six-fold higher than at baseline. All
patients displayed similar curves of iron concentration, with
elevated iron concentrations maintained up for to 12 h.
Efficacy. In the PEARL study [69], women with symptomatic
fibroids, excessive uterine bleeding, and anemia (Hb 10.2 g/dL)
were randomized to receive oral ulipristal acetate, a selective
progesterone receptor modulator [70], at a dose of 5 mg or 10 mg/
day or placebo for 13 weeks. All patients were supplemented with
80 mg of FSPC once daily during the study. At 13 weeks, uterine
bleeding was contained in more than 90% of the women receiving
ulipristal acetate and in 19% of those receiving placebo
(p50.001). The percentage of patients with normal Hb (412 g/
dL) increased over time in all groups and anemia was corrected in
most patients in the placebo group. Hb levels reached at least
13.50 g/dL ± 1.32 in the ulipristal group and 12.61 g/dL ± 1.30 in
the placebo group, showing that FSPC efficiently restored Hb
levels, despite ongoing bleeding.
A group of 144 women with unexplained fatigue received
either FSPC or placebo for four weeks. Half of them had SF
levels 20 mg/L. After one month of treatment with FSPC, the
level of fatigue, measured with a visual analog scale, decreased by
29% in the iron group and decreased by 13% in the placebo group
(p ¼ 0.004) [5].
Zaim et al. [71] demonstrated that the ability of the FSPC
80 mg prolonged-release formulation to restore Hb levels in
women with IDA was not inferior to that of a different dosage
(105 mg) of a reference ferrous sulfate formulation when admin-
istered for 12 weeks. This can be explained by better iron
absorption from the prolonged-release formulation.
Tolerability. A systematic review [72] analyzed the tolerability
of oral iron supplements in 111 studies including over 1000
patients. FSPC showed the lowest rate of GI adverse effects
(3.7%), compared to other FS (30.2%), ferrous fumarate (43.4%)
and preparations containing ferric iron (7%) (Figure 1).
This evidence on bioavailability, efficacy and tolerability of
FSPC was confirmed in Fadeenko et al.’s study [73], where
patient adherence, an important parameter for treatment efficacy
and tolerability, was considered excellent since more than 95% of
patients took their treatment until the end of the study.
Discussion
Risk factors for middle-aged women have been identified
Risk factors specific for the 40–55 year age group are well known
(Table 1) and should trigger further evaluation. Fatigue or
impaired exercise capacity by itself is associated with a risk of ID/
IDA and should prompt a biological assessment for anemia (Hb)
and iron status (SF, TSAT) [25]. ID is deleterious by itself and can
aggravate concomitant pathological conditions such as cardiovas-
cular diseases, recovery from surgery, or cancers [74,75].
Iron deficiency is not limited to developing countries
Even though ID is less prevalent than in developing countries,
where iron supplementation is recommended for adult women
4 A. Firquet et al. Gynecol Endocrinol, Early Online: 1–7
6. where the prevalence of IDA is 40% [50], ID remains a public
health concern in Western Europe as it affects large numbers of
women [8,13]. IDA-related signs and symptoms are nonspecific
and are often underestimated or overlooked by patients, who
therefore may not report them to their general practitioner or
gynecologist. A checklist (Table 2) in the form of an acronym has
been proposed for screening the main risk factors and deciding
whether in addition to Hb testing determining the ferritin level
would be useful to confirm the ‘‘deficit’’.
In addition to anemia correction, iron stores should be
restored to normal levels
In cases of IDA/ID, iron supplementation should be implemented
and combined with the treatment of the underlying condition. As
recommended by different guidelines [7,13,14,19,46], prescribing
oral ferrous sulfate at a dose of 60–120 mg/day for three months to
treat anemia, and for an additional three months to replenish the
iron stores, is a common approach [50]. Therefore, there is a need
to maintain the patient’s motivation for those who do not perceive
themselves to be ill.
What is the contribution of ferritin testing in the
management of iron deficiency anemia/iron deficiency?
Hb testing only detects anemia, which is a late-stage indicator of
ID. A higher Hb threshold has been proposed to optimize ID
screening [76]. Ferritin values, which represent the iron stores,
seem a better candidate for screening [77]. The British Columbia
Guidelines [19] consider that in adults, SF515 mg/L denotes ID,
at between 15 and 50 mg/L ID is probable, between 50 and 100 mg/
L ID is possible, and if SF4100 mg/L ID is unlikely. If SF is
persistently more than 1000 mg/L, the risk of iron overload should
be considered. Nevertheless, IDA may coexist with anemia due to
chronic disease, and the distinction between these forms of
anemia is sometimes difficult [16]. In case of CRP45 mg/L,
Kirschner et al. [38] recommend the assessment of Soluble
Transferrin Receptor (sTfR) instead of ferritin, and some authors
[46,78,79] have suggested raising the SF threshold to 50 mg/L or
even higher.
With the natural cessation of menstruation and the associated
decrease in iron loss, ferritin is expected to increase. At
menopause, the ferritin curve crosses the estradiol curve, which
is declining [80,81]. Some authors have even signaled a risk of
iron overload [79]. However, this represents the mean value and
does not take into account any extreme values [1]. A low ferritin
value confirms ID. An overly high ferritin value evokes either an
associated inflammatory process (with elevated CRP and
decreased TSAT suggestive of iron sequestration [62]) or
unmonitored high iron intake, such as by self-medication with
over-the-counter supplements containing iron, or a real iron
overload possibly related to genetic factors.
Considering the economic impact of ID and the large range of
ferritin values observed, all health care authorities should
recommend this additional marker as a screening test in middle-
aged women at risk of ID.
The essential role of physicians
Physicians are in a position to recognize the possible clinical
presentations of ID/IDA, and have a responsibility to search for
possible causes, explain the negative effects of excessive bleeding
and the consequences of ID. Considering that it is not realistic to
rely on dietary advice for the correction of ID/IDA, iron
supplementation represents a medical issue and should be
proposed to the patients until their iron status is restored to
normal [12].
Conclusions
Women between the ages of 40–55 years are at risk of ID/IDA and
merit attention as the symptoms of ID can be misinterpreted or
overlooked. The assessment of Hb to detect anemia, and at least
SF to confirm ID, should guide therapy initiation and follow-up.
The use of a slow release form of ferrous sulfate, such as FSPC,
with proven efficacy and tolerability, will help to ensure patient
compliance with treatment and seems to be a valuable choice to
treat ID/IDA and to restore quality of life.
Declaration of interest
All authors report receiving fees from Pierre Fabre Medicament
for preparing and presenting the information included in this
review, which they presented at the symposium entitled ‘‘Women
40–55 Years Old: Clinical Considerations and Quality of Life’’,
held at the 15th World Congress of the International Menopause
Society in September 2016 in Prague. Funding for editorial
support was provided by Pierre Fabre Medicament.
References
1. Peuranpa¨a¨ P, Helio¨vaara-Peippo S, Fraser I, et al. Effects of anemia
and iron deficiency on quality of life in women with heavy
menstrual bleeding. Acta Obstet Gynecol Scand 2014;93:654–60.
2. Patterson AJ, Brown WJ, Roberts DC. Dietary and supplement
treatment of iron deficiency results in improvements in general
health and fatigue in Australian women of childbearing age. J Am
Coll Nutr 2001;20:337–42.
3. NICE [Internet]. London: NICE; 2016 Update [cited 2017 Feb 02].
Heavy menstrual bleeding: assessment and management clinical
guideline. Available from: https://www.nice.org.uk/guidance/CG44/
chapter/Recommendations#pharmaceutical-treatments-for-hmb.
4. Nicula R, Costin N. Management of endometrial modifications in
perimenopausal women. Clujul Med 2015;88:101–10.
Figure 1. Rate of gastrointestinal adverse effects of iron supplements.
Table 2. DEFICIT checklist to detect the risk of iron deficiency and iron
deficiency anemia in middle-aged women.
Increased risk of iron deficiency
D Diet: weight loss, vegetarian or vegan diet,
low intake of Vitamin C, high intake of tea, Ca2+
E Excessive sport
F Fatigue or other symptoms of ID
I IUD or HMB
C Celiac disease
I Inflammatory conditions (IBD, obesity)
T Anticoagulants, antiplatelet agents, NSAIDs,
aspirin or excessive blood donation
DOI: 10.1080/09513590.2017.1306736 ID in women aged 40–50 5
7. 5. Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for
unexplained fatigue in non-anaemic women: double blind rando-
mised placebo controlled trial. BMJ 2003;326:1124.
6. World Health Organization [Internet]. Geneva: World Health
Organization; 1997 [cited 2017 Feb 02]. WHOQOL Measuring
quality of life. Available from: http://www.who.int/mental_health/
media/68.pdf.
7. World Health Organization [Internet]. Geneva: World Health
Organization; 2001 [cited 2017 Feb 02]. Iron deficiency anaemia.
Assessment, prevention, and control. A guide for programme
managers. Available from: http://apps.who.int/iris/bitstream/10665/
66914/1/WHO_NHD_01.3.pdf?ua¼1.
8. Kassebaum NJ, Jasrasaria R, Naghavi M, et al. A systematic analysis
of global anemia burden from 1990 to 2010. Blood 2014;123:
615–24.
9. Coad J, Pedley K. Iron deficiency and iron deficiency anemia in
women. Scand J Clin Lab Invest Suppl 2014;244:82–9.
10. Beard J, Tobin B. Iron status and exercise. Am J Clin Nutr 2000;72:
594S–7S.
11. Bitzer J, Sultan C, Creatsas G, et al. Gynecological care in young
women: a high-risk period of life. Gynecol Endocrinol 2014;30:
542–8.
12. Milman N, Paszkowski T, Cetin I, et al. Supplementation during
pregnancy: beliefs and science. Gynecol Endocrinol 2016;32:
509–16.
13. DeMayer EM, Dallman P, Gurney JM, et al. Preventing and
controlling iron deficiency anemia through primary health care.
Geneva: World Health Organization; 1989.
14. World Health Organization [Internet]. Geneva: World Health
Organization; 2011 [cited 2017 Feb 02]. Haemoglobin concentra-
tions for the diagnosis of anaemia and assessment of severity.
Available from: www.who.int/vmnis/indicators/haemoglobin.pdf.
15. Koo BB, Bagai K, Walters AS. Restless legs syndrome: current
concepts about disease pathophysiology. Tremor Other Hyperkinet
Mov (NY) 2016;22:401.
16. Levi M, Rosselli M, Simonetti M, et al. Epidemiology of iron
deficiency anaemia in four European countries: a population-based
study in primary care. Eur J Haematol 2016;97:583–93.
17. Agarwal R. Nonhematological benefits of iron. Am J Nephrol 2007;
27:565–71.
18. Beard JL. Iron biology in immune function, muscle metabolism and
neuronal functioning. J Nutr 2001;131:568S–79S.
19. British Columbia Guidelines—Iron deficiency. Vancouver; 2010
[cited 2017 Feb 02]. Available from: http://www2.gov.bc.ca/gov/
content/health/practitioner-professional-resources/bc-guidelines/
iron-deficiency.
20. Low MS, Speedy J, Styles CE, et al. Daily iron supplementation for
improving anaemia, iron status and health in menstruating women.
Cochrane Database Syst Rev 2016;4:CD009747.
21. Krayenbuehl PA, Battegay E, Breymann C, et al. Intravenous iron
for the treatment of fatigue in nonanemic, premenopausal women
with low serum ferritin concentration. Blood 2011;118:3222–32227.
22. Mun˜oz M, Villar I, Garcı´a-Erce JA. An update on iron physiology.
World J Gastroenterol 2009;15:4617–26.
23. Lomagno KA, Hu F, Riddell LJ, et al. Increasing iron and zinc in
pre-menopausal women and its effects on mood and cognition: a
systematic review. Nutrients 2014;6:5117–41.
24. Murray-Kolb LE. Iron status and neuropsychological consequences
in women of reproductive age: what do we know and where are we
headed? J Nutr 2011;141:747S–55S.
25. Stein J, Connor S, Virgin G, et al. Anemia and iron deficiency in
gastrointestinal and liver conditions. World J Gastroenterol 2016;22:
7908–25.
26. Centers for Disease Control and Prevention (CDC). Iron Deficiency –
United States, 1999–2000. MMWR Morb Mortal Wkly Rep.
2002;51:897–9.
27. Thefeld W, Ellert U. Eisenversorgung bei Frauen vor der Menopause
[Iron supply among menopausal women]. Bundesgesundheitsblatt
1998;11:502–3. German.
28. Hercberg S, Preziosi P, Galan P. Iron deficiency in Europe. Public
Health Nutr 2001;4:537–45.
29. Galan P, Yoon HC, Preziosi P, et al. Determining factors in the iron
status of adult women in the SU.VI.MAX study. SUpplementation
en VItamines et Mine´raux AntioXydants. Eur J Clin Nutr 1998;52:
383–8.
30. Jacobsen BK, Heuch I, Kva˚le G. Age at natural menopause and all-
cause mortality: a 37-year follow-up of 19,731 Norwegian women.
Am J Epidemiol 2003;157:923–9.
31. Waldmann A, Koschizke JW, Leitzmann C, et al. Dietary iron intake
and iron status of German female vegans: results of the German
vegan study. Ann Nutr Metab 2004;48:103–8.
32. Wojciak RW. Effect of short-term food restriction on iron metab-
olism, relative well-being and depression symptoms in healthy
women. Eat Weight Disord 2014;19:321–7.
33. Contreras-Manzano A, Cruz Vde L, Villalpando S, et al. Anemia
and iron deficiency in Mexican elderly population: results from the
Ensanut 2012. Salud Publica Mex 2015;57:394–402.
34. Ramakrishnan U, Frith-Terhune A, Cogswell M, et al. Dietary intake
does not account for differences in low iron stores among Mexican
American and non-Hispanic white women: Third National Health
and Nutrition Examination Survey, 1988–1994. J Nutr 2002;132:
996–1001.
35. Peneau S, Dauchet L, Vergnaud AC, et al. Relationship between iron
status and dietary fruit and vegetables based on their vitamin C and
fiber content. Am J Clin Nutr 2008;87:1298–305.
36. Qamar K, Saboor M, Qudsia F, et al. Malabsorption of iron as a
cause of iron deficiency anemia in postmenopausal women. Pak J
Med Sci 2015;31:304–8.
37. Fairweather-Tait SJ. Iron nutrition in the UK: getting the balance
right. Proc Nutr Soc 2004;63:519–28.
38. Kirschner W, Dudenhausen JW, Henrich W. Are there anamnestic
risk factors for iron deficiency in pregnancy? Results from a
feasibility study. J Perinat Med 2016;44:309–14.
39. Milman N, Byg KE, Ovesen L. Iron status in Danes 1994. II:
prevalence of iron deficiency and iron overload in 1,319
Danish women aged 40–70 years. Influence of blood donation,
alcohol intake and iron supplementation. Ann Hematol 2000;79:
612–21.
40. Janssen CA, Scholten PC, Heintz AP. Menorrhagia—a search for
epidemiological risk markers. Maturitas 1997;28:19–25.
41. Green BT, Rockey DC. Gastrointestinal endoscopic evaluation of
premenopausal women with iron deficiency anemia. J Clin
Gastroenterol 2004;38:104–9.
42. Bull-Henry K, Al-Kawas FH. Evaluation of occult gastrointestinal
bleeding. Am Fam Physician 2013;87:430–6.
43. Lanas A, Carrera-Lasfuentes P, Arguedas Y, et al. Risk of upper and
lower gastrointestinal bleeding in patients taking nonsteroidal anti-
inflammatory drugs, antiplatelet agents, or anticoagulants. Clin
Gastroenterol Hepatol 2015;13:906–12.e2.
44. Milman N, Rosdahl N, Lyhne N, et al. Iron status in Danish women
aged 35–65 years. Relation to menstruation and method of
contraception. Acta Obstet Gynecol Scand 1993;72:601–5.
45. Aigner E, Feldman A, Datz C. Obesity as an emerging risk factor for
iron deficiency. Nutrients 2014;6:3587–600.
46. Goddard AF, James MW, McIntyre AS, et al. Guidelines for the
management of iron deficiency anaemia. Gut 2011;60:1309–16.
47. Hudak L, Jaraisy A, Haj S, Muhsen K. An updated systematic
review and meta-analysis on the association between Helicobacter
pylori infection and iron deficiency anemia. Helicobacter
2017;22:e12330. doi: 10.1111/hel.12330.
48. Alaunyte I, Stojceska V, Plunkett A. Iron and the female athlete: a
review of dietary treatment methods for improving iron status and
exercise performance. J Int Soc Sports Nutr 2015;12:38.
49. Hamilton BE, Martin JA, Osterman MJ. Births: preliminary data for
2015. Natl Vital Stat Rep 2016;65:1–15.
50. World Health Organization. Guideline: daily iron supplementation in
adult women and adolescent girls. Geneva: World Health
Organization; 2016.
51. Saunders AV, Craig WJ, Baines SK, Posen JS. Iron and vegetarian
diets. Med J Aust 2013;199:S11–6.
52. Leblanc JC, Yoon H, Kombadjian A, et al. Nutritional intakes of
vegetarian populations in France. Eur J Clin Nutr 2000;54:443–9.
53. Institute of Medicine, Food and Nutrition Board. Dietary reference
intakes for vitamin a, vitamin k, arsenic, boron, chromium, copper,
iodine, iron, manganese, molybdenum, nickel, silicon, vanadium,
and zinc. Washington, DC: National Academy Press; 2001.
54. Marret H, Fauconnier A, Chabbert-Buffet N, et al. Clinical practice
guidelines on menorrhagia: management of abnormal uterine
bleeding before menopause. Eur J Obstet Gynecol Reprod Biol
2010;152:133–7.
6 A. Firquet et al. Gynecol Endocrinol, Early Online: 1–7
8. 55. Dorsey KA. Menorrhagia, active component service women, U.S.
Armed Forces, 1998–2012. MSMR 2013;20:20–4.
56. O’Flynn N. Menstrual symptoms: the importance of social factors in
women’s experiences. Br J Gen Pract 2006;56:950–7.
57. Santer M, Wyke S, Warner P. What aspects of periods are most
bothersome for women reporting heavy menstrual bleeding?
Community survey and qualitative study. BMC Womens Health
2007;7:8.
58. Matteson KA, Scott DM, Raker CA, et al. The menstrual bleeding
questionnaire: development and validation of a comprehensive
patient-reported outcome instrument for heavy menstrual bleeding.
BJOG 2015;122:681–9.
59. Munro MG, Critchley HO, Broder MS, et al. FIGO classification
system (PALM-COEIN) for causes of abnormal uterine bleeding in
nongravid women of reproductive age. Int J Gynaecol Obstet 2011;
113:3–13.
60. El-Halabi MM, Green MS, Jones C, et al. Under-diagnosing and
under-treating iron deficiency in hospitalized patients with gastro-
intestinal bleeding. World J Gastrointest Pharmacol Ther 2016;7:
139–44.
61. Fashner J, Gitu AC. Common gastrointestinal symptoms: risks of
long-term proton pump inhibitor therapy. FP Essent 2013;413:
29–39.
62. Nairz M, Theurl I, Wolf D, et al. Iron deficiency or anemia of
inflammation? Differential diagnosis and mechanisms of anemia of
inflammation. Wien Med Wochenschr 2016;166:411–23.
63. Brownlie T, Utermohlen V, Hinton PS, et al. Tissue iron deficiency
without anemia impairs adaptation in endurance capacity after
aerobic training in previously untrained women. Am J Clin Nutr
2004;79:437–43.
64. Hallberg L, Rossander L. Effect of different drinks on the absorption
of non-heme iron from composite meals. Hum Nutr Appl Nutr 1982;
36:116–23.
65. Cade JE, Moreton JA, O’Hara B, et al. Diet and genetic factors
associated with iron status in middle-aged women. Am J Clin Nutr
2005;82:813–20.
66. Palacios S. Ferrous versus ferric oral iron formulations for the
treatment of iron deficiency: a clinical overview. Sci World J 2012;
2012:846824.
67. Zimmermann MB, Biebinger R, Egli I, et al. Iron deficiency up-
regulates iron absorption from ferrous sulphate but not ferric
pyrophosphate and consequently food fortification with ferrous
sulphate has relatively greater efficacy in iron-deficient individuals.
Br J Nutr 2011;105:1245–50.
68. Leary A, Barthe L, Clavel T, et al. Pharmacokinetics of ferrous
sulphate (TardyferonÕ
) after single oral dose administration in
women with iron deficiency anaemia. Drug Res (Stuttg) 2016;66:
51–6.
69. Donnez J, Tatarchuk TF, Bouchard P, et al. Ulipristal acetate versus
placebo for fibroid treatment before surgery. N Engl J Med 2012;
366:409–20.
70. Nisolle M, Closon F, Firquet A, et al. Ulipristal acetate (Esmya): a
selective modulator of progesterone receptors, new treatment of
uterine fibromatosis. Rev Med Liege 2014;69:220–5.
71. Zaim M, Piselli L, Fioravanti P, et al. Efficacy and tolerability of a
prolonged release ferrous sulphate formulation in iron deficiency
anaemia: a non-inferiority controlled trial. Eur J Nutr 2012;51:
221–9.
72. Cancelo-Hidalgo MJ, Castelo-Branco C, Palacios S, et al.
Tolerability of different oral iron supplements: a systematic
review. Curr Med Res Opin 2013;29:291–303.
73. Fadeenko GD, Kushnir IE, Maloy LT. Treatment of iron deficiency
anemia: clinical efficacy and safety of tardyferon. Results of a
Multicenter Study Conducted in Ukraine. Suchasna Gastroenterol
2009;5:74–80.
74. Kaiafa G, Kanellos I, Savopoulos C, et al. Is anemia a new
cardiovascular risk factor? Int J Cardiol 2015;186:117–24.
75. Moral Garcı´a V, A´ ngeles Gil de Bernabe´ Sala M, Nadia Diana K,
et al. Anemia as a surgical risk factor. Med Clin (Barc) 2013;141:
47–54.
76. Sekhar DL, Kunselman AR, Chuang CH, et al. Optimizing
hemoglobin thresholds for detection of iron deficiency among
reproductive-age women in the United States. Transl Res
2017;180:68–76.
77. Enko D, Wagner H, Kriegsha¨user G, et al. Assessment of human
iron status: a cross-sectional study comparing the clinical utility of
different laboratory biomarkers and definitions of iron deficiency in
daily practice. Clin Biochem 2015;48:891–6.
78. Turgeon O’Brien H, Blanchet R, Gagne´ D, et al. Using soluble
transferrin receptor and taking inflammation into account when
defining serum ferritin cutoffs improved the diagnosis of iron
deficiency in a group of Canadian preschool Inuit children from
Nunavik. Anemia 2016;2016:6430214.
79. Thurnham DI, McCabe LD, Haldar S, et al. Adjusting plasma
ferritin concentrations to remove the effects of subclinical inflam-
mation in the assessment of iron deficiency: a meta-analysis. Am J
Clin Nutr 2010;92:546–55.
80. Jian J, Pelle E, Huang X. Iron and menopause: does increased iron
affect the health of postmenopausal women? Antioxid Redox Signal
2009;11:2939–43.
81. Zacharski LR, Ornstein DL, Woloshin S, et al. Association of age,
sex, and race with body iron stores in adults: analysis of NHANES
III data. Am Heart J 2000;140:98–104.
DOI: 10.1080/09513590.2017.1306736 ID in women aged 40–50 7