Should women over 60 take iron supplements? What you need to know

With menopause comes the end of monthly menstrual bleeding — and the regular loss of iron this process entails. But many women over 60 may wonder if they still need an extra quota of the mineral, popping iron supplements “just in case.” Yet too much iron can be as problematic for our health as too little, a Harvard expert says.

Without sufficient iron, we can’t make enough red blood cells, which carry oxygen to every part of the body. This condition is called iron-deficiency anemia, which affects up to 17% of Americans 65 and older, according to the American Society of Hematology.

Some older women assume they have anemia merely because they feel fatigued and sluggish, the condition’s hallmark symptoms. But Dr. Suzanne Salamon, the clinical chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center, urges them to dig deeper.

“We’re born with a certain amount of iron in the body, and it’s carried in the blood cells. When blood cells die, the iron is reused,” she explains. “So if your iron level starts to get low, you need to figure out why.”

Iron-sapping conditions

Menstruating women need more iron to replace blood lost through periods, which is why the Recommended Dietary Allowance (RDA) for women up to age 50 is 18 milligrams (mg) daily. But after menopause, the RDA for iron drops to just 8 mg for women 51 and older. (Pregnant women should get 27 mg of iron daily.)

“After menopause, you’re just like a man — you shouldn’t be losing iron,” Dr. Salamon says.

But a variety of situations and conditions — some of them stealthy — can indeed lead to low iron or iron loss. They include

• gastrointestinal bleeding (from ulcers, colon polyps, diverticulitis, diverticulosis, or cancer)
• celiac disease or gastric bypass surgery, which can lead to problems absorbing nutrients
• kidney disease
• certain medications that hinder iron absorption
• vegetarian or vegan diets that don’t include iron-fortified foods.

“It’s possible you may be eating enough iron but you may not be absorbing it well enough,” Dr. Salamon says. “But when I see someone with iron deficiency, there’s usually something wrong — often blood loss.”

Low iron symptoms

If you’re losing iron, it’s likely you’ll feel the effects. Signs of iron deficiency can include

• pale skin
• fatigue
• shortness of breath
• weight loss
• chest pain.

But don’t decide on your own to take iron supplements — or multivitamins that contain iron — if you’re having any of these symptoms. It’s crucial to get to the bottom of why they’re happening, Dr. Salamon says. Your doctor will likely perform tests to do so. (See “What iron testing involves.”)

“Testing can be a way we find colon or stomach cancer, or another reason for blood loss,” she says. “If you’re taking iron, it can mask the problem.”

Taking iron supplements unnecessarily can also lead to problems of its own. Too much iron in the body, called iron overload, can damage the heart, liver, pancreas, and other major organs as well as the joints.

Signs of iron overload may include joint pain, fatigue, and abdominal pain — nonspecific symptoms that can also occur with other issues.

“The body doesn’t just get rid of iron if there’s too much of it. It can really accumulate,” Dr. Salamon says. “It’s fine to take if you’re deficient, once you’ve figured out what’s causing that.”

Best iron supplements

Healthy women 60 and older can usually meet their needs through food, and the body absorbs iron from food more effectively than iron from supplements. Foods rich in iron include lean red meat, poultry, fish, beans, lentils, spinach, and fortified cereals.

If you still need more, which supplements can deliver? Various types line drugstore shelves, including ferrous sulfate and ferrous gluconate. While both are used to treat iron-deficiency anemia, ferrous sulfate is generally the better choice since it is better absorbed by the body, Dr. Salamon says. “Ferrous sulfate has more side effects, but it gives you a bigger bang for the buck — you get a lot more iron in it,” she says. But ferrous gluconate is an option if side effects from ferrous sulfate — such as nausea, diarrhea, or constipation — prove problematic.

Some studies suggest it is better to take iron pills every other day instead of every day, both to minimize side effects and to improve absorption. Iron infusions are also available by prescription for people who experience severe side effects from supplements, she notes.

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