Iron Supplementation in Female Athletes - A Review of Current Recommendations

Abstract

Background. Iron deficiency is the most prevalent nutritional deficit in female athletes, affecting up to 60% depending on discipline, training load and menstrual status. Despite its impact on endurance, oxygen transport and recovery, sport-specific recommendations remain fragmented across haematology, sports medicine and nutrition.

Aim. To synthesize current evidence on the epidemiology, pathophysiology, diagnosis and treatment of iron deficiency in female athletes, and to propose an integrated set of supplementation recommendations aligned with international guidelines.

Material and methods. A structured narrative review using PubMed/MEDLINE, Web of Science and Scopus (2016–2026), prioritizing systematic reviews, meta-analyses and consensus statements from the IOC, the British Society of Gastroenterology, the European Hematology Association and the International Society of Sports Nutrition. Twenty-five sources met the criteria.

Results. Female athletes show markedly higher prevalence of iron deficiency than males and non-athletic women. Ferritin < 30 µg/L (and 40–50 µg/L under intensive training) is broadly endorsed. Oral iron improves ferritin and exercise performance, greatest when baseline ferritin ≤ 30 µg/L; daily and alternate-day regimens show comparable efficacy but different tolerability. Intravenous iron restores stores in non-responsive or severely depleted athletes but does not clearly improve performance in non-anaemic subjects. Iron status is closely linked to the energy-availability spectrum and the Relative Energy Deficiency in Sport (REDs).

Conclusions. A risk-stratified model of screening, individualized oral supplementation and judicious intravenous iron, embedded in the REDs framework and coordinated across sports medicine, haematology and nutrition, constitutes the most defensible current standard of care.