Systemic iron homeostasis in female athletes: hepcidin, exercise and sex influence

Abstract

Iron is necessary for adequate deliver oxygen to the tissues since it is an essential component of the haemoglobin. However, iron deficiency remains a common problem among athletes, particularly for women experiencing the menstrual bleeding every month. The iron losses through menstrual blood loss during the early follicular phase (or menses) and an inadequate dietary intake of iron are two important factors contributing to this disease. Furthermore, the large hormonal changes that women experience along the menstrual cycle, especially in oestrogen and progesterone may influence on the optimization of iron absorption. Iron absorption is mainly mediated by hepcidin hormone, which seems to be affected by several stimulus and factors such as oestrogen and progesterone concentrations. Moreover, the regular practice of exercise is another important modulator of this hormone. Therefore, premenopausal active females are the most susceptible population to develop an iron deficiency or iron deficiency anemia, affecting their health and performance due to the less iron availability within the body and consequently a reduction of haemoglobin which compromise the oxygen transport. To date, most studies have not explored the acute post-exercise hepcidin response taking endogenous and exogenous sexual hormones influence into account. This narrative review will focus on how iron homeostasis is modulated by different factors mainly influenced by exercise and female sexual hormones.

Serum iron availability, but not iron stores, is lower in naturally menstruating than in oral contraceptive athletes

“…By reducing menstrual bleeding, ferritin —the primary form of stored iron in cells— and iron concentrations may be enhanced in users of combined OC compared to women with natural menstrual cycles (Barba‐Moreno, Alfaro‐Magallanes, Calderón, & Peinado, 2020). Screening for ID is widely recommended in premenopausal female athletes (Barba‐Moreno et al, 2020); however, the effects of the hormonal fluctuations that occur during the menstrual cycle and OC cycle on iron markers in the athlete population present conflicting results. It should be noted that few studies have evaluated iron markers within the menstrual cycle or OC cycle in female athletes and furthermore, these studies present a diverse methodology in terms of identifying the phases of the menstrual and OC cycle.…”

“…The former frequently use different types of oral contraceptives (OCs) to control their menstrual cycles, reduce menstrual symptoms and shorten menstruation (Schaumberg et al, 2018). By reducing menstrual bleeding, ferritin —the primary form of stored iron in cells— and iron concentrations may be enhanced in users of combined OC compared to women with natural menstrual cycles (Barba‐Moreno, Alfaro‐Magallanes, Calderón, & Peinado, 2020). Screening for ID is widely recommended in premenopausal female athletes (Barba‐Moreno et al, 2020); however, the effects of the hormonal fluctuations that occur during the menstrual cycle and OC cycle on iron markers in the athlete population present conflicting results.…”

Antioxidative behavior of a2-macroglobulin in intervertebral disc degeneration

“…Liver is responsible for the production of hepcidin, and any imbalance in the levels of this hormone is due to various reasons, such as inflammations, disruption of erythropoiesis process, or the interference of genetic factors, eventually that lead to abnormal levels of iron in the blood (9). Iron absorption is controlled by hepcidin, and this ability is influenced by many factors such as sex hormones such as estrogen and progesterone (10). Trans plays an important role in the metabolism of iron and its transfer to the cells of the body and also acts as a growth factor.…”