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Summary Anaemia is common, particularly in women and the commonest underlying cause, iron deficiency, is often overlooked. Anaemia is associated with increased morbidity and mortality in patients undergoing anaesthesia; however, women are defined as being anaemic at a lower haemoglobin level than men. In this narrative review, we present the history of iron deficiency anaemia and how women’s health has often been overlooked. Iron deficiency was first described as ‘chlorosis’ and a cause of ‘hysteria’ in women and initial treatment was by iron filings in cold wine. We present data of population screening demonstrating how common iron deficiency is, affecting 12–18% of apparently ‘fit and healthy’ women, with the most common cause being heavy menstrual bleeding; both conditions being often unrecognised. We describe a range of symptoms reported by women, that vary from fatigue to brain fog, hair loss and eating ice. We also describe experiments exploring the physical impact of iron deficiency, showing that reduced exercise performance is related to iron deficiency independent of haemoglobin concentration, as well as the impact of iron supplementation in women improving oxygen consumption and fitness. Overall, we demonstrate the need to single out women and investigate iron deficiency rather than accept the dogma of normality and differential treatment; this is to say, the need to change the current standard of care for women undergoing anaesthesia.

Iron deficiency (ID) is the most common micronutrient deficiency in the world. It is of concern for women and girls of reproductive age as, despite frequent normalization, excessive menstrual blood loss and the iron demands associated with pregnancy increase the risk of developing an ID. Iron deficiency reduces health‐related quality of life with symptoms of fatigue, heart palpitations, difficulty concentrating, and poor mental health. When left untreated, ID can escalate to iron deficiency anemia (IDA), where there is an insufficiency of red blood cells, or hemoglobin within these cells, to meet the bodily demands for oxygen transport. Substantial guidance on screening for ID can be found in specific at‐risk groups, including pregnant women and patients with renal, cardiac, and inflammatory bowel disease. However, it was unclear whether guidance is available for women of reproductive age. We performed a literature search to explore the current recommendations for screening women of reproductive age for ID. While four manuscripts supportive of screening were found, no official guidance appears to exist regarding screening for this group. In line with the World Health Organization's 10 Principles of Screening, we present a case for ID screening in women and girls of reproductive age.

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