Comparison of Ferrous Salt vs. Liposomal Iron in Adult Women With Iron-Deficiency Anemia

Iron-deficiency anemia is the most common type of anemia worldwide and disproportionately affects adult women, particularly those with chronic or abnormal uterine bleeding. This condition can lead to fatigue, reduced physical and cognitive performance, and impaired quality of life. Oral iron supplementation is the standard first-line treatment; however, conventional ferrous salt formulations are frequently associated with gastrointestinal side effects that limit adherence and reduce treatment effectiveness in real-world settings.

Ferrous salts, such as ferrous fumarate, are effective in replenishing iron stores but often cause nausea, abdominal discomfort, constipation, or diarrhea. These adverse effects may lead to poor compliance or early discontinuation. Recent evidence suggests that alternate-day dosing of ferrous salts may improve tolerability by reducing intestinal iron overload and hepcidin-mediated absorption blockade, but comparative data remain limited.

Liposomal iron is an alternative oral formulation in which iron is encapsulated within phospholipid vesicles. This technology allows iron to be absorbed through different intestinal pathways, reducing direct contact with the gastrointestinal mucosa and potentially minimizing adverse effects. Liposomal iron may therefore offer similar or improved efficacy with better tolerability, but clinical evidence comparing it directly with standard ferrous salts in adult women with iron-deficiency anemia is still insufficient.

This study is designed as a prospective, randomized, controlled clinical trial to compare the effectiveness and tolerability of three oral iron supplementation strategies in adult women with iron-deficiency anemia secondary to abnormal uterine bleeding. Eligible participants will be randomly assigned to one of three treatment groups: daily ferrous salt, ferrous salt administered every other day, or daily liposomal iron. All treatments will be administered orally for a total duration of three months.

The primary outcome of the study is the change in hemoglobin concentration from baseline to the end of treatment. Secondary outcomes include changes in iron metabolism parameters (such as ferritin and serum iron), red blood cell indices, frequency of gastrointestinal adverse events, and rates of treatment intolerance or discontinuation.

Participants will undergo baseline clinical evaluation and laboratory testing before starting treatment. Follow-up assessments will be conducted to monitor hematologic response, adherence, and safety. Adverse events will be documented throughout the study period. The study aims to identify whether liposomal iron or modified dosing of ferrous salts can provide a more tolerable and effective treatment option for women with iron-deficiency anemia.

By comparing these commonly used oral iron strategies, this study seeks to generate evidence that may inform clinical decision-making and optimize anemia management, with the goal of improving patient adherence, treatment outcomes, and overall quality of care.

Inclusion criteria

• Female patients of reproductive age (15 to 49 years) with a diagnosis of iron-deficiency anemia secondary to dysfunctional uterine bleeding.
• Patients with iron-deficiency anemia who are treatment-naïve or whose last administration of iron therapy, either oral or parenteral, occurred at least three months prior to enrollment and who continue to have anemia.
• Patients with a functional oral route.
• Signed informed consent.

Exclusion criteria

• Patients with abnormal uterine bleeding secondary to cancer
• Severe intolerance to iron supplementation
• Patients with gastritis or chronic use of proton pump inhibitors
• Concomitant treatment with dietary supplements rich in calcium, magnesium, or zinc
• Patients with endocrine disorders (hypothyroidism, hyperthyroidism)
• Uncontrolled type 2 diabetes mellitus
• Associated gastrointestinal bleeding
• Patients with esophageal disorders