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Abstract
Background: Iron deficiency anemia (IDA) has a broad differential diagnosis. In postmenopausal women, the absence of menstrual blood loss increases the likelihood that iron deficiency reflects occult gastrointestinal blood loss or impaired absorption. Gastrointestinal malignancy is the most serious consideration, although nonmalignant conditions and normal examinations are more common. Objective: To summarize current evidence and guideline recommendations for the diagnosis, gastrointestinal evaluation, and treatment of IDA in postmenopausal women. Methods: Narrative synthesis of contemporary clinical practice guidelines, systematic reviews, meta-analyses, and selected primary studies. Results: A ferritin concentration below 45 ng/mL is a useful diagnostic threshold for iron deficiency in patients with anemia, although ferritin rises with inflammation. The American Gastroenterological Association (AGA) recommends bidirectional endoscopy as the initial gastrointestinal evaluation for unexplained IDA in postmenopausal women and men. Pooled diagnostic yield was 8.9% for lower-gastrointestinal malignancy and 2.0% for upper-gastrointestinal malignancy. Oral iron remains appropriate for most patients; intravenous iron is preferred when oral iron is not tolerated, ineffective, or unlikely to be adequately absorbed. Conclusions: Unexplained IDA in a postmenopausal woman warrants evaluation for an underlying cause rather than iron replacement alone. Bidirectional endoscopy is the central initial investigation.
Keywords: iron deficiency anemia; postmenopausal women; gastrointestinal malignancy; bidirectional endoscopy; colonoscopy; fecal immunochemical testing; iron replacement
Authors: Maha Mohieldin M Mohamed, MD; Osama Ibrahim E Ahmed, MD
Affiliation: Michigan State University, USA
Accepted: 3 October 2026 · Published: 6 October 2026 · Vol. 1, Issue 2 · pp. 12–15