Can daily Ibuprofen cause low iron in post-menopausal women?

Question

Hello doctor,

I am a 58‑year‑old postmenopausal female. I remain healthy, with anxiety and controlled blood pressure. Three months ago, I experienced fatigue and underwent bloodwork, which revealed ferritin at 28 ng/mL. My complete blood count (CBC), including hemoglobin and red blood cell readings, was normal. I have been supplementing with 65 mg of iron daily.

A recent follow‑up iron panel showed ferritin at 41 ng/mL, total serum iron at 52 µg/dL, total iron‑binding capacity (TIBC) at 365 µg/dL, and iron saturation at 14 percent. I researched online and noted that low iron saturation may sometimes be associated with gastrointestinal malignancies; however, I have no abdominal pain, I maintain normal bowel movements, and there is no bleeding.

I underwent a colonoscopy eight years ago, which yielded normal results. A recent CT scan, performed to evaluate lung nodules, which were found to be normal, noted that my esophagus and upper stomach were unremarkable. I take ibuprofen daily at doses of 600 mg or more, and I wonder whether this could be causing damage to my stomach lining and resulting in low iron saturation.

The CT scan also mentioned “inferior right hepatic lobe cysts” that were present on a prior CT scan done six years ago. I would appreciate your thoughts on whether anything in my presentation is worrisome with regard to GI cancer, and whether those liver cysts are cause for concern.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

With normal hemoglobin levels, you may have had relative iron deficiency; that is, your body’s need for iron in hemoglobin formation is relatively less compromised.

Iron is absorbed in the small intestine, especially the duodenum, which is the first part of the small intestine, and its absorption can be affected by multiple factors such as excessive coffee or tea consumption, long‑term calcium supplementation, and even long‑term use of NSAIDs (non-steroidal anti-inflammatory drugs) like Ibuprofen.

Your previous colonoscopy was normal, which is reassuring, and your recent CT scan shows a normal esophagus and stomach. In cases of gastrointestinal (GI) malignancy, anemia is more common than isolated iron deficiency. The GI tract can be evaluated with a simple stool test known as fecal occult blood testing or FIT (fecal immunochemical test) testing. For fecal occult blood testing, you must stop taking Ibuprofen; for FIT testing, you do not need to stop taking ibuprofen. This simple test can indicate GI blood loss (a yes or no result).

A liver lesion of similar size on the latest scan compared to the six-year-old scan could be a simple liver cyst; I do not think there is anything to worry about. Gynecological history is also important, especially considering your age. I assume that you do not experience monthly blood loss.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Answer 2

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

Yes, the FIT test will help you rule out gastrointestinal blood loss. This is what we use for screening the gastrointestinal tract before invasive workup. There are no gynecological-related losses, which is great.
Ibuprofen is a very good painkiller; however, iron deficiency or iron deficiency anemia can be a potential side effect. You can switch to a Paracetamol formulation, which is safe and will not cause stomach inflammation. You can also use ibuprofen occasionally rather than regularly.
You can take good dietary iron, especially meat products. This will help improve your body's iron stores while reducing ibuprofen intake.
You have already responded to oral iron supplements, so I expect that if you follow the above steps, your iron levels should improve.
You can share your FIT results once done; no issues.

I hope that this answers your query.

Kindly follow up if you have more doubts.