Iron Deficiency in Female Endurance Athletes: The Role of Hepcidin Regulation, Training Load, and Dietary Strategies in Optimizing Performance and Health

Purpose: Examine iron deficiency (ID) mechanisms in female endurance athletes, focusing on hepcidin dysregulation, training impacts, and dietary strategies. Materials and Methods: Systematic review of 30 years of research on IL-6/hepcidin pathways, menstrual iron loss, supplementation (oral/IV), and dietary iron bioavailability. Data included hormonal studies, biomarker tracking (ferritin, CRP), and trials. Basic Results: Post-exercise hepcidin surges (peaking 6h) cut absorption 30-50%. Menstrual losses (0.5–2 mg/day) worsen depletion. Tapering cut hepcidin 35%; follicular-phase iron intake improved absorption. Oral iron (100mg/d) raised ferritin 20-30µg/L; IV iron boosted performance 8-12% in severe deficiency. Borderline cases (ferritin 30-50) had variable outcomes. Conclusions: Integrated strategies: hepcidin-aware training, cycle-aligned nutrition (heme iron + vitamin C), ferritin monitoring (>30µg/L). Future research on progesterone’s hepcidin effects and improved iron formulations. Holistic ID management boosts performance/health.