Australian women are turning to intravenous iron at a rate that has increased dramatically over the past decade, according to a population-based study from researchers at Flinders University, the South Australian Health and Medical Research Institute and collaborating institutions. Analysis of Pharmaceutical Benefits Scheme data shows that intravenous iron use among women aged 18 to 44 rose from 0.3 women per 100 in 2013 to 5.0 per 100 in 2024. In practical terms, that means approximately one in 20 women of reproductive age received intravenous iron in 2024, marking a 17-fold increase over the study period. The researchers say the trend reflects growing recognition of iron deficiency as a significant and treatable contributor to fatigue, impaired concentration, reduced physical capacity and diminished quality of life. At the same time, the scale and uneven distribution of treatment raise questions about clinical decision-making, affordability and equitable access to care.
Iron deficiency is particularly common during the reproductive years because women can lose iron through menstrual bleeding and may require additional iron during pregnancy, childbirth and breastfeeding. Iron is essential for producing haemoglobin, the oxygen-carrying protein in red blood cells, as well as for energy metabolism, muscle function and several cellular processes. When iron stores become depleted, the body initially attempts to preserve haemoglobin production by drawing on ferritin stored in tissues. If deficiency progresses, iron-deficiency anaemia can develop, reducing the blood’s capacity to transport oxygen. Symptoms may appear before anaemia is diagnosed and can include persistent tiredness, headaches, shortness of breath during exertion and difficulty concentrating. Oral iron tablets are commonly used to restore iron, but absorption can be limited, and gastrointestinal side effects such as nausea, abdominal discomfort, constipation or diarrhoea can make sustained treatment difficult.
Intravenous iron bypasses the gastrointestinal tract and delivers iron directly into the bloodstream, where it is taken up primarily by cells of the reticuloendothelial system. These cells process the iron-containing complex and gradually release iron for incorporation into haemoglobin and replenishment of storage proteins such as ferritin. Depending on the formulation and the patient’s clinical circumstances, a substantial amount of iron can be administered in one or a small number of infusions, potentially restoring iron stores more rapidly than oral treatment. This can be useful when oral iron has failed, cannot be tolerated, is unlikely to be absorbed adequately, or when rapid replacement is medically necessary. However, intravenous treatment requires administration in a clinical setting and is not risk-free. Infusion reactions, temporary changes in laboratory measurements and, rarely, serious complications can occur, while inappropriate treatment may delay investigation of the underlying cause of iron loss.
The economic consequences of the increase are also substantial. Government and patient spending on intravenous iron medicines alone climbed from approximately 1.1 million Australian dollars in 2013 to more than 82 million dollars in 2024, according to the study. The researchers note that the medicine cost captured in PBS data does not represent the full financial burden for patients. Some private clinics charge several hundred dollars for an infusion, and additional expenses may include consultation fees, pathology testing and travel. These costs can be especially significant for people without concession benefits or for those requiring more than one infusion. Although intravenous iron may reduce the inconvenience of prolonged oral therapy for some patients, the price of treatment could also influence whether a person begins therapy, returns for a recommended dose or completes the prescribed course.
The study found that nearly one in four women did not complete their prescribed intravenous iron treatment course. The available data cannot establish why treatment was incomplete, but the researchers identify several possible explanations. Some women may have experienced an improvement in symptoms after an initial infusion and decided that further treatment was unnecessary. Others may have faced out-of-pocket costs, difficulty attending appointments or uncertainty about the need for additional doses. The finding is clinically important because an early improvement in energy does not necessarily mean that iron stores have been fully restored or that the source of iron loss has been addressed. Without appropriate follow-up, deficiency can recur, particularly when heavy menstrual bleeding, pregnancy-related demands or another ongoing condition continues to increase iron requirements.
Ferric carboxymaltose, a newer intravenous iron formulation, accounted for almost 94 per cent of prescriptions in 2024. The formulation can deliver relatively large doses in a limited number of administrations, which may help explain its widespread use. General practitioners issued more than 60 per cent of intravenous iron prescriptions in 2024, indicating that treatment has increasingly moved into primary care rather than remaining concentrated in hospitals or specialist services. Yet the researchers found substantial variation in the overall rate of treatment and in the type and dose of iron prescribed. Differences were associated with where women lived, their age, concession card status and the type of clinician involved in prescribing. In some regions, treatment rates were more than three times higher than in others, a disparity that cannot be explained solely by the national prevalence of iron deficiency.
Associate Professor Luke Grzeskowiak of Flinders University’s College of Medicine and Public Health, the study’s senior author, says intravenous iron can be an important option for women whose symptoms persist despite oral treatment or who experience troublesome side effects. By replenishing iron stores more quickly, an infusion may help patients recover function and wellbeing sooner. Nevertheless, he and his colleagues emphasise that the growing use of intravenous iron should remain grounded in evidence-based assessment. Iron deficiency is not itself a final diagnosis: clinicians may need to investigate menstrual blood loss, pregnancy, dietary insufficiency, gastrointestinal bleeding, malabsorption or other medical conditions. Treating laboratory results without considering the cause can provide temporary correction while allowing a potentially important source of iron loss to continue unnoticed.
Lead author Dr Gizat Kassie of SAHMRI says the geographic and demographic variation raises questions about whether Australian women are receiving equitable access to the most appropriate treatment. Regional differences may reflect genuine variation in disease burden, differences in prescribing practices, access to pathology or specialist care, and local availability of infusion services. Socioeconomic factors may also affect treatment decisions and completion. Women with concession cards appeared in a different treatment pattern from those without them, highlighting how financial circumstances can shape the practical use of a therapy that may be clinically appropriate. The researchers say further work is needed to determine whether the observed variation represents under-treatment in some communities, overuse in others, or a mixture of both. The PBS analysis describes prescribing patterns but cannot determine whether every infusion was clinically necessary or whether untreated deficiency remained widespread.
Published in the Internal Medicine Journal, the study provides one of the clearest national pictures yet of how intravenous iron has entered routine care for Australian women of reproductive age. Its findings do not suggest that intravenous iron should replace oral iron as a first-line option in every situation, nor do they imply that all women with fatigue require an infusion. Instead, the results point to the need for consistent assessment, transparent discussion of benefits and risks, attention to the cause of deficiency and follow-up that confirms whether iron stores have been adequately restored. As demand continues to rise, policymakers and clinicians will also need to consider how treatment costs, prescribing standards and regional service availability affect access. The researchers argue that intravenous iron should remain a targeted, effective intervention—available when indicated, affordable enough to complete and delivered consistently across Australia.
Subject of Research: People; Australian women of reproductive age
Article Title: Increasing utilisation of intravenous iron among Australian women of reproductive age, 2013–2024: an Australian population-based study
Web References: https://doi.org/10.1111/imj.70494; https://www.flinders.edu.au/people/luke.grzeskowiak; https://sahmri.org.au/people/gizat-molla-kassie
References: Kassie GM, Jackson H, Clarke L, Gonete K, Ilomaki J, Whitehead CL, Green T, Grzeskowiak LE. “Increasing utilisation of intravenous iron among Australian women of reproductive age, 2013–2024: an Australian population-based study.” Internal Medicine Journal. DOI: 10.1111/imj.70494
Image Credits: Flinders University; Associate Professor Luke Grzeskowiak, College of Medicine and Public Health, Flinders University
Keywords: intravenous iron, iron deficiency, iron-deficiency anaemia, women’s health, reproductive age, ferric carboxymaltose, Pharmaceutical Benefits Scheme, primary care, Australia, public health
