Trends and Clinical Outcomes of Anemia in Women of Reproductive Age: A Retrospective Study Across India

Background Iron deficiency anemia (IDA) is highly prevalent among women of reproductive age. Despite the wide availability of oral iron formulations, real-world evidence on prescribing practices, treatment outcomes, and patient experiences remains limited. This retrospective, questionnaire-based study evaluated clinical management strategies for anemia in women, focusing on the comparative effectiveness and tolerability of commonly used oral iron salts. Methods This retrospective, multicentric, observational study analyzed anonymized electronic medical records (2018-2024) of anemic women aged 15-49 years across diverse Indian regions. A structured digital questionnaire captured patient-reported symptoms, treatment preferences, and management strategies. The impact of oral iron supplements on hemoglobin, hematocrit, ferritin levels, quality of life, and their associated safety profiles was evaluated. Newer-generation iron formulations were excluded to maintain data uniformity. Results Participants (ages 15-49 years, mean 32.79) were drawn from all major regions of India, providing a geographically diverse representation. Hemoglobin was the main diagnostic criterion (91.01%). Anemia severity was moderate in 46.62%, mild in 44.01%, and severe in 9.37%, with iron deficiency as the leading cause in 95.80% cases. All iron supplements showed significant improvement (all p < 0.001) in hemoglobin, hematocrit, and ferritin. Ferrous fumarate, the most frequently prescribed iron salt, likely due to its high elemental iron content and convenient dosing regimen, demonstrated significant improvement in hemoglobin levels, increasing from 8.67 ± 1.12 to 11.66 ± 1.18 g/dL. The greatest hemoglobin rise was seen with ferrous fumarate (2.99 ± 1.45 g/dL), followed by ferrous sulfate (2.45 ± 1.29), ferrous ascorbate (2.31 ± 1.27), and ferrous gluconate (1.98 ± 1.38). Quality of life improved most with ferrous fumarate (90.10% reporting better overall health). Adverse events were reported in 29% of participants, most commonly constipation (39.06%). Conclusion This large-scale, real-world analysis reinforces the central role of oral iron salts in managing IDA among women of reproductive age in India. Ferrous fumarate emerged as the most effective formulation, delivering superior hematologic improvements and quality of life gains with an acceptable safety profile. Notably, its efficacy may be further enhanced when combined with absorption-promoting agents such as protein hydrolysates, which improve non-heme iron solubility and bioavailability. These findings underscore the importance of evidence-based, patient-tailored supplementation strategies and highlight the potential of optimizing existing formulations with synergistic enhancers to strengthen national anemia control efforts.