A University of Michigan (UM) study found that 4 out of 10 girls and young women ages 12 to 21 have low iron levels that result in low energy, dizziness and other symptoms. What’s more, many of them are unaware that they have an iron deficiency.

UM researchers said this could be because regular health screenings for girls and young women generally do not include a ferritin test, a blood test that measures the body’s iron reserves, according to a UM article about the study.

Published in JAMA Network, the study also found that 1 in every 17 girls ages 12 to 21 years have iron levels low enough for an iron deficiency anemia diagnosis, which can lead to more severe health issues, such as heart failure, delayed growth and development, and problems during pregnancy, according to the Mayo Clinic.

The study utilized national data from a sample of young women who participated in a health survey conducted by the Centers for Disease Control and Prevention.

Researchers found that the overall iron deficiency rate in the group was 40% and that the rate was about 30% higher among young Latina and Black women compared with non-Hispanic white counterparts.

While menstruation has been linked to lower iron levels, 27% of girls who had not yet started their period already had low iron levels. The rate of iron deficiency in the remaining young women in the study group did not change with the number of years the young women had already started menstruating.

Angela Weyand, MD, the study’s lead author and a clinical associate professor of pediatrics at UM Medical School, said the findings underscore the need for routine screening of iron levels in adolescent and young women whether they have symptoms, which include fatigue, rapid heartbeat, headache, shortness of breath during exercise, cognitive or mental health issues or pale or yellow skin.

“Iron deficiency is an underrecognized problem with adverse impacts, but its symptoms and even those of anemia are normalized in young females,” Weyand told UM. “Why are we not screening for a condition that is highly prevalent, easily diagnosed, easily treated and associated with serious symptoms and increased risk of death if not addressed?”

Socioeconomic status may contribute to the likelihood of developing iron deficiency, according to study authors. In fact, nearly one third of young women in the study had family incomes below 130% of the poverty level. A slightly lower proportion of young women reported experiencing food insecurity. Both young women who experienced food insecurity and low-income young women were more likely to have anemia.

Weyand hopes the study findings will push health care providers to include ferritin tests in young women’s routine health screenings and advise them to eat iron-rich foods, such as fruits, vegetables, nuts, seeds and animal-based foods. For those with low iron levels, providers should recommend a multivitamin with iron or iron supplements, which are both effective and low cost.