Gynecology & Reproductive Health
Open AccessThe Impact of Obesity on Hormonal IUD versus Copper IUD Failure: A Comprehensive Systematic Review
Authors: Amber Khemlani, Vanchi Ly, Joshua Singavarapu, Ranjitha Vasa, Ozgul Muneyrrici-Delale, Mudar Dalloul.
Abstract
Introduction: Obesity is a growing global health concern that significantly affects female reproductive health and may alter contraceptive efficacy. Given the increasing prevalence of obesity worldwide, it is essential to understand how elevated body mass index (BMI) impacts the performance of hormonal and copper intrauterine devices (IUDs). This systematic review evaluates current evidence on the influence of obesity on IUD failure, aiming to clarify inconsistencies and guide clinical recommendations for contraceptive counseling in this population.
Methods: A systematic review was conducted using PubMed, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from April to July 2025. Studies published between 2010 and 2025 in English and classified as meta-analyses or systematic reviews were included. Two independent reviewers screened titles, abstracts, and full texts according to predefined inclusion and exclusion criteria, extracted relevant data, and assessed risk of bias. Discrepancies were resolved through discussion.
Results: Of 13,713 studies identified, eight met the inclusion criteria. Most studies concluded that IUD efficacy is generally unaffected by BMI, with both levonorgestrel-releasing (LNG-IUS) and copper IUDs maintaining high contraceptive effectiveness across weight categories. Some evidence indicated higher expulsion rates in individuals with class III obesity (BMI ≥40 kg/m²), but no significant increase in pregnancy or overall failure rates. Copper IUDs consistently demonstrated stable performance in both routine and emergency contraception, while LNG-IUS efficacy appeared locally preserved despite lower systemic levonorgestrel levels in obese users.
Conclusions: Current evidence suggests that obesity does not significantly compromise the contraceptive efficacy of hormonal or copper IUDs, though higher expulsion rates in morbid obesity may warrant attention. However, existing studies are limited by small sample sizes, lack of BMI-stratified outcomes, and heterogeneity in defining IUD failure. Further high-quality, obesity-focused research is needed to strengthen evidence-based contraceptive guidance and ensure equitable reproductive care for individuals with obesity.
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