This is National Women’s Health Week. I am trying to highlight key health-related news all week. This night’s post also comes from the latest ACOG 2017 meeting from last week.
Obesity is already a risk factor for various health conditions, such as diabetes, cardiovascular diseases and so on. For long term, reversible contraception, it is recommended that obese women opt for IUD over oral pills or patches, as the chances of venous thromboembolism is higher in obese and overweight women, than in women of normal weight. Please see referenced link below. It is an earlier paper by the same lead author/group as the current one, coming from Hawaii.
Weight classification, takes women and men from underweight to normal weight, overweight and obese. Within obesity, depending on waist size, the classification goes from Class I to Class III, representing extreme obesity. I have attached an NIH reference for your convenience.
It appears that in women with Class III obesity, IUDs can shift inside the uterus, also commonly termed IUD expulsion, at a higher rate than in women of other weight classes. This was the focus of the presentation at ACOG last week.
The current study
A retrospective cohort study, in Hawaii, with access to a diverse population including approximately a third each of Asian women and Native Pacific Islanders, has shown that obese women with Class III obesity have a risk, that is 3.06 times other women. Read other details in the paper summary and the article linked below.
The study itself was only performed, retrospectively to titrate risks. Some theories have been presented by the authors.
Placement itself might pose difficulties because of obesity.
Another risk of obesity is heavy menstrual bleeding, and therefore, IUD expulsions might be encouraged.
The authors however continue to encourage the use of IUDs in all women, regardless of body weight, as the benefits outweigh risks.
While on one end, further studies are needed, and will likelihood indicate why IUD expulsions occur at a higher rate in obese women, women should not stop opting for IUDs.
Additional studies that describe the causes for IUD expulsion might indicate that it is solely not a function of obesity, and it has already been shown that obesity is but one risk factor for expulsion.
Knowing why IUDs dislodge or move would make for better IUD design!
Until the reasons are known and designs could be potentially improved, for the long term, women should focus on efforts that help them lose weight, in a healthy and practical manner.
- ACOG Presentation Summary: http://mobile.journals.lww.com/greenjournal/Abstract/2017/05001/Levonorgestrel_Intrauterine_Device_Complications.235.aspx
- A previous article by the same group: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642497/
- The mdedge article http://www.mdedge.com/clinicalendocrinologynews/article/137744/gynecology/beware-hormonal-iud-expulsion-obese-women?channel=261&utm_source=News_CEN_eNL_051317_F&utm_medium=email&utm_content=Are%20some%20obese%20women%20having%20issues%20with%20IUDs?
- NIH Weight Classification: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmi_dis.htm
- Some information on IUD Expulsion and what to do: http://www.healthline.com/health/birth-control/iud-fell-out#5
- Retrospective Cohort Studies: https://en.wikipedia.org/wiki/Retrospective_cohort_study
- Image Courtesy, Pexels: https://www.pexels.com/photo/backlit-beach-dawn-dusk-227674/