Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review

Contraception. 2013 Apr;87(4):486-96. doi: 10.1016/j.contraception.2012.09.025. Epub 2012 Nov 2.


Background: The use of intrauterine devices as a contraceptive method has been steadily growing in developing countries. Anemia in reproductive-age women is a growing concern in those settings.

Study design: A systematic review of studies with measured hemoglobin and serum ferritin at baseline and after 1 year of use of copper intrauterine devices (IUDs) or a levonorgestrel-releasing intrauterine system (LNG IUS) was performed.

Results: Fourteen studies involving copper IUDs in nonanemic women and 4 studies in anemic women and 6 involving the LNG IUS met the criteria for the systematic review. Meta-analyses for hemoglobin changes showed significant decreases for users of copper IUDs and an increase for the LNG IUS, but with limited data. In general, ferritin levels followed the same pattern.

Conclusion: Decreases in hemoglobin mean values in copper IUD users were not sufficient to induce anemia in previously nonanemic women. Women who are borderline anemic would likely benefit from using the LNG IUS.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Anemia / blood
  • Anemia / drug therapy
  • Anemia / etiology
  • Contraceptive Agents, Female / administration & dosage
  • Contraceptive Agents, Female / blood
  • Female
  • Ferritins / blood*
  • Hemoglobins / metabolism*
  • Humans
  • Intrauterine Devices, Copper* / adverse effects
  • Levonorgestrel / administration & dosage
  • Levonorgestrel / adverse effects
  • Levonorgestrel / blood*


  • Contraceptive Agents, Female
  • Hemoglobins
  • Levonorgestrel
  • Ferritins