Polycystic ovary syndrome (PCOS) is a common hormonal disorder affecting approximately 8-13% of reproductive-aged women. It is characterized by irregular menstrual cycles, excess androgens, and/or polycystic ovaries. PCOS can lead to a variety of symptoms, including irregular periods, weight gain, excess hair growth, acne, and infertility. It is also linked to other chronic health conditions such as type 2 diabetes, high blood pressure, heart disease, and endometrial cancer.
If you have PCOS and are looking for birth control or help managing your symptoms, you may be wondering if an IUD is the right choice for you. IUDs are long-acting, reversible contraceptives that are highly effective at preventing pregnancy. There are two main types: hormonal and copper. This article will discuss what IUDs are, how they work, how IUDs affect PCOS, and what you should consider before getting one, focusing on the Mirena IUD and its potential impact on weight loss and symptom management.
Understanding IUDs: Types and Mechanisms
An intrauterine device (IUD), often called "the coil," is a small, T-shaped device inserted into the uterus by a doctor or nurse. According to the American College of Obstetricians and Gynecologists (ACOG), IUDs are over 99% effective at preventing pregnancy and can offer additional benefits depending on the type.
Copper IUD (Paragard)
- Hormone-free: This device does not contain hormones.
- Mechanism: It contains a small amount of copper, creating a hostile environment for sperm and preventing it from reaching the egg.
- Duration: It can last up to 12 years.
Hormonal IUDs (Mirena, Kyleena, Liletta, Skyla)
- Hormone Delivery: Sometimes referred to as an intrauterine system (IUS), these IUDs release the hormone progestin directly into the womb.
- Mechanism: Progestin prevents pregnancy by thickening the mucus in the cervix, making it difficult for sperm to pass through, and can sometimes prevent the ovaries from releasing an egg (ovulation).
- Duration: These last 3-8 years, depending on the brand. Mirena, specifically, is effective for up to 5 years.
IUDs and PCOS: A Viable Option?
Yes, you absolutely can get an IUD if you have PCOS. In fact, depending on your PCOS symptoms and why you need birth control, an IUD might be the best option for you. Your healthcare professional can discuss the different options available and which might suit you best.
How IUDs Affect PCOS Symptoms
Both hormonal and copper IUDs are highly effective at preventing pregnancies, but they work in different ways, which can have different effects on PCOS symptoms.
Read also: The Mirena IUD and Your Weight
Hormonal IUDs and PCOS Symptoms
These progesterone-only contraceptives can impact PCOS symptoms in the following ways:
- Regulate the Menstrual Cycle: Irregular periods are common in women with PCOS, and the hormonal IUD can help regulate the menstrual cycle.
- Lighten or Stop Heavy Periods: If you suffer from heavy periods, the hormonal IUD can significantly reduce the amount of bleeding you experience.
- Protect Against Endometrial Cancer: Women with PCOS are up to 5 times more likely to develop endometrial cancer (cancer of the lining of the womb). Using hormonal contraceptives like the combined oral contraceptive or the hormonal IUD can protect the endometrium and lower the risk of endometrial cancer. A 2023 meta-analysis supports this.
What the Hormonal IUD Won’t Do:
Unlike the combined oral contraceptive (COC), the hormonal IUD does not contain estrogen, meaning it has no anti-androgen effect. So, if you suffer from symptoms of high androgens such as excess hair growth or acne, the hormonal IUD is unlikely to improve this. However, other medications can be used alongside the hormonal IUD to treat the symptoms of high androgen.
Copper IUD and PCOS Symptoms
The copper IUD doesn’t contain any hormones, meaning it is unlikely to have an effect on your PCOS symptoms and does not reduce the risk of endometrial cancer. The copper IUD is a good option for women with few PCOS symptoms who are looking for a hormone-free, long-acting contraceptive. However, it is not recommended for people with very irregular or heavy periods, and some find that copper IUDs can worsen cramps, regularity, and flow.
Mirena IUD: Specific Considerations for PCOS
Mirena is a hormonal IUD that releases progestin, a synthetic form of progesterone, to prevent pregnancy. It is over 99% effective and can be used for up to 5 years. Mirena thins the uterine lining, thickens cervical mucus, and inhibits sperm movement. This may lead to shorter, lighter, or even absent periods, which can be appealing for women with PCOS who experience heavy or irregular bleeding.
Potential Benefits of Mirena for PCOS
- Symptom Relief: Mirena offers temporary relief from PCOS symptoms such as irregular periods, cramping, and heavy bleeding.
- Endometrial Cancer Protection: It may also help protect against endometrial cancer, which women with PCOS are at higher risk of developing.
- Reduction of Endometrial Hyperplasia Risk: Levonorgestrel reduces the risk of endometrial hyperplasia by thinning the uterine lining.
Potential Drawbacks of Mirena for PCOS
- Temporary Relief: The effects of Mirena are temporary. Once the IUD is removed, PCOS symptoms may return.
- No Anti-Androgen Effects: Mirena does not contain estrogen and will not improve symptoms of high androgens, such as acne or excess hair growth.
- Potential Side Effects: There is a low risk of side effects, including headache, acne, breast tenderness, and mood changes such as anxiety or depression. It is also important to consider potential Mirena IUD neurological side effects and discuss them with your healthcare provider.
Mirena and Weight Loss: What the Research Suggests
While Mirena is not specifically a weight loss device, some women with PCOS have reported weight loss after getting the Mirena IUD.
Read also: Guide to PCOS Exercise
Personal Anecdotes
One woman with PCOS shared her experience of losing weight after getting the Mirena IUD. She had previously struggled with heavy periods and PCOS symptoms that did not improve with birth control pills. After getting the Mirena IUD, she experienced lighter periods and noticed that the extra puffiness around her middle seemed to melt away. Her sweet cravings also disappeared.
Research on Weight Loss and Progestin Treatment
A study published on the National Institutes of Health website found that weight loss improves response rates in women with obesity and atypical hyperplasia or low-risk endometrial cancer undergoing conservative management with intrauterine progestin. The study found that women who lost more than 10% of their total body weight were more likely to respond to progestin treatment.
The study suggests that weight loss, whether through bariatric surgery or low-calorie diet, can improve oncological outcomes in women with obesity and endometrial neoplastic abnormalities undergoing progestin treatment.
Considerations
It is important to note that the link between Mirena and weight loss is not fully understood, and more research is needed. Weight loss may be related to a combination of factors, including hormonal changes, lifestyle changes, and overall health improvements.
Pros and Cons of Using Hormonal IUDs for PCOS
Pros:
- 99% effective at preventing pregnancy
- Long-term (some can last up to 8 years before they need replacing)
- Can reduce heavy bleeding
- Can regulate your menstrual cycle
- Requires minimal maintenance, and effectiveness is not compromised during illness
- Can be used for women when COC is contraindicated (for example, for women who are at high risk for blood clots)
- Safe to use while breastfeeding
- Can be used as emergency birth control within 5 days of unprotected sex
- Reduces the risk of endometrial cancer
Cons:
- Possible side effects include spotting, acne, cramping, pelvic pain, and headaches
- Baseline fertility returns almost immediately after removal
- Won’t improve symptoms of high androgen like excess hair growth or acne
- Cannot be used in women who have a history of breast or cervical cancer
- Cannot be used in women who have a pelvic infection
- Cannot be used in women who have vaginal bleeding with no known cause
Important Considerations When Choosing an IUD for PCOS
If you’re thinking about getting an IUD, the best thing to do is chat with your healthcare provider. They will be able to tell you what options are available and which could work best for you. Here are a few key things to think about before deciding on an IUD for PCOS:
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- Personal Needs: Are you looking to prevent pregnancy, or are you hoping to manage PCOS symptoms as well?
- Lifestyle and Contraceptive Needs: An IUD is a low-maintenance option that doesn’t require you to remember to take it, lasts for years, and isn’t affected by common illnesses like vomiting or diarrhea.
- Side Effects and Personal Comfort: Side effects like lighter periods might be beneficial to you, but if you’re looking for something to help with broader PCOS symptoms like excess hair growth, then an IUD might not be the best fit.
- Individual Health Needs: Depending on your individual health, your birth control options might be more limited. In general, an IUD can be used by women who are at higher risk of developing a blood clot and therefore can't take the COC.
Alternatives to IUDs for PCOS Management
If you’re unsure if an IUD is right for you, remember you have a few other options for contraceptives that don’t negatively impact your hormone balance.
Other Contraceptive Options
- Natural Family Planning: This method involves tracking your menstrual cycle and avoiding intercourse during fertile periods.
- Condoms: Condoms are a barrier method of contraception that can help prevent pregnancy and STIs.
Lifestyle Changes
- Diet: Making dietary changes, such as reducing processed foods and increasing whole foods, can help manage PCOS symptoms.
- Exercise: Regular exercise can help improve insulin sensitivity, reduce weight, and improve overall health.
- Supplements: Certain supplements, such as inositol and omega-3 fatty acids, may help improve PCOS symptoms.