IUD and PCOS: Copper or Hormonal

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition affecting many women. This condition can cause a multitude of symptoms, including irregular menstrual cycles, infertility, and hormonal imbalances. These symptoms can greatly affect the quality of life for affected women. One of the major challenges for women with PCOS is finding a contraceptive method that is not only effective but does not exacerbate existing symptoms. The intrauterine device (IUD) is a popular option. In this article, we will explore in depth the relationship between the IUD and PCOS, examining the advantages, disadvantages, and debunking some misconceptions.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects about 10% of women of reproductive age. This condition is characterized by the presence of multiple follicles on the ovaries, irregular menstrual cycles, insulin resistance, and increased levels of androgens (male hormones) in the body. These hormonal imbalances can lead to various symptoms, such as:

• Infertility: Due to irregular cycles and lack of ovulation.
• Acne and Hirsutism: Resulting from elevated androgen levels.
• Weight Gain: Often related to insulin resistance.
• Fatigue and Depression: Related to hormonal imbalances and the psychological effects of PCOS.

Treatment for PCOS varies based on symptoms but often includes lifestyle changes, medications to regulate menstrual cycles, and treatments to manage insulin and androgen levels, as well as dietary supplements. You are in the right place.

The IUD: What is it?

The intrauterine device (IUD) is a small T-shaped device inserted into the uterus to prevent pregnancy. There are two main types of IUDs:

• Copper IUD: A non-hormonal device where copper acts as a spermicide, preventing sperm from fertilizing an egg.
• Hormonal IUD: It releases a small amount of progestin, a hormone that thickens cervical mucus, making it more difficult for sperm to pass through, and can also prevent ovulation.

The Copper IUD and PCOS

Advantages of the Copper IUD for Women with PCOS

The copper IUD is a non-hormonal contraceptive method, which means it does not interfere with the body’s hormone levels. For women with PCOS, this point is crucial because hormonal contraceptives can sometimes worsen certain symptoms of PCOS, such as acne, weight gain, and mood swings.

• No Hormones: The main advantage of the copper IUD for women with PCOS is that it does not contain hormones. This means there is no risk of increasing androgen levels or exacerbating insulin resistance.

• Long-Term Effectiveness: Once inserted, the copper IUD can remain in place and be effective for 5 to 10 years, making it a convenient option for women who do not want to think about daily contraception.

• No Effect on Natural Cycle: Unlike hormonal contraceptives, the copper IUD does not alter the natural menstrual cycle, which can be beneficial for women who want to monitor their cycles or who are working to stabilize their periods naturally.

Disadvantages of the Copper IUD for Women with PCOS

Despite its advantages, the copper IUD also has some drawbacks, especially for women with PCOS:

• Heavier and More Painful Periods: One of the most common side effects of the copper IUD is increased menstrual flow and cramping. For women with PCOS, who may already have irregular and painful periods, this can worsen the situation.

• Risk of Anemia: Heavier periods can increase the risk of anemia, especially in women who already experience fatigue and low iron levels due to PCOS.

• Increased Risk of Infections: Although rare, the use of a copper IUD can increase the risk of vaginal infections, which may be concerning for women with weakened immune systems or those prone to infections.

• Vaginal Microbiome - Yeast Infections and IUD: This phenomenon could be explained by several factors. First, the copper in the device has an acidifying effect on cervical mucus, which can disrupt the natural pH of the vagina. An overly acidic or basic pH can imbalance vaginal flora, promoting infection development. The impact of the IUD on menstrual flow can also alter vaginal pH, as menstrual blood tends to make the pH more basic, encouraging the growth of bacteria responsible for vaginosis.

• Excess Copper: Excess copper, potentially exacerbated by the IUD, can lead to various disorders such as migraines, fatigue, and zinc deficiencies, the latter being crucial for skin, hair, and nail health.

• IUD and Urinary Tract Infections: Even though the copper IUD does not introduce bacteria causing these infections, the inflammatory state it may induce could create a favorable environment for infection development, making urinary tract infections more frequent for some users. It is therefore essential to monitor symptoms and discuss these potential risks with a healthcare provider when choosing this contraceptive method.

• Copper IUD and Weight Gain: There is no direct link between the use of a copper IUD and weight gain, unlike some hormonal contraceptive methods (such as the pill or hormonal IUD) that may, in some cases, lead to water retention or metabolic changes resulting in weight gain.

The Hormonal IUD and PCOS

In France, four types of hormonal IUDs are available on the market: DONASERT, JAYDESS, KYLEENA, and MIRENA. Women who use a hormonal IUD are generally over 35 years old and often have more gynecological history compared to those opting for a copper IUD. The hormonal IUD is prescribed by a doctor and is reimbursed 65% by health insurance.

Advantages of the Hormonal IUD for Women with PCOS

The hormonal IUD, such as Mirena, releases a small amount of progestin, a hormone that can be beneficial for women with PCOS in several ways:

• Regulation of Menstrual Cycles: The hormonal IUD can help regulate menstrual cycles, reduce heavy and painful periods, and even stop periods completely in some women. This can be a great relief for women with PCOS who suffer from irregular and painful periods.

• Reduction of PCOS Symptoms: The progestin released by the hormonal IUD can help reduce some symptoms of PCOS, such as hirsutism (excessive hair growth) and acne, by balancing hormone levels in the body.

• Decrease in Risk of Endometrial Cancer: Women with PCOS have an increased risk of developing endometrial cancer due to the accumulation of endometrial tissue related to the lack of regular ovulation. The hormonal IUD helps protect the endometrium by reducing its thickening, thus decreasing this risk.

Disadvantages of the Hormonal IUD for Women with PCOS

Like any hormonal contraceptive, the hormonal IUD has its own drawbacks:

• Risk of Hormonal Imbalance: For women with PCOS, who already have hormonal imbalances, adding any type of progestin could potentially worsen these imbalances, although this is less likely with a hormonal IUD compared to other forms of hormonal contraception.

• Cost and Accessibility: The hormonal IUD can be more expensive than the copper IUD, although most insurance plans partially or fully cover the cost. Additionally, access to this type of contraception may vary depending on regions and available practitioners.

Side Effects of the Hormonal IUD

Hormonal IUDs, in particular, can be associated with various side effects, which vary depending on the type of IUD used and the individual characteristics of the patient:

• Very Common Side Effects (affecting more than 1 in 10 women) include headaches, abdominal pain, bloating, changes in the duration or intensity of periods (with absence of periods in about 1 in 3 women), vulvar or vaginal irritation, and vaginal discharge.

• Common Side Effects (affecting between 1 in 10 and 1 in 100 women) include depression, anxiety, irritability, decreased libido, migraines, nausea, dizziness, skin issues like acne, increased hair growth, back pain, breast tenderness, weight gain, spontaneous expulsion of the IUD (sometimes unnoticed), painful periods, and ovarian cysts.

• Uncommon Side Effects (affecting fewer than 1 in 100 women) include hair loss, itching, eczema, swelling, uterine infections, pregnancy masks, and skin hyperpigmentation. There is also a risk of uterine perforation, which is higher in women who are breastfeeding, those who have given birth within the past 36 weeks, or those with a retroverted and fixed uterus.

• Other Adverse Effects of indeterminate frequency include high blood pressure, blood infections, breast cancer, allergic reactions (redness, rashes, swelling, difficulty breathing), fatigue, and a feeling of weakness.