Can You Use Progesterone With An IUD?
There seems to be a lot of controversy around using an IUD and progesterone therapy. Honestly, anything that involves hormones in women creates questions lately. In this article, I will break down the types of IUDs, when a progestin-only IUD is recommended, and if you can use progesterone (such as a capsule or cream) at the same time.
What Is An IUD:
IUD stands for intrauterine device. It’s a T-shaped device that is inserted up into your uterus for a variety of reasons. There are two types: copper and progestin-only. The copper IUD is known as a Paragard® and will not be the focus of this article as it does not contain any hormone (but you can use progesterone therapy with it at the same time - ask your provider).
The progestin-only IUD has a few registered names: Mirena, Skyla, Kyleena and Liletta. They contain various amounts of progestin which is synthetic progesterone.
The IUD is often called a ‘set it and forget it’ type of birth control as they can remain in your uterus for 3-8 years depending on the type you have.
When Is An IUD Used:
Besides birth control, the progestin IUD has a few other uses.
If you have heavy menstrual bleeding and/or bad cramps, the progestin in the IUD is known to calm both quite well. You still have to do your due diligence and figure out WHY you have heavy bleeding and/or cramps - but that progestin will thin out the inner layer of your uterus resulting in less or no bleeding. In fact, many women with this IUD report no periods to a little spotting.
Because it can thin the inner layer of the uterus, it is indicated to reduce the risk of uterine hyperplasia. This is where too much estrogen (or what’s called unopposed estrogen) kind of goes crazy on the cells and creates a lot of thickness in that inner uterine layer. The result tends to be heavy bleeding however it also increases the risk of uterine cancer - which is not good. If you’re over 40 and on estrogen therapy and you still have a uterus, the progestin IUD may have been suggested to combat the effects of estrogens down there.
Side Effects:
Be aware, the progestin in the IUD and progesterone as made by your body are not the same thing.
The progestin in the IUD is systemic and not just local to the uterus. It has the ability to impact the brain and ovulation.
According to the Access FDA paper on the Mirena®, after 1-year of use, 65% of women did not ovulate and thus, did not produce their own progesterone. After 4-years of use, 25% of women did not ovulate and thus, did not produce their own progesterone.
Other systemic side effects can include: acne, irregular periods, headache, nausea, mood changes, hair changes, and more.
If you’ve been told that the progestin IUD is only local to the uterus -you have been misinformed.
I’m often asked about the risk of breast cancer with different birth control options, including the IUD. The American College of Obstetricians and Gynecologists state that the relationship between progestin only contraceptives and breast cancer risk warrants further study because there is some risk. Essentially, it’s not zero, but it is low. This makes sense given the famous Women’s Health Initiative study that was halted - in the end it appears the combination of the synthetic estrogens with progestin combination had the slight increased risk. (Please note, the synthetic estrogen only portion of the study did not have an increased risk - it was the addition of the progestin that did it).
Can I Use Progesterone with my Progestin IUD?
The short answer is yes. The longer answer is, it depends on if this is the best course of action for your case! However, I had plenty of women who loved their progestin IUD for birth control or cramps but wanted the oral progesterone benefits of reduced anxiety and better sleep. You can read this article on progesterone to learn more. I also have this progesterone video!
Using a progestin IUD does not automatically disqualify you from using progesterone too. Phew!