If you’re considering using birth control to (a) avoid pregnancy and/or (b) manage perimenopause and menopause symptoms, which birth control method would you use?

How about the one most OB/GYNs choose for themselves?

Pretty overwhelmingly, women’s health care providers choose the IUD as their preferred family planning method. It’s also a popular choice for docs prescribing solutions for managing bleeding and irregular periods in perimenopause.

We thought it was worth taking a closer look at the tiny little T that can do so much.

What is an IUD?

An IUD or intrauterine device is a small, T-shaped piece of flexible plastic that is threaded up through the vagina and into the uterus (hence “intrauterine”). Once placed, they can remain for years, effectively preventing pregnancy without impacting future fertility. IUDs for perimenopause and menopause symptoms have also become popular, and often effective, treatments.

Copper IUDs (ParaGard) are wrapped in a bit of copper and rely on sperm’s dislike of that metal to repel sperm away from an egg. Generally, copper IUDs contain no hormones and are not particularly useful for managing peri/menopause symptoms. In fact, they tend to make periods slightly heavier.

Hormonal IUDs (Mirena, Kyleena, Liletta) use a synthetic hormone to prevent pregnancy. These may be more useful for the midlife crowd, and taking estrogen along with Mirena is increasing in popularity as a treatment for symptom relief.

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Why do ob/gyns prefer the hormonal IUD?

For women generally, the hormonal IUD is a good option for family planning and managing periods.

With a 99 percent effectiveness rate, they’re highly effective at preventing pregnancy (the Pill weighs in at around 93 percent). Considering perimenopausal women have the second-highest rate of unintended pregnancy (after teens), that can be a real benefit.

They don’t require “perfect use” from the woman. Unlike the Pill, you don’t have to remember to take them, and unlike condoms, you really can’t be caught without.

They can make periods lighter, reduce cramps, have few or no side effects, and last for years. For these reasons, hormonal IUDs for perimenopause symptoms are often the most common.

What about IUDs for perimenopause and menopause?

Dr. Rebecca Dunsmoor-SuOur own ob/gyn Director of Health, Dr. Rebecca Dunsmoor-Su, is an advocate of the hormonal IUD Mirena® for women in midlife, so we asked her to explain the benefits and any risks.

Note: Dr. Rebecca particularly likes and recommends the Mirena® because it has been on the market the longest, so we asked her specifically about that brand of IUD. This information may also pertain to similar devices; however, be aware that the information below is based on the Mirena.

How does the Mirena work?

Dr. Rebecca: Mirena is an intrauterine device that contains levonorgestrel (a progesterone).  It was originally designed for, and is used mostly for, birth control. It provides highly successful birth control for 5-7 years. 

It works by placing progesterone directly into the uterus. Progesterone's effect is multiple in that place:

  1. It thickens cervical mucus and prevents sperm penetration (this is primarily how it prevents pregnancy).
  2. It thins out the lining of the uterus and makes menses lighter; sometimes periods disappear altogether (this is the backup birth control effect, it will prevent implantation if the sperm get past it). 
  3. It has the most effect right at the uterus, and you absorb very little of the progesterone systemically after the first month or so, so your ovaries generally continue to cycle normally (or not, depending on where you are in the menopausal transition).

How does it compare with other types of birth control?

Dr. Rebecca: It is placed during a doctor visit and stays in place for 5-7 years, so for ease of use, it cannot be beat. It has less impact than pills on your systemic hormones, which tend to continue to do "their own thing" while the Mirena is in. In terms of efficacy, it is one of the best, as it does not rely on the human factor, and you can't forget to use it! It doesn't prevent STDs, so if you are with a new partner or have multiple partners, condoms are still recommended.

Why do you recommend it for women in perimenopause? What is the impact of Mirena on menopause?

Dr. Rebecca: In perimenopause, cycles can get more irregular, with bleeding occurring less frequently. When this happens, periods can be heavy and crampy. The Mirena keeps the uterine lining thin, so periods get much lighter and less painful and easier to manage, without having to use systemic hormonal manipulation to achieve this. 

Also, it’s good protection for the uterine lining (prevents the tissue build up that can lead to endometrial cancer), so if a woman needs estrogen to ease hot flashes or sleep disruption, she doesn't need to take oral progesterone if a Mirena is in place, providing the Mirena has been there less than 7 years and is still working.

How long can it be left in, and is it safe long-term?

Dr. Rebecca: It works for 5-7 years, and is safe to leave in that long. It doesn’t hurt you to leave it longer, but it no longer works as birth control or to suppress menstruation, and will no longer protect the lining if you are taking estrogen.

Are there side effects? If using Mirena for menopause, when should it be removed?

Dr. Rebecca: There is discomfort with placement and removal. 

People are often concerned about infections, as they remember reports from decades ago about different IUDs. With the Mirena, there is a small risk of infection when it is inserted and removed (these are rare occurrences), but once in, it actually thickens the protective cervical mucus and reduces the likelihood of infections travelling up to the pelvis.

Many women see irregular bleeding or spotting over the first 3-6 months after the device is implanted, which resolves. 

While there are reports on the Internet of weight gain, in fact, studies show weight gain is not a side effect of the IUD because, remember, it results in very low hormones being circulated systemically.

Who is a good candidate for the Mirena IUD?

Dr. Rebecca: Most women are good candidates; only women with a history of allergic reaction to levonorgestrel, who have a current pelvic infection, or who have a uterine anomaly are not good candidates.

Unlike estrogen, progesterone is generally considered safe for women who have blood clot risk, and as the Mirena is very low dose, it’s even safer. 

Use of Mirena for women with a history or high risk of breast cancer is generally, but not always, discouraged, so have a good conversation with your doctor about the benefits and risks.

Is it OK if a woman enters full menopause with a Mirena implanted?

Dr. Rebecca: Yes. The Mirena can easily be removed by a medical professional, if the woman is more comfortable without it, but there’s no additional health risk of leaving it in, even after full menopause is achieved. And often it can be the source of progesterone if you need to use estrogen during the early years of menopause.

What’s the procedure for having a Mirena implanted? Does it hurt?

Dr. Rebecca: At the doctor's office, the IUD is placed through the cervix. You may feel crampy for a few minutes, but taking some Ibuprofen before the procedure can help with that. Implanting the Mirena takes 5-10 minutes and is almost always covered by insurance. 

Are there things I should look out for if I have a Mirena?

Dr. Rebecca: Bleeding can be irregular for up to 6 months, and this is normal. You should talk to your doctor if you have severe pain, high fevers, or significant discharge from the vagina. Rarely, the IUD can fall out (expel), but generally you will notice, as you will see it come out.

Does the Mirena help with vaginal dryness or atrophy?

Dr. Rebecca: No, it does not, as it provides progesterone only. If you are having these symptoms, vaginal estrogen would be recommended.

I notice it has strings – can your partner feel it or dislodge it during penetrative sex?

Dr. Rebecca: No, the strings are soft and typically tuck behind the cervix. If a partner does feel something, your gynecologist can trim the strings short. Intercourse will not dislodge it. The only times I’ve seen them dislodged are when folks use menstrual cups and accidentally grab the strings when reaching up to remove the cup.

If you're in perimenopause and experiencing heavy bleeding, and/or you need an effective birth control method, a hormonal IUD such as the Mirena may be a good, safe option for you. As ever, check with your doctor to discuss any risk factors you may have. 

Have you used an IUD to prevent pregnancy or handle perimenopause symptoms? We'd love to hear about it. You can talk with us in the comments below, in our community forums, on our Facebook page, or in Midlife & Menopause Solutions, our closed Facebook group. 


Shannon Perry

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