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As a labor and delivery nurse, there are countless times I've talked with women about the dragging side effects of hormonal contraception. They agree that hormonal contraception is not the best choice, stating, “Oh, I don’t use hormonal contraception. I have an IUD instead.”

Yet the most popular implanted intrauterine devices—commonly known as IUDs—do have synthetic hormones, similar to the pill, that disrupt the body's normal hormonal equilibrium and continuum. Copper IUDs also alter the interior workings of the reproductive system.

Women who use IUDs may only have a narrow view of the larger picture. Here are five facts about IUDs to know before making a decision that will greatly affect your health.

01. IUDs secrete copper or synthetic hormones into the body.

Let’s start with the basics. An IUD is a small, T-shaped device that is placed into the uterus by a trained health professional during an office visit. It provides continuous birth control for several years depending on which one is chosen.

There are two classes of IUDs: Copper (Paragard) and Hormonal (Mirena, Skyla, Liletta and the new Kyleena). These fall within a larger class of long-acting reversible contraceptives (LARCs). According to the CDC, use of these contraceptives have increased five-fold in the past decade among women aged 15-44 from 1.5% in 2002 to 7.2% in 2013.

Paragard is the only 100% hormone-free IUD. But don’t jump too hastily at this being good news. It works by constantly secreting copper into the uterine cavity. Paragard states that “it interferes with sperm movement, egg fertilization, and possibly prevents implantation” by creating an inflammatory reaction within the endometrial cavity of the uterus. The typical failure rate of a copper IUD is 0.8%.

Hormonal IUDs have a typical failure rate of 0.2%. According to Mirena’s website, it is the No. 1 prescribed IUD in the U.S. It is synthetically coated with 52 mg of the hormone levonorgestrel, a much higher dosage amount than the less popular Skyla that contains 13.5 mg. The newly launched Kyleena IUD contains 19.5 mg levonorgestrel and was created for women who have never had a child before. All three have several mechanisms to prevent pregnancy: thickening of cervical mucus to inhibit sperm passage and survival, and alterations in the endometrium (the lining shed during menstruation). It's worth noting that the majority of levonorgestrel IUD users are affected by the same hormonal influences as women on the pill.

02. It's a foreign object. 

Our culture is obsessed with what we put in our bodies. From Non-GMO to organic, we all want to be fit, feel well, and be free from the threats of additives. An IUD is a foreign object inserted into the uterine wall that releases foreign chemicals. Most objects placed into the body are there to aid the natural processes of the body, like a heart pacemaker. But an IUD hinders the natural processes of a woman’s body: ovulation, fertilization, implantation, and sometimes adverse pregnancy outcomes.

Many women report discomfort upon the implantation—for some, it is severe. Cramping is considered par for the course, but in some instances, women have reported nausea and dizziness or have even fainted. Another risk of using an IUD is infection and pelvic inflammatory disease, according to the American College of Obstetrics and Gynecology. If the infection goes too long undetected, it could cause permanent damage like sterilization.

03. It can triple the risk of mental illness.

In women who have had a child, most IUDs are inserted by the 6 week postpartum office visit. Mirena, for instance, is a popular IUD deemed compatible with breastfeeding. Postpartum depression (PPD) can be debilitating for a woman and her family. According to the CDC, about 1 in 8 women experience PPD. Some women struggling with PPD may really be suffering from the side effects of their IUD and may not know it. 

Non-postpartum women are also at increased risk for depression. A recent Danish study concluded that "compared with nonusers, users of hormonal contraception had a 40 percent increased risk of depression after six months of use. Some types of contraceptives carried even greater risk. Women who used progestin-only pills more than doubled their risk, for example, while those who used the levonorgestrel IUD (brand name Mirena) tripled their risk.”

04. It creates a loss of hormonal equilibrium.

When asked about noticeable differences with an IUD, one Mirena user shares, “I mostly do not have periods with my IUD. In the rare occasions when I get a period, they are much lighter and shorter when compared to the flow and duration of my periods without the IUD. Pre-menstrual cramps are also much lighter.” The majority of side effects with levonorgestrel-releasing IUDs include changes in uterine and vaginal bleeding which occur about 52% of the time and cessation of menstruation which occurs at least 24% of the time.

Endometrium shedding (i.e., bleeding), increasing estrogen, ovulation, and rising progesterone are all necessary to our overall health. Estrogen, for instance, promotes bone growth while progesterone promotes bone maintenance. If these hormones aren't reaching their optimal levels each month, over time, lack of estrogen and progesterone can lead to osteoporosis in postmenopausal women.

05. The side effects of an IUD can mask underlying health concerns.

Sometimes IUDs are prescribed to “solve” heavy menstrual periods or debilitating cramps. But IUDs should not be the panacea for abnormalities because it doesn’t fix the underlying problems. Dr. Mary Kotob, a Board Certified OB-GYN in Newport Beach, California, specializes in gynecologic surgery. She has seen firsthand the side effects of IUDs in her patients.

Dr. Kotob notices the opposite outcome when using an IUD to alleviate period-related symptoms. She says “bleeding can increase and so can cramping with menses. I often see patients who have returned to their own doctor's office requesting the IUD taken out only to be told by a nurse practitioner that they're doing fine. No ultrasound is done. No labs. She is just advised to put up with it. The bleeding with an IUD can mask other problems such as pregnancy, thyroid disease, ovarian cysts, and precancerous lesions—further investigation is always warranted." In fact, Human Reproductive Update found that many gynecologists concentrate on simply regularizing bleeding patterns without understanding the underlying hormonal environment.

A woman’s reproductive cycle is a collection of events that need sufficient quality and quantity to nurture and sustain her whole healthy self. It is interesting how gynecology is the only area of medicine where finding the root of the problem is the last answer and, instead, it is “cured” with unnatural remedies. All women deserve to know more about their cycle; only then will we be able to recover our health as it was intended.

Photo Credit: Horn Photography