This Integrative Gynecologist Wants Us Asking Questions About The IUD

But as we learned with the recent discovery of hormone birth control's association with an elevated incidence of breast cancer, even trusted daily medications carry risk, and it's possible we haven't asked as many questions about our birth control as we should. As an OB/GYN, it's important to me that I inform my patients that, like many other medications, IUDs carry risks and have shortcomings that we should all start talking about. Here's how I handle birth control with my patients.

There are two main types of IUDs: the copper-containing IUD and the levonogesterol-releasing IUD. They share similarities, but there are also some important differences. I normally recommend the copper IUD to my patients becaise it’s very effective in preventing pregnancy. The reason why I remain wary of the copper IUD is simply because we are still making new discoveries about the reproductive system that change our understanding of how it functions. For example, we did not understand or even recognize that women have a microbiome1 in our female reproductive systems, including in the vagina, the uterus, the fallopian tubes, and even of the ovaries, until quite recently. We did not understand that the inflammatory reaction created by the copper of the IUD could potentially disturb and alter the normal bacterial environment2 of a woman’s reproductive system, which could potentially lead to yeast or bacterial infections. The research into this area is very much in its infancy, and will hopefully expand and produce the information we need in order to make proper decisions about our birth control.

The full FDA prescribing information concerning levonorgestrel-releasing IUDs carries both warnings and documentation of adverse reactions. The package insert states that the studied incidence of migraines and headaches is 16.3 percent, of depression is 6.4 percent and of breast pain is 8.5 percent. Additionally, it warns that such IUDs should not be used in women with acute liver disease or with known or suspected breast cancer. When these IUDs first came to market, I was told that the levonorgestrel did not get absorbed into the body as a whole and that all its effects were localized. But that belief does not line up with the incidence of adverse events unrelated to the pelvis nor with the carried warnings. I have concerns that the levonorgestrel present in the IUD is actually being significantly absorbed and distributed throughout the body, with the potential for negative results. That being said, many women don't experience any uncomfortable symptoms and love the IUD. In other words: We need more research. There is no definitive proof that IUDs are unsafe in this way, but there isn't great evidence that they are safe, either. This is why we need more scientists and researchers to help us understand the short- and long-term effects.

All of this goes to show that we don’t know precisely how IUDs are impacting our bodies, particularly in the long-term. We certainly know that they help to prevent unwanted pregnancies, which can't be under appreciated, but that doesn't mean we should stop asking questions—just like we do with other medications. Women's bodies are designed to have their hormones in a certain balance for their overall health. And "hormonal" IUDs are nothing of the sort: They contain NO hormones, but rather contain a progestin, which is actually a pseudo-progesterone. What I worry about is the information coming from the environmental literature concerning levonorgestrel. This chemical is apparently getting into lakes and rivers and is modifying3 sexual behavior and genital anatomy in certain fish. It behooves us to take this information seriously and demand the data to prove safety in the long run for those using IUDs.

Want to know more about the IUD? Here's a great place to start.