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The IUD: Intrauterine Damage

by drgangemi on February 4, 2014

IUD:Intrauterine DeviceI’ve been meaning for several years to write about intrauterine devices (IUDs) since it’s a very important and neglected topic. After all, over 200 million women worldwide use an IUD. In my practice I treat a lot of women for hormonal issues such as PMS, menopausal symptoms, problems with conception, as well as a host of thyroid and adrenal gland related disorders. I am not a fan of “the Pill” due to the unnatural hormonal influence it has on a woman’s body, and therefore only a few of my female patients use it as a form of contraception. These women would be extremely distraught if they got pregnant, so I yield and help them deal with the negative effects of the hormones. But I am adamantly against IUDs. Actually I will not treat a woman more than once, if at all, if she is using an IUD because it’s a certainty that it’s causing some, if not all of, her problems. I haven’t seen an exception yet.

The purpose of this article is inform women, based off my clinical experience as well as current research, regarding the prevalent problems associated with IUDs. You, or someone you know, may love your/their IUD and think it’s the safest, easiest, and most effective form of birth control. Hey, Mirena’s slogan is “Birth control for busy moms.” I’d agree with you that it is both very easy and effective. But safe it is not; actually it’s far from safe. It’s often not a question whether your IUD is causing some health problem but how much of a problem it is causing.

Types of  IUDs and Their Mechanism of Action

paraguardThe intrauterine device is the most effective type of reversible birth control, (reversible being a key word here). Simply put, an IUD is a ‘T’ shaped device that is inserted into the uterus as a form of long acting (5-10 years) contraception. Let’s first talk about the main types of IUDs and how they work.

Basically there are two main types of IUDs. There’s a hormonal type which is most commonly sold as Mirena and a lesser-used device sold under the brand name Skyla. Then there is a copper IUD which is sold under the brand name Paraguard. Some countries outside the US, UK, Canada, and China still use an inert IUD made of stainless steel but it’s not as effective as the copper or hormonal IUD.

Mirena releases a continuous low amount of synthetic progesterone which acts to thicken the cervical mucus to keep sperm from penetrating the ovum. As there is some hormonal influence with Mirena, some women use it to help with heavy menstrual bleeding. It’s effective for up to five years.

Paraguard uses copper wire around the stem of the ‘T’-shaped IUD which basically acts as a spermicide. This also increases copper ions in the cervical mucus as copper is being continuously released, and therefore there is evidence of some women having issues with too much copper causing health problems. I will discuss this more in a bit. To lessen the copper exposure, some countries are starting to use gold or silver wrapped around the copper wire. Another “advantage” of the copper IUD is that it can provide emergency contraception if inserted within five days after possible conception. While Mirena can help with menstrual bleeding, Paraguard has been linked with heavier periods and painful cramps. It is slightly less effective than Mirena but it can remain in for up to twice as long – ten years.

The Problems with an IUD

IUD PlacementYes, IUDs are very effective and they’re very user-friendly. If you don’t want to get pregnant then they sure beat having to chart your cycle, use condoms, or refrain from sex. But their problems, in my opinion, are far underestimated, reported, and realized. There is some evidence to support this, and I will share this with you. But there is much more clinical experience on my part, having seen many women with IUDs over my sixteen years in practice. It’s not a matter of if you will have a problem with your IUD, but when. And you might not even be realizing that you’re having such a problem. Typically when I explain to a woman the link between her health problem and her IUD she responds, “Oh, that makes sense now.”

An IUD is a foreign device in the body. Though the drug companies, researchers, and physicians say that the most common side effect is expulsion, (sometimes because of improper insertion by the doctor), a woman’s body is not meant to have a piece of metal constantly irritating her uterus – especially for five, if not ten years. Think about walking around with a small pebble in your shoe 24 hours a day. Pelvic Inflammatory Disease (PID) incidence is a risk factor as is infection and other complications. The IUD can literally implant itself in the uterine wall which can also become a problem during removal. Unfortunately, some women do die from this. A patient of a colleague of mine had a sibling die from such a complication. Many women experience “normal” discomfort, irregular bleedings, loss of libido, or mysterious pains which are never linked back to the IUD itself.

Excess Copper…

With Paraguard, copper is being continuously released. Some women can respond in strange ways to copper since although it is a necessary mineral it can also act as a heavy metal, much like iron. Although most studies point to only risk factors in women with Wilson’s Disease, (a genetic disease of copper overload), copper acts similarly as any other metal (mineral) when it is out of balance in the body. Copper is a main component of bile salts and therefore too much copper can greatly impact the health of the gallbladder as well as the liver. I discuss this more in my articles on the gallbladder and below I note a case history of how this can affect a woman’s gallbladder. Copper also influences estrogen and therefore as copper increases it is said that similarly estrogen does too. Estrogen excess is involved with a host of problems such as PMS, excess bodyfat, and certain cancers. There is also a fine balance between copper and zinc. Copper-zinc imbalances are implicated in hormonal problems especially those related to blood sugar handling issues. Finally, some note that the copper can erode, which obviously would be a major problem, if not an emergency, and there is evidence pointing to copper oxidizing and causing damage to the cervix and uterus. This is why some countries are starting to use other metals around the copper wire for added protection.

…Or Excess Synthetic Hormone

With Mirena, a slight amount of synthetic progesterone (levonorgestrel) is being released continuously at a rate of 20 mcg per day. As with birth control pills, this alone can be a problem as it suppresses a woman’s natural hormonal secretion and her natural monthly rhythm. After all, it is normal to have varying amounts of progesterone (and estrogen) secreted throughout the month – it’s not a constant level every day. Additionally, levonorgestrel is a synthetic hormone – it’s not the same type of progesterone the body naturally makes.

In my practice I use manual muscle testing as a form of biofeedback which helps me assess what is going on with the patient. The muscles of the pelvis – specifically the gluteus muscles, (maximus, medius, and minimus), the piriformis, and some of the adductors – are related to the health and function of the uterus, (as well as the ovaries). Therefore, anything which negatively affects the uterus will have a similar effect on those muscles. Essentially, an IUD causes a general inhibition (fatigue/weakness) in these muscles, which can result in back pain, hip pain, abdominal/core weakness, or essentially any weakness associated with pelvic instability. Since the pelvis is so vital in supporting the spine and everything below (legs/feet), then any instability in the pelvis can cause problems elsewhere too. Yes, I’m saying that an IUD can cause knee, foot, ankle, and even neck problems. It’s a lot more common than you may think.

IUD Clinical Case Histories

IUD ProblemsI’d like to share some of my more notable experiences I’ve had treating women with IUDs. I don’t get to see too many anymore, maybe just a few a year at most, as I won’t treat a woman with one in. If I see a woman with an IUD, then it is only for one appointment as it needs to be removed for me to help her with her presenting problems. Typically women coming to my practice have already had the IUD removed or never put one in the first place as they know my position on the matter.

Here are several memorable and significant cases I’ve seen with IUD use.

  • A college student I had previously seen in years past suddenly was having extreme bouts of depression during her fall semester. She had to drop three of her four classes by November. Upon discussing her situation, she revealed that her mood changed just a week or so after she had Mirena inserted in early September. She had the IUD removed and her depression resolved 100% over the next two weeks. There is a new study discussing Mirena affecting menstrual bleeding (the lack of) resulting in iron overload and depression. (Turok et al, 2013)
  • A woman presented in my office with right-sided hip and lower back pain that was much worse when she slept at night. Though she had her IUD in for many years, the pain was more recent. Upon removal, her pain resolved 100% after one treatment session. She also noticed that other “nagging” aches that she previously never thought much of were resolved too. It’s not uncommon for women to slowly develop health issues due to the IUD that are passed off as normal or age-related issues.
  • A woman came to my office complaining of lower back, hip, and left ankle pain which was worse when she ran. Many muscles in those same areas were not functioning properly and I suspected, due to the type of assessment I employ, that they were an issue because of her IUD. Although seemingly healthy, she had her gallbladder removed several years earlier at age 25 for unexplained trouble with the organ. Interestingly, she had Paraguard inserted just about six months before the gallbladder troubles began. Nobody had ever made the connection.
  • I recently consulted with a woman who was experience debilitating and unexplained pain in her entire abdomen, pelvis, and thigh areas. On her history forms she did not mention any use of birth control. I suspected an IUD to be the cause and rather surprised her when I asked such a direct question. She had Paraguard inserted two years prior, but the pain was more recent in the last six to seven months. She had the IUD removed immediately and surprisingly learned that it had dropped down towards her cervix – meaning it wasn’t even in the correct place and she was lucky as to not have become pregnant. Upon discussing her history she noted excessive bleeding problems ever since the IUD was inserted, (she was told this was normal), and problems with her libido.
  • A woman complaining of jaw pain (TMJ dysfunction) presented in my office. We discussed her history and the time at which it occurred which didn’t seem to correlate with her IUD. Though she did note intermittent bouts of lower back pain and significant cramping at certain times throughout the month, but she just took NSAIDs for the problems and didn’t think too much of them. I explained to her the connection between the sacroiliac (SI) joints to the jaw joints and the relevance of SI area to the uterus and therefore the IUD. Once the IUD was removed the TMJ problem resolved completely as did most of her monthly hormonal problems, (which were also dietary related).

Other Contraception Alternatives

contraceptivesUnfortunately, there are not many alternatives to contraception that are both safe and effective. Charting daily temperatures and noting signs such as cervical mucus as in the Rhythm Method can be effective, yet there are other factors that can influence these parameters and the window of time for truly safe, unprotected sex is narrow. Condoms, when used correctly, provide 98% protection, (Paraguard is 99.2% and Mirena is 99.8% – both though only within their first year of use), though many don’t like the feeling of condoms, may react to the material (including synthetic lubricants on most brands), or simply just don’t want to deal with the trouble of going that route. Of course, condoms provide some protection against sexually transmitted diseases whereas IUDs do not. Tubal ligation for a woman or a vasectomy for a man can come with side-effects and are rarely reversible.

Ultimately, it is up to the woman, not her doctor, if she wants to remove her IUD. Most doctors, in my experience, don’t want to remove the IUD unless she is having definite symptomatic problems (such as pain), with it in. Though I recently saw a woman who, upon talking to her OBGYN about removing it and how we felt it was causing some of her hip pain, mentioned that her doctor commented that she wasn’t very surprised that it was giving her trouble as it’s more common than what she felt was reported.

Of course, though it should go without saying, I don’t want you to remove your IUD and get pregnant. So if you decided to have it removed, you should do so based upon your own research and your individual health and situation. Most all doctors think IUDs are perfectly safe, and even a newer “improved” version of the IUD may soon be available, an IUB – intrauterine ball. Alternative forms of contraception should be used and your cycle could take some time to normalize once you removed your IUD; it’s impossible to say how long or what the scenario is for each woman. I’ve also seen some women remove their IUD and not experience noticeable relief immediately because of the way it was impacting their body for so long. It’s almost like if a circuit was tripped in the body, much like a circuit breaker in a fuse box providing power to your house. Even once the power is back on, the circuit stays off until someone goes and resets it. This can be the case for some women and can often be corrected through various body therapies, (ie: deep tissue release, acupuncture, chiropractic). In the case of hormonal imbalances caused by Mirena or copper toxicity or mineral imbalance problems caused by Paraguard, some hormonal, nutritional, or visceral (organ) therapies may be warranted.

I typically don’t provide references when I write articles, (“blog posts”), for my site but for this one I decided to due to the both the sensitive and very important nature of the subject. Below are several studies I referenced. Please feel free to leave a comment as I always reply, though I am unable to provide you with individualized advice in such a manner.

References

Haliloglu B, Celik A, Ilter E, Bozkurt S, Ozekici U. Comparison of uterine artery blood flow with levonorgestrel intrauterine system and copper intrauterine device. Contraception. 2011 Jun;83(6):578-81.

Beltran-Garcia MJ, Espinosa A, Herrera N, Perez-Zapata AJ, Beltran-Garcia C, Ogura T. Formation of copper oxychloride and reactive oxygen species as causes of uterine injury during copper oxidation of Cu-IUD. Contraception. 2000 Feb;61(2):99-103.

Arnal N, de Alaniz MJ, Marra CA. Alterations in copper homeostasis and oxidative stress biomarkers in women using the intrauterine device TCu380A. Toxicol Lett. 2010 Feb 15;192(3):373-8.

Patai K, Berényi M, Sipos M, Noszál B. Characterization of calcified deposits on contraceptive intrauterine devices. Contraception. 1998 Nov;58(5):305-8.

Imani S, Moghaddam-Banaem L, Roudbar-Mohammadi S, Asghari-Jafarabadi M. Changes in copper and zinc serum levels in women wearing a copper TCu-380A intrauterine device. Eur J Contracept Reprod Health Care. 2013 Dec 5.

Turok DK, Jacobson JC, Dermish AI, Simonsen SE, Gurtcheff S, McFadden M, Murphy PA. Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates. Contraception. 2013 Nov 22. pii: S0010-7824(13)00732-4.

Baram I, Weinstein A, Trussell J. The IUB, a newly invented IUD: a brief report. Contraception. 2014 Feb;89(2):139-41.

From → Health Concerns

14 Comments

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  1. Kerry permalink

    Hi Dr. Gangemi,

    Thanks for posting this article. This is timely for my wife and I– she’s just had her Mirena IUD removed. We’re deciding what to use in the future.

    Interestingly, she developed and is being treated for hyperthyroid (not hypo-). After reading the article, I’d have to suspect a corollary, if not direct causality– diet, stress, and exercise are largely under control, following SockDoc and Maffetone principals.

    We’re considering vasectomy because we do not desire children; I’m 45, she’s 36, so I consider this a reasonable choice. I’d be curious to hear your perspective on the possible unanticipated side effects of vasectomy and tubal ligation.

    Any thoughts?

    Thanks for all your work on this site, as well as the SockDoc site. I refer to them both constantly.

    Kind Regards,
    Kerry

    • Thanks Kerry. I have unfortunately heard several horror stories from women who have had tubal ligation, (a few of them recently posted on my FB page under the IUD post). Personally, my wife and I think it’s too risky to go that route.

      I’m also still a bit skittish on the vasectomy procedure. There is a case for immune issues as your body will want to kill off old sperm after some time; so some say this could provoke an autoimmune disease or a compromised immune system. I’ve also seen a couple guys who have had complications from vasectomies (constant pain).

      So for right now, we stick with condoms and cycle charting.

      • Kerry permalink

        Thanks for the reply, Doc! I’m thinking we’ll avoid the surgical procedures, stick to something that’s not likely to tax the autoimmune system. Thank you for sharing the method you and your wife use– that’s probably the route we’ll use too.

        Kind Regards,
        Kerry

  2. Clare permalink

    Thank you for taking the time to share your observations and expertise. I am so grateful for the thorough explanation and references provided. Incidentally, I have had chronic issues with my right tensor fasciae latae (in addition to the “normal” IUD side effects)- seems like you have plenty of evidence, but here’s one more case in support of conclusions. I also wanted to recommend “Taking Charge of Your Fertiltiy” by Toni Weschler (http://www.amazon.com/gp/product/0060881909/ref=oh_details_o03_s00_i00?ie=UTF8&psc=1). This book has been a great source of information to me. Thanks again!

  3. Very thought provoking post.

    It alway seemed to me that the basic principle of how the IUD works (chronic irritation to the body) was not such a great idea.

    Perhaps those that really want to use IUDs should do 2 yrs on / 2 yrs off (e.g.) rather than continuously year after year.

  4. Megan permalink

    Great article! I’ve been reading your other articles with special interest in the ones on the gallbladder. I started having chest pains 4 months ago and during these episodes my whole body seemed out of whack (they would come and go all day long). Long story short, after tons of tests the dr’s ruled out heart problems, muscular skeletal problems, and the only GI problem found was from a HIDA scan showing my gallbladder at 10% but no gall stones. I had a baby that was 6 months old at the time and had the Mirena inserted after he was born. I was the one that thought my problems might be due to the Mirena even though my OBG said it wasn’t but I insisted on having it taken out.

    After the IUD was removed a lot of the weird side effects disappeared but I still have the chest pains and a pain in the center of my back which the dr said was from anxiety. I’m a low stress, easy going person on no medications. I asked if it could be from my IUD and gallbladder but he said no. I get burping and I feel hormonal with it still as well so I’m wondering if you’ve seen a similar story to mine? And if so do I just need to wait until my body normalizes after having the IUD out? (it’s been 2 months) and is it possible that my gallbladder will go back to functioning normally? Could the chest pain be from my gallbladder and hormonal interactions? I know you can’t answer specifically but my other Dr doesn’t seem to know and I think it is right up this alley with IUD’s. Thanks!

    • I’d say your situation is more than common. Of course, the general MD isn’t going to associate problems together – they’re trained to focus on one area and not figure out how one organ influences another which in turn, another. Of course I can’t say what is going on with you w/o seeing you, but as I note in this IUD article and the gb articles, hormones have a huge affect on the gb. And they (the MDs) love to scare their patients with the HIDA scan results. If you figure out what is causing the gb problem then it’s irrelevant whether it’s at 5%, 10% or 30% or whatever the number.

  5. Iris permalink

    Thank you for posting this on IUDs. I insisted on having the non-hormonal one removed after 4 months of constant infections and pain since the insertion. Unfortunately, prior to that i was on birth control pills for over 10 years and the depo-provera shot for 5 years. It has been 4 years since I stopped using birth control, and my husband and I have been having trouble holding a pregnancy. I still have faith that in using diet, excercise, and natural remedies and allowing my body more time to heal, we will have our baby. Thanks again.

  6. Karen permalink

    Hi,

    I’m considering getting the Mirena IUD removed. I’ve had it for 2.5 years now. I believe it to be causing the slight iron overload recently in my blood work results. It was suggested that I go on Mirena because I had iron deficient anemia caused by heavy, long and frequent periods and I had refused “the pill” because of extreme moodiness that it caused fights so bad we were going to divorce. I hadn’t thought Mirena could be causing any problems. I also have a right knee that hurts sometimes like arthritis might (it runs in my family though). The iron overload and Rosacea that I have does not run in my family. I would not be surprised that the Rosacea is caused by Mirena or the iron overload due to Mirena (periods are reduced to next to nothing these days, which is nice to deal with but not if I will suffer from complications of the iron overload). The removal of the Mirena sounds scary too. I also do not know what to do about the heavy periods and the iron deficiency anemia when it comes back. What are some suggestions? I’d gotten my results back from my GP and have not called him yet to discuss that it’s due to the Mirena. He sent a requisition to repeat blood work and additionally to test for hemachromatosis in 3 months. If I get the a Mirena removed, I’d also want a good solution for the original problems that the a Mirena was supposed to be a “patch” for – the iron deficiency and bad periods (also hoping the Rosacea would disappear completely – is Rosacea caused by blood and iron problems? I know when I have facial flushing it is blood that rushes up and causes the “beet red” face coloring). Thanks for any suggestions!!

  7. Carolina permalink

    Such an excellent and timely read! I had a copper iud inserted a year ago, and over the last few months have had numerous body issues. Right side low back pain, extremely heavy periods, and what feels like a uti but my urine culture comes back clean for bacteria.

    Have you had any women complain of bladder issues with a uti? Do you think copper iud’s could cause bladder irritation?

    • I personally have not but wouldn’t be surprised as copper toxicity can cause many other issues.

  8. Kaylin permalink

    Hi
    I’d be interested to know your thoughts on the the new IUB developed by Ocon which has just started instigating sales in Europe.
    It is still a copper-based device so any possible physiological contra-indications I may have linked from having a copper IUD may or may not be ‘solved’ through choosing this new ball device.
    I’ve had pain down my left leg (almost like sciatic pain), pelvic area and lower back area for 18 months. I’m going through physio now to strengthen the core muscles. All issues you have addressed in your article and case studies.
    I’d be interested in your thoughts.
    Many thanks in advance.

    • Kaylin – I mention the new IUBs in the article and I’d recommend staying away from them just like an IUD. Are you saying you have an IUD currently in and are going through PT for your pain? If that’s the case I sincerely hope you consider the possibility of the IUD causing this as noted in the article.

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