I’ve been meaning for several years to write about intrauterine devices (IUDs) since it’s a very important and neglected topic and many women suffer from IUD pain and from other IUD problems. 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 IUD problems associated with these devices. 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
The 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.
IUD Pain and other IUD Problems
Yes, 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.
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
I’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
Unfortunately, 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.
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.