Is Your IUD Disrupting Your Vaginal Microbiome?

Photo: Marc Bordons

"It’s more natural than hormonal birth control," is something I often hear my patients say about the copper IUD, and I tend to agree! The copper IUD permits ovulation and natural hormone balance and does not cause the hair loss, depression, and weight gain associated with the steroidal drugs of hormonal birth control. It’s one of five alternative contraceptive methods that I recommend in my book Period Repair Manual.

At the same time, there’s something not entirely natural about putting a copper and plastic device inside your uterus. It can cause the well-known side effects of pain and heavier periods. It can also cause the lesser-known side effect of an altered vaginal microbiome. Here's what you need to know.

What you need to know about the vaginal microbiome.

Just like your gut, your vagina is full of good bacteria. It’s called the vaginal microbiome, and it consists primarily of lactic-acid-producing bacteria from the genus Lactobacillus. A healthy vaginal microbiome protects against infection by discouraging the growth of bad bacteria, yeast, and viruses. It also keeps the vagina acidic and stimulates the right kind of mucus production. An unhealthy vaginal microbiome, on the other hand, can result in yeast infections or a condition called bacterial vaginosis.

Photo: GIC

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The scientific link between the copper IUD and bacterial vaginosis.

Bacterial vaginosis (BV) is an overgrowth of normal vaginal bacteria that causes the symptom of watery, fishy-smelling vaginal discharge. It affects almost one in three women and is typically treated with antibiotics.

The link between the copper IUD and BV is not new. Women have reported the problem since the IUD was first invented 50 years ago. Scientists finally looked at it last year and discovered that yes, copper IUDs double the risk of BV. The effect is attributed to the heavier and longer menstrual flow of IUD users, which depletes Lactobacillus and permits the overgrowth of Gardnerella and other bacterial species associated with BV.

I suspect there’s more to the story than just heavy flow. Copper IUDs may have additional direct effects on the microbiome that we have yet to discover. For example, the devices have been shown to foster the growth of bacterial microfilms and to transfer yeast cells from the vagina to the uterus. Luckily, new designs such as the circular Ballerine IUD may improve some of these issues.

What to do.

Right now you might be thinking "Great, one more thing I have to worry about." The good news is that if you’re not experiencing a problem with BV, then you’re probably OK with your IUD, and you don't need to change anything. But if you are experiencing recurrent BV and have yet to identify a root cause or find a treatment that helps—then you should know that it could be because of your IUD. If this is you, it's important to speak to your doctor and also consider the following natural BV treatments.

  • Support your gut microbiome by feeding it the fiber it needs from vegetables and legumes. (There’s a strong connection between the gut microbiome and the vaginal microbiome.)
  • Avoid, as much as possible, all the things that damage the vaginal microbiome. These include antibiotics, spermicide, feminine washes, and douching. Your vagina is an efficient self-cleaning system—there is absolutely no reason to douche.
  • Consider supplementing with the probiotic strains Lactobacillus rhamnosus and Lactobacillus reuteri, which have been clinically proven to improve BV. The probiotic combination works when taken orally, but you can also insert it vaginally for additional benefit.

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