This Integrative Gynecologist Wants Us Asking Questions About The IUD
There are many medications— oral contraceptives, antacid medications, and cholesterol-lowering drugs— that have become so trusted and commonplace in the modern American life that we rarely stop to consider their side effects. When it comes to birth control, few methods are as lauded as intrauterine devises. With their 99 percent effectiveness and low rate of complication, IUDs have safely prevented unwanted pregnancies for years, benefitting women, children, and society as a whole.
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.
As an OB/GYN I recommend the copper IUD, but it may cause side effects we don't yet understand.
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.
What we've know about hormone-releasing IUDs has changed over the years.
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.
It's important for patients to ask questions and for practitioners to be open-minded.
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.
If you have an IUD—or plan on getting one—here's what to do.
If you are utilizing an IUD as a contraceptive, there are certain actions you can take to further your efforts to develop optimal health. As there is data to support4 that the vaginal microbiome is altered by IUDs, it's very important to incorporate an appropriate probiotic to encourage as healthy a vaginal microbiome as possible. Various strains of lactobacillus, particularly Lactobacillus ramnuncus, can help curb the development of vaginitis.
The levonorgestrel IUDs can lower your estrogen level and consequently cause the bones to suffer, becoming weaker and encouraging osteoporosis development. Therefore small doses of calcium, magnesium, and vitamin D can help. Eating large quantities of vegetables is also helpful as it alkalinizes the blood, encouraging bone growth.
Lastly, the "hormonal" IUD can affect mood, so it is essential to get in plenty of B vitamins, magnesium, and small doses of lithium oratate. Don't forget calming herbs such as lemon balm, hokey basil, lavender, Chinese scullcap, valerian, and ashwaganda to support your body as much as possible if you decide the IUD is still the right choice for you.
Preventing unwanted pregnancies is hugely important, but we can't assume that all birth control is harmless or without side effects in the short- and long-term. That's why I ask all my patients and colleagues to keep an open mind and never fear questioning the status quo. Always seek answers and ask the hard questions when it comes to your health.
Want to know more about the IUD? Here's a great place to start.
Felice Gersh, M.D. is a multi-award-winning, board-certified obstetrician and gynecologist living in Orange County, California. She is the founder of the highly successful Integrative Medical Group of Irvine, and received her education from Princeton University and USC. With more than 40 years of experience in all matters relating to women's health, her main area of expertise is hormonal management, specifically polycystic ovary syndrome. She has held the post of clinical assistant professor of OB/GYN at the Keck-USC School of Medicine and remains affiliated with the University of Arizona School of Medicine, where she completed a fellowship in integrative medicine. She is also an expert reviewer for the medical board of California and a qualified forensic expert. Gersh is a prolific lecturer, writer, podcaster, and broadcaster on ZubiaLive and is soon to finish her first book.