Do I Need to Remove my IUD Before Perimenopause?

I am 40 years old and have no current hormonal concern. I had my IUD placed a few years ago after the birth of my second child, and I have had its placement checked annually, with no issue. The influence of social media and topics like HRT have me wondering what I need to do next. What should I plan for? Or am I just under the influence and fine to stay on this path?

—Anonymous

If you are feeling good and happy with your IUD, you don’t need to do anything differently right now. You have contraception covered. The average age of menopause is 51.4 years, so you may have more than a decade of smooth sailing ahead of you.

Some women do experience symptoms during the late-reproductive stage and early perimenopause. Most women enter the late-reproductive stage between the ages of 35 and 45, and they may experience symptoms during those years. You can treat any symptoms you have as they come up. In fact, with a progesterone-eluting IUD in place, you can just add estrogen in the form of a patch or gel to manage any symptoms when they arise.

While we talk about hot flushes and night sweats often, remember that there are many other symptoms that can be related to the perimenopausal transition, including sleep changes, mood changes, weight gain, and cognitive changes. However, there is no good data to support taking hormone therapy before you experience perimenopausal symptoms. So there is no need to add estrogen or switch forms of contraception now.

In the meantime, you can never go wrong spending some time and energy to develop healthy habits: a diet rich in vegetables and whole grains and low in refined sugars, and an exercise routine that you enjoy and that includes strength training. Build relationships with your gynecologist and primary care doctor so that you feel comfortable reaching out to them if problems arise. And make sure you are up to date with your health maintenance.

The takeaway: There is no evidence that taking hormone therapy is beneficial if you don’t have perimenopausal symptoms. Establishing healthy habits is the best way to prepare for perimenopause.