A friend and I were recently discussing the use of hormonal birth control — namely, the Mirena IUD — during perimenopause and thereafter, not to prevent pregnancy but to reduce the symptoms of menopause. Is there any evidence to suggest that continuing the use of Mirena will help reduce menopause symptoms? If so, is it legitimate to continue to ask my doctor to replace my IUD well into my 50s? And if I currently have a Mirena IUD and am not experiencing many adverse symptoms of the late-reproductive stage or perimenopause, how do I know when I should remove it for good?
—Nancy J
Progestin-eluting intrauterine devices like Mirena and Kyleena work by releasing a small amount of progestin into the cavity of the uterus. The progestin keeps the uterine lining thin, which prevents the implantation of an embryo. The dose of progestin in IUDs is quite small, and as a result it does not typically enter the bloodstream in high levels.
Because blood progestin levels are low, they aren’t likely to have much effect on systemic symptoms of perimenopause and menopause like hot flushes and night sweats. But IUDs can still be useful during this time. IUDs prevent the buildup of the uterine lining, so they can be very helpful for preventing heavy periods during perimenopause.
Women who have a uterus and take estrogen to help with symptoms of perimenopause and menopause need to take progesterone to prevent increased thickness of the uterine lining, which can increase the risk for uterine cancer. Progestin-eluting IUDs are an excellent way to prevent an overgrowth in uterine lining in women taking estrogen.
The takeaway: Progestin-eluting IUDs don’t help with hot flushes or night sweats but prevent heavy buildup of the uterine lining, which can be useful for some women during perimenopause and menopause. Once you are off the estrogen, you can lose the IUD too.
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