Do I Have to Take Out My IUD to Know I Hit Menopause?

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Do I have to take out my IUD in order to know when I’ve hit menopause? (I don’t get periods with my IUD in.)
Anonymous

The average age of menopause is 51.4 years. But the range of age at menopause is large. If the life span of your IUD is coming to a close, you might want to know if you should have another one placed. Or if your IUD is expected to last long past your 51st birthday, you might want to know if you should have it removed early.

One of the best things about progestin-eluting IUDs like Mirena and Kyleena is that many women do not have regular periods with the IUD in place. While that can make it less obvious when menopause occurs, we can get around this.

Progestin-eluting IUDs work by releasing a small amount of the synthetic hormone progestin into the uterus. This keeps the uterine lining from building up, so there is no place for a fertilized egg to implant. However, the amount of progestin is so small that it doesn’t circulate in significant amounts outside of the uterus.

The hormones that regulate the rest of your cycle are not affected. In particular, your pituitary gland, which tells your ovaries to ovulate, and your ovaries themselves go about their business as usual. Some women are very aware of this, experiencing cyclic symptoms. You’re still ovulating; there is just no implantation.

We can measure one of the hormones your pituitary makes to stimulate the ovaries to ovulate — follicle-stimulating hormone again — to get some sense of whether you are in menopause. A high FSH is consistent with menopause. So if your FSH is high, it would be reasonable to remove your IUD and see if you get your period. If you do get your period, you can decide if you want to have a new IUD placed. I would recommend using backup birth control while you are waiting to see if you get a period; if you aren’t in menopause, it is possible to get pregnant.

On the other hand, there is no harm in leaving an IUD in place to the end of its life span. In fact, it can be a great way to provide progestin as a part of hormone replacement therapy (more on this in a later Hot Flash post).