Do IUDs Help With Fibroids?

I am 38 years old, am finished having kids, and have a family history of fibroids that cause excessive bleeding and eventual hysterectomies. My mother started having extremely heavy periods at age 40, which culminated in a hysterectomy at age 43. I wonder if the Mirena/Kyleena IUDs would help with symptoms from fibroids and lower the chance of a future hysterectomy, or would they just mask the problem of large fibroids?
—Family history of fibroids

Fibroids are indeed highly heritable. So it is reasonable to be concerned that you may develop them if your female family members have had them, especially your mother or sisters. Not all fibroids cause heavy bleeding, but about 30% of women with fibroids will experience heavy menstrual bleeding as a symptom. Beyond inconvenience, heavy uterine bleeding can cause anemia and iron deficiency, so it is important to address it.

Fibroids grow in response to estrogen. As a result, some treatments for heavy uterine bleeding, like combination birth control pills, can be counterproductive. And because estrogen declines with menopause, if a woman’s symptoms can be managed until menopause, fibroids will often shrink after menopause, and hysterectomy can be avoided.

IUD device — Reproductive Health Coalition / Pexels

A review of IUDs in women with fibroids found that uterine bleeding is reduced in women with fibroids when a progestin-eluting IUD like Mirena is placed. Two of the included studies showed not only reduced bleeding but an increase in blood hemoglobin levels, suggesting that the reduced bleeding may be helping prevent or reverse anemia too.

Some of the women in the review experienced irregular bleeding, and in some cases women experienced increased bleeding when an IUD was placed. Women with fibroids are also more likely to expel an IUD than women who don’t have them — about 11% of women with fibroids will expel an IUD compared to up to 3% of women without fibroids.

The upshot: Progestin-eluting IUDs have been shown to reduce heavy uterine bleeding from fibroids. It would be very reasonable to try an IUD prior to considering surgery.