5 things to say to your doctor about the hormonal IUD: Birth Control 101

One of the most common birth control misconceptions that I have encountered is the myth of the locally-acting IUD. This is the belief that the hormones in the IUD “act locally”, affecting women’s reproductive organs, but not their brains.

But it doesn’t work this way.

Hormones go everywhere in the body that blood travels and bind to every cell that has receptors for them. 

And guess where many of these hormone receptors live? 

That’s right: the brain.

Because of this, even though the hormone levels in the IUD are low, most women who go on it stop ovulating. At least for a little while. Here are the numbers according to the research:

• In the first year, about 65 percent of people using a 52 mg IUD won’t ovulate. 

• After four years, about 25 percent of people using a 52 mg IUD still won’t ovulate (1). 

Ovulation is initiated by the brain, not the ovaries. So, if the hormones were actually acting locally (again – a biological impossibility, but let’s use our imaginations), ovulation would still occur.

It’s also important to note that – even if you are ovulating on your IUD – this doesn’t mean that the hormones aren’t affecting your brain. And it certainly doesn’t mean that the hormones are acting locally. It simply means that the effects on the hypothalamus (the brain region that coordinates ovulation) are not sufficient to prevent ovulation.

So, what can you say to your doctor if (s)he suggests the hormonal IUD because it is “more natural” than other forms of hormonal contraceptives?

1. Since hormones travel through the blood stream and get everywhere that blood travels, doesn’t that mean that they will get to my brain? 

2. I read that the majority of women on the hormonal IUD don’t ovulate, at least not in the first year they are on it. Since ovulation is initiated by the brain (you can specifically mention the hypothalamus if you want add style points), wouldn’t this mean that it affects the brain?

3. On average, how long does it take women to begin ovulating again once they are on the hormonal IUD? Do their side-effects begin to decrease after ovulation resumes?

4. Why do you recommend that I go on the hormonal IUD instead of using the non-hormonal cooper alternative? What are the plusses and minuses of each choice? Why do you prefer the hormonal version for me?

5. A recent study in JAMA found that the risk of subsequently developing depression was greater among women who were prescribed the hormonal IUD than it was for women who were prescribed several different types of combined oral contraceptive pills. This makes me concerned about the mental health side-effects of the hormonal IUD. Are you concerned about these side-effects for me?

You have to remember that your doctor – even when (s)he has your best interest in mind – will never care about your body and mental health the same way you do. Listen and learn from your doctor’s wisdom, but you need to be part of the conversation. Be an advocate for yourself. Ask questions. And don’t feel like you have to agree with the recommendation made by your doctor. If you don’t want to use hormonal birth control, you don’t have to. There are other options. If you are interested in using hormonal birth control, there are some options (see next paragraph) that should be less disruptive to ovulation than others. Bottom Line: YOU are the expert on your body and both you and your doctor need to respect that expertise.

Other factoids to help your convo with your doc. Hormonal IUDs are available with different doses of hormones. Higher dose IUDs impact ovulation more than lower dose IUDs (1, 2, 3). And many people using the 19.5 mg IUD continue to ovulate (4) and appear to have normal ovarian function (4). The same is true with the 13.5 mg IUD (3). If you would like to continue to ovulate while on the hormonal IUD, talk to your doctor about using a lower dose variant. 

Take care. Be well. Do ridiculous things just for fun. Xoxo