Why are we talking about this?  It is estimated that more than 15% of the women using contraception in the US are using IUDs, making this a meaningful topic for many women entering into perimenopause. Understanding how these contraception methods function and their potential impacts on perimenopause and menopause can inform how women approach these milestones.

 

Types of IUDs. There are two primary categories of interuterine devices (IUDs): Hormonal and non-hormonal (copper). In the United States, five FDA-approved brands are currently available (Lanzola & Ketvertis, 2023).

 

How do IUDs work?

 

• Hormonal IUDs, which all use a synthetic progestin called levonogestrel (LNG), work locally within the uterus. The progestin thickens cervical mucus, keeps the lining of the endometrium thin,  and in higher dose devices may partially suppress ovulation. This form of contraception acts predominantly within the uterine cavity, systemic absorption is less than that of oral progestin (Pinkerton et al, 2022), which is a meaningful distinction in perimenopause symptom management.

 

• Copper IUDs operate differently from the hormonal IUDs. The copper ions from this type of IUD create a spermicidal environment without any hormonal action.

 

Potential Impact of IUD on Perimenopause Symptoms & Changes

 

Hormonal IUDs

 

• Help to prevent heavy bleeding which is sometimes associated with perimenopause. With Hormonal IUDs, the endometrium is where the impact of IUDs and perimenopause overlap is the heaviest. As estrogen levels fluctuate, the uterine lining can thicken unpredictably and contribute to heavy menstrual bleeding. LNG IUDs contract this by promoting a thin inactive lining as a result these IUDs have been used off-label to has the progestin component of Hormone Replacement Therapy, which helps manage heavy menstrual bleeding and risk of endometrial cancer (Clark & Westberg, 2021).

• Masking menstrual irregularities as these IUDs often consistently decrease period frequency and duration. These IUDs are also often associated with a decrease in period frequency or an increase in menstrual cycles. These IUDs can obscure menstrual irregularity associated with perimenopause as well as the onset of menopause. Up to 40% of Mirena users experience amenorrhea within 3 years of insertion (Bayer HealthCare Pharmaceuticals, 2024). Clinical guidance suggests many women can continue hormonal IUDs until approximately age 55, at which point most women have likely gone through menopause.

• Mixed Research on mood changes. Research on whether IUDs impact symptoms of depression is mixed ((Elsayed et al, 2022), and most studies focus generally on women of reproductive age. Additional research or reviews are needed here specifically on the intersection of IUDs and mood changes in women experiencing perimenopause.

• Little or no impact on symptoms across other systems. Given that these devices and the progestin they release act predominantly in the uterine cavity, they don't address the symptoms of perimenopause across the rest of the body like vasomotor symptoms (hot flashes), GSM symptoms, and cognitive changes. (Pinkerton et al, 2022)

 

 

Copper IUDS

• Little or no impact on symptoms and changes associated with perimenopause. There are often reports of heavier bleeding and cramping in the first few months after insertion, this form of contraception doesn't alter the frequency of a woman's menstrual cycle so any shifts in period frequency which are often a first sign of perimenopause won't be masked.

 

 

Bone Mineral Density (BMD).  Neither type of IUD on its own has a material impact on bone mineral density for women who are near menopause. Since the IUDs act locally, it makes sense that an impact across other body systems hasn't been found (Yang et al, 2012).

 

 However, IUDs have been used as a part of Hormone Replacement Therapy to provide endometrial protection while estrogen can provide protection against fractures (Mukherjee & Davis, 2025).

 

How will I know if I've entered into menopause? The Menopause Society states 90% of women will reach menopause by age 55 and recommends the continued use of contraception until then or menopause is confirmed. There are two main types of test for whether or not menopause has occurred.

  

   1) Stop use of hormonal birth control and watch for a year to see if a period returns.

   2) Testing FSH levels. The process here will vary by birth control type.
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