Q: Can a hormonal intrauterine device (IUD) be used to help manage heavy or irregular bleeding that often occurs during the transition to menopause?
A: Yes, they are sometimes prescribed for this purpose—though they don’t help with other menopause-related symptoms like hot flashes, night sweats, and vaginal dryness.
Used mainly for contraception, hormonal IUDs release a steady stream of levonor-gestrel, a synthetic version of the hormone progesterone (called a progestin). A side effect, which is welcomed by many women, is that the devices decrease or even stop menstrual bleeding over time. For this reason, the FDA has approved hormonal IUDs (as well as birth control pills) to manage heavy or irregular periods, including those that commonly accompany perimenopause (the years leading up to menopause, also called the “menopausal transition”).
In addition to their use for excessive bleeding, hormonal IUDs are sometimes prescribed off-label in the U.S. to women who are taking estrogen therapy for menopausal symptoms. In women who have not had a hysterectomy, it’s necessary to prescribe progesterone or a progestin along with estrogen—called combined hormone therapy—to prevent overgrowth in the uterine lining, a potential side effect of estrogen replacement that increases the risk of endometrial cancer. Most women are prescribed oral progesterone or a progestin for this purpose, but the IUD can be used as an alternative in women who have difficulty tolerating the hormone orally. Since an IUD leads to lower concentration in the blood than progesterone or progestins taken orally, it carries a lower risk of side effects, which include fatigue, breast tenderness, weight gain, headache, and mood changes. The FDA has not approved hormonal IUDs for this purpose, but some 140 other countries have.
There’s still another way a hormonal IUD can be useful as a woman goes through menopause: It can prevent an unplanned pregnancy, which is still possible until a woman has had her final menstrual period.
If you are nearing menopause and are experiencing troublesome bleeding, or if you are considering or already taking combination hormone therapy to treat menopausal symptoms and are concerned about side effects from oral progesterone or progestins, you could talk with your gynecologist about having a hormonal IUD inserted. It’s a relatively simple (though not necessarily painless) procedure that is done during a regular office appointment. Once inserted, the IUD can be left in for three to five years.
Jeanine Barone contributed to this article.
This article first appeared in the UC Berkeley Wellness Letter.
