IUDs for PCOS: What you need to know

In a nutshell

• IUDs are long acting, reversible contraceptives that are highly effective at preventing pregnancy.
• There are two types of IUD—hormonal and copper. 
• Hormonal IUDs can lower the risk of endometrial cancer and lighten heavy periods.
• They can be an effective birth control option for women with PCOS who don’t experience high androgen symptoms and are seeking reliable contraception.
• Your healthcare provider can discuss the available options and help determine the best one for you.

Polycystic ovary syndrome (PCOS) is a chronic hormonal condition that affects around 8–13% of reproductive aged women. It can cause irregular periods, weight gain and excess hair growth and is the leading cause of infertility. It is also linked to other chronic health diseases like: type 2 diabetes, high blood pressure, heart disease and endometrial cancer.

If you have 2 of the following 3 symptoms you may be diagnosed with PCOS:

• Irregular menstrual cycle. Irregular periods mean your ovaries are not regularly releasing an egg. Periods can also be intermittent, heavy, or completely absent.
• Excess androgens. PCOS can cause high levels of the ‘male’ hormones called androgens. This can result in excess facial or body hair, acne, or rarely, male pattern baldness.
• Polycystic ovaries. An ultrasound scan will see enlarged ovaries with multiple fluid—filled sacs (follicles). Follicles contain eggs that don’t mature enough to be released.   

If you have PCOS and are looking for birth control, or help managing your symptoms, you may be wondering if an IUD is the right choice for you. Here we will discuss what IUDs are, how they work, how IUDs affect PCOS and what you should consider before getting one.

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What is an IUD? Types and how they work

An IUD, or intrauterine device - often called “the coil”-is a small T-shaped device that a doctor or nurse inserts into your uterus. According to the American College of Obstetricians and Gynecologists (ACOG), IUDs are over 99% effective at preventing pregnancy and can offer additional benefits depending on the type. Here’s a look at the different types of IUD:

1. Copper IUD (brand name: Paragard). some text
   • Doesn’t contain hormones 
   • This device contains a small amount of copper. This creates a hostile environment for the sperm and prevents it from reaching the egg. 
   • Can last up to 12 years.
2. Hormonal IUD (brand names: Mirena, Kyleena, Liletta, Skyla). some text
   • Sometimes referred to as an IUS (intrauterine system)
   • Releases the hormone progestin directly into the womb.
   • Progestin prevents pregnancy by thickening the mucus in the cervix making it hard for sperm to pass through and can sometimes prevent the ovaries releasing an egg (ovulation). 
   • Lasts 3–8 years depending on the brand.

Can you get an IUD if you have PCOS?

Yes, you absolutely can. In fact, depending on your PCOS symptoms and why you need birth control, the IUD might be the best option for you. Your healthcare professional can chat with you about the different options available, and which might suit you best. 

How IUDs affect PCOS symptoms

Both the hormonal and copper IUD are highly effective at preventing pregnancies, but, because they work in different ways, they can have different effects on PCOS symptoms. 

Hormonal IUD and PCOS symptoms

This progesterone—only contraception can impact PCOS symptoms in the following ways:

• Regulate the menstrual cycle. Irregular periods are common in women with PCOS and the hormonal IUD can help to regulate the menstrual cycle.
• Lighten or stop heavy periods. If you suffer from heavy periods then the hormonal IUD can significantly reduce the amount of bleeding you experience. 
• Protect against endometrial cancer. According to a 2023 meta analysis, women with PCOS are up to 5 times more likely to develop endometrial cancer (cancer of the lining of the womb). Using hormonal contraceptives like the combined oral contraceptive or the hormonal IUD can protect the endometrium and lower the risk of endometrial cancer.  

What won’t the hormonal IUD do?

Unlike the combined oral contraceptive (COC), the hormonal IUD does not contain estrogen, this means it has no anti—androgen effect. So, if you suffer from symptoms of high androgens such as excess hair growth or acne, the hormonal IUD is unlikely to improve this. There are however other medications available that can be used alongside the hormonal IUD to treat the symptoms of high androgen. Your healthcare provider will be able to discuss the different options available and help you to decide the best choice for you.

Copper IUD and PCOS symptoms 

The copper IUD doesn’t contain any hormones, this means it is unlikely to have an effect on your PCOS symptoms and does not reduce the risk of endometrial cancer. 

The copper IUD is a good option for women with few PCOS symptoms who are looking for a hormone—free, long acting contraceptive.  

Pros and cons of using hormonal IUDs for PCOS

‍Pros

• 99% effective at preventing pregnancy 
• Won’t improve symptoms of high androgen like excess hair growth or acne
• Long term (some can last up to 12 years before they need replacing)
• Can reduce heavy bleeding
• Cannot be used in women who have vaginal bleeding with no know cause
• Can regulate your menstrual cycle 
• Requires minimal maintenance and effectiveness not compromised during illnes
• Can be used for women when COC is contraindicated (for example for women who are high risk for blood clots)
• Safe to use while breastfeedin
• Can be used as emergency birth control within 5 days of unprotected sex
• Reduces the risk of endometrial cancer

Cons

• Possible side effects include spotting, acne, cramping pelvic pain and headaches
• Baseline fertility returns almost immediately after removal
• Cannot be used by women with a history of breast, uterine or cervical cancer
• Cannot be used in women who have a pelvic infection
  

Important things to consider when choosing an IUD for PCOS

If you’re thinking about getting an IUD then the best thing to do is to have a chat with your healthcare provider. They will be able to tell you what options are available and which could work best for you. Here are a few key things to think about before deciding on an IUD for PCOS: 

1. Personal needs. Are you looking to prevent pregnancy or are you hoping to manage PCOS symptoms as well.
2. Lifestyle and contraceptive needs. An IUD is a low maintenance option that doesn’t require you to have to remember to take it, lasts for years, and isn’t affected by common illnesses like vomiting or diarrhea.
3. Side effects and personal comfort. Side effects like lighter periods might be beneficial to you, but if you’re looking for something to help with broader PCOS symptoms like excess hair growth then an IUD might not be the best fit.
4. Individual health needs. Depending on your individual health, your birth control options might be more limited. In general the IUD can be used by women who are at higher risk of developing a blood clot and therefore can't take the COC.

Frequently asked questions

• Is the IUD good for people with PCOS? Yes, an IUD, particularly the hormonal IUD, can be a good option if you have PCOS and are looking for a low maintenance, long—acting birth control. It won't reduce the symptoms of high androgens but if you suffer from heavy periods it can significantly improve them.
• Is an IUD the best birth control option for PCOS? Depending on your individual needs the hormonal IUD might be a good option for you. However, if you suffer from a range of PCOS symptoms or insulin resistance then your healthcare provider may recommend the COC first. 
• Are there any problems with PCOS and IUD? You can experience side effects like spotting or cramps with the IUD and the copper IUD can cause heavier periods. They also don’t address all PCOS symptoms so depending on your unique situation they may not be the most appropriate birth control option.

Final verdict 

If you have PCOS and are looking for birth control or a way to manage certain PCOS symptoms then an IUD might be a good fit for you. Hormonal IUDs in particular can be good for women with PCOS who suffer from heavy, irregular periods. The hormonal IUD can also reduce the risk of endometrial cancer which is often higher in women with PCOS.

An IUD won’t address all PCOS symptoms, particularly those caused by high androgen levels. If you’re seeking birth control or ways to manage your PCOS symptoms, speak with your healthcare provider. They can offer a personalized approach to help you find the best option for your needs.