Intrauterine devices (IUDs) are small, T-shaped devices inserted into the uterus to prevent pregnancy. They are a highly effective form of long-acting reversible contraception (LARC), offering over 99% effectiveness. Many individuals find IUDs convenient due to minimal maintenance and long-term protection. However, questions sometimes arise regarding their potential influence on mood.
The Direct Connection: IUDs and Mood
The scientific evidence concerning a direct link between IUDs and depression is complex. Some research indicates a small, yet statistically significant, association between hormonal IUDs and an increased risk of depressive symptoms. For instance, a 2016 study of over one million individuals found that hormonal birth control, including levonorgestrel-releasing IUDs (LNG-IUDs), was associated with a higher risk of depression diagnoses and antidepressant use. Approximately 2.2% of users were prescribed antidepressants within a year, compared to 1.7% of non-users.
A 2023 study also suggested LNG-IUD use was associated with a 57% increased risk of depression, particularly for adolescents and new users. However, other systematic reviews have found mixed results. A 2022 review of 22 studies on LNG-IUDs and psychiatric symptoms reported varied outcomes: some showed increased depressive symptoms, others no association, and some a decreased risk. Overall, hormonal IUDs may have some association with mood changes for certain individuals.
Hormonal IUDs: Exploring the Mechanism
Hormonal IUDs, such as Mirena, Skyla, Kyleena, and Liletta, release a synthetic progestin called levonorgestrel directly into the uterus. While their primary action is local, levonorgestrel can be absorbed into the bloodstream, leading to systemic effects. Product labeling for LNG-IUDs includes potential mood symptoms.
Progestin may influence mood by interacting with neurotransmitters and hormone receptors in the brain. It can affect neurochemicals like serotonin, GABA (gamma-aminobutyric acid), and dopamine, which play roles in mood regulation. Progestin can also influence the hypothalamic-pituitary-adrenal (HPA) axis, the body’s central stress response system, potentially altering its function. Individual responses to these hormonal influences can vary significantly due to biological makeup.
Non-Hormonal IUDs and Mood Considerations
In contrast to hormonal IUDs, non-hormonal IUDs, like the copper IUD (e.g., Paragard), do not release hormones. Consequently, they do not directly influence mood through hormonal pathways. However, non-hormonal IUDs can still be indirectly associated with mood changes through other side effects.
A common side effect of copper IUDs is heavier and more painful menstrual periods. Periods can become 20% to 50% heavier for up to 12 months after insertion, and cramping may be severe for some individuals. This increased physical discomfort, coupled with potential fatigue or even anemia from greater blood loss, can contribute to feelings of low mood, irritability, or reduced well-being. Some individuals using copper IUDs have reported mood swings and intensified premenstrual syndrome (PMS) symptoms, which they attribute to these indirect physical effects.
Recognizing Signs and Seeking Support
If an individual experiences mood changes after IUD insertion, recognizing the signs of depression is important. Common symptoms include persistent sadness, loss of interest or pleasure in activities, and changes in sleep patterns or appetite. Other indicators are fatigue, difficulty concentrating, feelings of worthlessness, irritability, or restlessness.
Track any new or worsening symptoms and communicate these observations to a healthcare provider. Self-diagnosing or attempting to remove an IUD without medical consultation is not advised. Open communication with a doctor about all symptoms and potential contributing factors, including IUD use, is helpful. Healthcare professionals can assess the situation, discuss potential connections, and explore various treatment options, which might include considering an alternative birth control method, prescribing antidepressant medications, or recommending therapy. Lifestyle adjustments, such as regular exercise, can also provide mood support.