Can an IUD Cause Hair Loss? What to Know

Hormonal IUDs that release levonorgestrel, a synthetic progestin, can cause hair loss in a small percentage of users. The best available estimate puts the cumulative incidence at roughly one in 300 users, making it uncommon but far from unheard of. The connection traces back to levonorgestrel’s chemical ancestry: it belongs to a family of progestins that retain some androgen-like activity, and androgens are well-established drivers of hair thinning. Copper IUDs are a separate story, with a different set of claims and a weaker evidence trail.

Why Levonorgestrel Can Affect Your Hair

Levonorgestrel is a progestin derived from 19-nortestosterone. Removing one carbon atom from testosterone shifts the primary hormonal effect from androgenic to progestogenic, but these “19-nor” steroids still carry varying degrees of androgenic activity. That residual androgenicity is dose-related and shows up both metabolically and symptomatically, including through effects on skin and hair.

1PubMed. The androgenicity of progestins

One way this plays out involves a protein called sex hormone-binding globulin, or SHBG. SHBG circulates in your blood and binds to androgens like testosterone, keeping them inactive. When SHBG drops, more free androgens become available to act on tissues including hair follicles. Studies of levonorgestrel IUD users have found a strong correlation between circulating levonorgestrel levels and SHBG: as levonorgestrel goes up, SHBG tends to come down.

2PubMed. Serum SHBG levels during normal menstrual cycle and after insertion of levonorgestrel-releasing IUD

This matters because hair follicles on the scalp are sensitive to androgens. When more free testosterone and its potent derivative dihydrotestosterone (DHT) are available, susceptible follicles gradually miniaturize. The hair they produce gets finer and shorter with each growth cycle until, in some cases, the follicle stops producing visible hair altogether. This is the same basic process behind female pattern hair loss in general, which is why IUD-related thinning can look nearly identical to genetic hair loss.

That said, the hormonal IUD is designed primarily as a local device. Most of the levonorgestrel stays in the uterus, with relatively low amounts reaching the bloodstream compared to oral contraceptives containing the same progestin. Research shows that even after six years of use, serum levonorgestrel levels remain stable, hovering around 300 to 470 picomoles per liter depending on whether the user is still ovulating regularly.

3PubMed Central. Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual pattern after long-term use Those levels are modest, which is why only a fraction of users ever notice hair effects. But “modest” is not zero, and individual sensitivity to androgens varies enormously.

How Common Is Hair Loss with a Hormonal IUD

The most cited figure comes from a study that used data from New Zealand’s Intensive Medicines Monitoring Programme and the World Health Organization’s adverse drug reaction database. Among a cohort of levonorgestrel IUD insertions tracked from 2000 to 2001, five cases of alopecia were identified, giving an estimated cumulative incidence of 0.33%. The WHO database held an additional 68 reports.

4PubMed. Hair loss with use of the levonorgestrel intrauterine device

A separate analysis of the FDA’s Adverse Event Reporting System (FAERS) found hundreds of reports of both diffuse alopecia and, interestingly, excessive hair growth (hypertrichosis) in levonorgestrel IUD users. In that database, hypertrichosis was actually reported more frequently than hair loss, with over 450 reports compared to about 240 for diffuse alopecia.

5Heliyon. Safety profile of levonorgestrel intrauterine system: Analysis of spontaneous reports submitted to FAERS

These numbers deserve some context. Adverse event reporting systems capture spontaneous reports from patients and clinicians, not controlled data. They are good at flagging signals but poor at establishing how frequently something actually happens. The 0.33% figure from the New Zealand cohort is more methodologically sound as an estimate, but even that study was relatively small. The honest summary: IUD-related hair loss happens, it is not imaginary, but it affects a small minority of users.

When Hair Thinning Typically Appears

Many users who report hair changes notice them within the first few months after insertion. This timing can make it tricky to pin down the cause, because the same window coincides with several other life events that commonly trigger hair shedding. If you recently stopped a combined oral contraceptive pill before switching to an IUD, the withdrawal of estrogen alone can cause a wave of shedding known as telogen effluvium, a temporary shift where a large batch of hairs enter their resting phase simultaneously and fall out weeks later. Stress from the insertion procedure, changes in routine, or unrelated health events can produce the same effect.

A broader review of dermatologic effects of hormonal contraceptives found that progesterone-only methods, including implants and hormonal IUDs, tend to trigger or worsen conditions like acne, hirsutism, and alopecia.

6PubMed. Hormonal Contraceptives and Dermatology The pattern is consistent with what you’d expect from a progestin that leans androgenic: more oil production, more body hair, and, in susceptible individuals, thinner scalp hair. Not everyone gets all three. Some get acne without hair changes; others notice thinning but no skin issues. The variable presentation makes it harder to identify the IUD as the culprit.

Does a Copper IUD Cause Hair Loss

Copper IUDs contain no hormones at all, so the androgenic pathway described above does not apply. Still, you will find plenty of online reports from copper IUD users who swear their hair thinned after insertion. Two explanations get floated most often: copper toxicity and iron deficiency.

The copper toxicity theory suggests that copper released by the device raises systemic copper levels enough to interfere with zinc metabolism, thyroid function, or hair growth directly. The evidence for this is weak. A study of long-term copper IUD users found no change in serum copper levels over 24 months and no difference in urinary copper excretion compared to controls, suggesting the copper released from the device may not be readily absorbed from uterine fluid into the bloodstream.

7PubMed. Serum copper in long-term users of copper intrauterine devices A more recent literature review that examined 12 studies on the question came to a mixed conclusion: eight studies showed no increase in blood copper, while four found significant increases.

8PubMed. A Literature Review of the Effects of Copper Intrauterine Devices on Blood Copper Levels in Humans So the data do not cleanly support or refute the copper toxicity idea, but the bulk of evidence leans against it causing meaningful systemic effects.

The iron deficiency explanation has slightly more going for it. Copper IUDs are well-known for making periods heavier. A systematic review found significant decreases in hemoglobin and ferritin levels among copper IUD users, consistent with chronic increased menstrual blood loss.

9Elsevier / Contraception. Hemoglobin and serum ferritin levels in women using copper-releasing or levonorgestrel-releasing intrauterine devices: a systematic review Iron deficiency is an established contributor to hair shedding, so if a copper IUD is making your periods substantially heavier and you’re not compensating with dietary iron, thinning hair could follow. The device itself is not causing the hair loss in this scenario; the iron depletion is. That distinction matters because the fix is straightforward: check your ferritin levels and supplement if they’re low.

Sorting IUD-Related Thinning from Other Causes

Hair loss in women of reproductive age has many possible causes, and an IUD is just one item on a long list. Thyroid disorders, iron deficiency, autoimmune conditions, rapid weight loss, postpartum hormone shifts, and genetic predisposition can all produce thinning that overlaps with what an IUD might cause. The most common endocrinological condition associated with female pattern hair loss is polycystic ovarian syndrome (PCOS), which involves elevated androgens and can produce gradual thinning along the crown and part line.

10PubMed Central. Female pattern hair loss

This overlap creates a diagnostic headache. If you already had early-stage female pattern hair loss that was masked by a combined pill’s estrogen content, switching to a hormonal IUD can reveal what was happening underneath. You might blame the new device for thinning that was genetically programmed all along. Similarly, the transition from one contraceptive to another can trigger telogen effluvium from the hormonal shift itself, separate from any ongoing androgenic effect of the IUD.

A few questions can help you and your clinician narrow things down. Did the thinning begin within a few months of insertion and appear as diffuse shedding all over the scalp? That pattern is more consistent with telogen effluvium from the hormonal transition. Is the thinning concentrated along the part line and crown, progressing slowly? That leans more toward an androgenic pattern. Did you recently stop a combined pill? Did you lose weight, change your diet, or go through a stressful period around the same time? Each of these is a competing explanation worth ruling out before attributing the loss to the IUD.

Blood work can help. Checking thyroid function, ferritin, complete blood count, and hormone levels gives your provider a clearer picture. Interestingly, one study of 60 women with female pattern hair loss found no consistent relationship between the severity of hair loss and lab values, including hormone levels, suggesting that individual follicle sensitivity matters as much as what’s circulating in the blood.

11PubMed Central. Female pattern hair loss: clinico-laboratory findings and trichoscopy depending on disease severity

What Happens If You Remove the IUD

If the hormonal IUD is genuinely the cause, removing it should allow hair to recover, but the timeline is slow. Hair follicles operate on cycles that span months. The resting phase alone lasts around three months, and the growth phase takes much longer than that. Most people who notice improvement after removal describe it as a gradual process that takes six months to a year before they feel their hair is back to normal.

There is also a frustrating wrinkle: removal itself can trigger another round of telogen effluvium. Any hormonal shift, insertion or removal, can push follicles into their resting phase. So some people experience a brief increase in shedding right after the IUD comes out, which understandably feels alarming when hair loss was the reason they removed it in the first place. This is usually temporary and resolves within a few months as the hair cycle resets.

If thinning does not improve several months after removal, the IUD was likely not the primary cause, or it unmasked an underlying pattern of genetic hair loss that will continue regardless of contraceptive choice.

Contraceptive Options That Are Gentler on Hair

Not all progestins are equally androgenic. Levonorgestrel and norethindrone are among the more androgenic progestins, while newer compounds were designed to have less androgen-receptor activity. Laboratory studies comparing progestins across generations have shown that first-, second-, and third-generation progestins display androgenic activity similar to natural androgens, while fourth-generation progestins like drospirenone and nomegestrol acetate actually have anti-androgenic properties.

12PubMed Central. Comparing the androgenic and estrogenic properties of progestins used in contraception and hormone therapy

Combined oral contraceptives that pair estrogen with a low-androgenic or anti-androgenic progestin tend to be the friendliest option for hair. The estrogen component boosts SHBG production, which binds up free androgens and reduces their availability at the hair follicle. This is why dermatologists sometimes recommend specific combined pills as part of a treatment plan for female pattern hair loss. All combined oral contraceptives provide some benefit for androgenic symptoms, though pills containing anti-androgenic progestins like drospirenone offer the strongest effect.

13PubMed. Update on androgenicity

Of course, not everyone can or wants to take a combined pill. People with migraine with aura, a history of blood clots, or other risk factors for cardiovascular events are generally advised to avoid estrogen-containing contraceptives. For those individuals, the decision becomes a trade-off between the convenience and effectiveness of a hormonal IUD and the small but real risk of hair-related side effects. A copper IUD avoids the androgenic concern entirely, though with the trade-off of heavier periods and the potential for iron depletion mentioned earlier.

The Lower-Dose Hormonal IUDs

Hormonal IUDs are not all identical. Several versions are available that differ in size and in the amount of levonorgestrel they release. The original device releases about 20 micrograms per day initially, while smaller versions release roughly half that amount. Because the androgenic effects of levonorgestrel are dose-related, lower-dose devices should theoretically carry a lower risk of hair-related side effects. That logic is pharmacologically sound, but no head-to-head trial has directly compared alopecia rates between the high-dose and low-dose IUDs. The clinical data on hair loss comes almost entirely from studies of the original, higher-dose device.

If you want the convenience of a hormonal IUD but are worried about hair thinning, asking your provider about a lower-dose option is reasonable. Just know that the evidence behind that choice is more inference than proof.

Why Dermatologists and Gynecologists Sometimes Disagree

There is a genuine disconnect in how different specialties view this issue. Gynecologists and reproductive health specialists tend to emphasize that the hormonal IUD acts primarily as a local device, with minimal systemic absorption, and that alopecia is listed as an uncommon side effect. Dermatologists who treat hair loss, on the other hand, see a steady stream of patients whose thinning coincided with IUD insertion and whose other potential causes have been ruled out. One recent dermatology-focused commentary noted that while many studies have reported acne in association with levonorgestrel IUDs, minimal information is available on other androgenic cutaneous effects, including alopecia and hirsutism, suggesting the side effect may be underrecognized.

14Journal of the American Academy of Dermatology. Levonorgestrel intrauterine devices and androgenic cutaneous effects

This gap is not unusual in medicine. When a side effect is uncommon and develops gradually over weeks or months, it is easily missed. It also doesn’t help that the hormonal IUD’s marketing has long emphasized its local action, which can make both providers and patients skeptical that a uterine device could affect hair follicles on the scalp. Yet the measurable systemic levels of levonorgestrel, the known androgenic properties of the compound, and the consistent (if small) adverse event reports all point in the same direction.

One study that examined serum androgen levels in IUD users found that total testosterone, androstenedione, DHT, DHEAS, and SHBG all declined after insertion, while free testosterone and hair shaft diameter did not change significantly.

15PubMed. Levonorgestrel effects on serum androgens, sex hormone-binding globulin levels, hair shaft diameter, and sexual function At first glance, that seems to argue against the IUD causing hair trouble. But the decline in SHBG is the detail that matters most: when SHBG falls, even if total testosterone also falls, the ratio of free-to-bound testosterone can shift in a direction that affects androgen-sensitive tissues. Hair shaft diameter, measured in that study at a single time point, may not capture the slow miniaturization process that unfolds over many months. This is one of those areas where a single study’s snapshot results can be misleading if you read only the headline conclusion.

Practical Steps If You’re Experiencing Thinning

If you’ve noticed increased shedding or thinning since getting a hormonal IUD, a few practical steps can help you figure out what’s going on before making any drastic decisions.

  • Track the timeline: Note when you first noticed changes relative to insertion. If it started within one to three months, telogen effluvium from the hormonal shift is a strong possibility and may resolve on its own.
  • Get bloodwork: Ask for thyroid function, ferritin, and a complete blood count at minimum. Low iron and thyroid issues are treatable and common enough that they should be ruled out early.
  • Look at the pattern: Diffuse shedding all over the scalp points more toward telogen effluvium. Gradual thinning along the part line suggests androgenic effects or underlying genetic hair loss.
  • Give it time: If you’re within the first six months of insertion and the shedding is modest, waiting to see if it stabilizes is reasonable. Many cases of early shedding after IUD placement do resolve without intervention.
  • Consider a dermatology referral: A dermatologist who specializes in hair can use tools like dermoscopy to evaluate your follicles and distinguish between different types of hair loss, which helps determine whether the IUD is a likely contributor.

Removing the IUD is always an option, but it makes sense to gather information first. If the real culprit turns out to be low iron or thyroid dysfunction, you’d be giving up a contraceptive method for no benefit.

The Hypertrichosis Puzzle

One of the odder findings in the FAERS data is that excessive hair growth was reported even more frequently than hair loss among levonorgestrel IUD users. This might seem contradictory: how can the same device cause some people to lose scalp hair and others to sprout extra body or facial hair? The answer lies in how androgens affect different types of hair follicles. Scalp follicles, particularly those on the crown and temples, tend to miniaturize in response to androgens. Follicles on the face, chest, and abdomen tend to do the opposite, growing thicker and darker. The same hormonal signal produces opposite effects depending on the follicle’s location and genetic programming. This is the same reason men can go bald on top while growing a full beard.

For IUD users, this means that androgenic side effects are not limited to hair loss. Some people notice new dark hairs on the chin or upper lip, increased body hair, or both hair thinning and new growth in different places simultaneously. The presence of hirsutism alongside thinning scalp hair is actually a fairly strong signal that androgenic activity is at play, which can help distinguish IUD-related changes from other causes of shedding.