Q: Can an IUD help manage menopausal hot flashes and bleeding?
Menopause is a normal a part of a woman’s life cycle—just like puberty and pregnancy. Yet it is a dynamic change for the person experiencing it, and is different for every woman. Some women will have very few or relatively minor symptoms. Others will experience multiple symptoms, some of which may be disruptive enough to daily life to require treatment.
Decreases in the female hormone, estrogen, commonly cause:
- Abnormal bleeding (irregular bleeding, long periods, and heavy bleeding)
- Hot flashes
- Night sweats
- Mood changes
- Vaginal dryness
- Sleep disruptions
- Sexual desire or enjoyment changes.
A progesterone IUD can help with some, but not all, of these symptoms. Progesterone is “the other female hormone” and is important for regulating the endometrial lining of the uterus—the layer of cells inside the uterus that builds up each month and is then shed, causing a period. Supplementing progesterone with an IUD can help with irregular bleeding that often occurs during both perimenopause (the years leading up to menopause) and menopause itself. An IUD often decreases and may even stop menstrual bleeding.
Unfortunately, the progesterone IUD alone will not stop vulvar or vaginal changes or vasomotor symptoms such as hot flashes or night sweats—these symptoms are typically treated with nutritional supplements or hormone replacement therapy. That said, the progesterone IUD can play an important role during hormone therapy.
If a woman has an intact uterus (she had not had a hysterectomy) and needs estrogen replacement therapy, she’ll also need a progesterone replacement to protect the lining of the uterus and prevent postmenopausal bleeding or endometrial hyperplasia (an overgrowth of uterine lining which can become cancerous over time). For women needing estrogen replacement, a progesterone IUD can protect the uterine lining during hormone therapy.
While an IUD doesn’t provide complete relief from perimenopausal or menopausal symptoms, women in these stages may still want to use one for pregnancy prevention. During a woman’s transition from her childbearing years to the time in her life when she is no longer at risk for pregnancy, periods may become irregular, lighter, heavier, and generally less predictable. While pregnancy is less likely during this time, a woman is still at risk for unplanned pregnancy until she has gone a full year without a period.
Everyone has heard a story about a woman who was surprised to find herself pregnant in her late 40s or even early 50s because she was sure she had been through “the change” and could not get pregnant anymore. While some women may choose to delay pregnancy until their 30s or even 40s, pregnancy after age 40 carries significant risks to the mother and baby. The risks are even higher for unintended pregnancy. Numerous women’s health care groups recommend women continue birth control until menopause is complete.
Certified nurse midwives care for women throughout the lifespan, including during menopause. If you have questions about perimenopausal changes, signs of menopause, or treatment of symptoms, or if you are considering a progesterone IUD for contraception or treatment of menstrual concerns, we’d be happy to talk with you.
Christine Weinmeister is a certified nurse midwife at Vancouver Clinic. She strives to help all her patients feel informed and empowered in their health care decisions.