Hormonal IUDs and Sex Drive

For women on an IUD sex drive changes are often reported, and there may be a biological basis for those on hormonal IUDs, of which now there are three: Mirena, Skyla, and Lilleta. We have already discussed relationships between the levels of testosterone and a woman's sexual function in a prior post.  Women on OCs (oral contraceptives, birth control pills) have a known decreased levels of male hormones due to suppression of their hormones naturally made by their ovaries. We take advantage of that fact, and it is a bonus non-contraceptive effect of the pill, that when using OCs to suppress ovarian male hormones this treatment therefore helps to control acne, PMS, heavy bleeding, menstrual cramps as well as other hormonal symptoms such as breast pains. But a disadvantage of this is that some studies have reported that the suppression of testosterone by OCs also suppress sexual function and desire. We know that even aging changes our male hormone levels, by your mid 40s you probably have about a 30% decrease in your male hormones due to decreased ovulation and decreased adrenal gland function. Add contraceptive or other hormonal treatments to this natural decline, or be one of those individuals who has even naturally lower levels of testosterone, then the effects on sexuality may be more dramatic.Switching over to a medicated IUDs from OCs is often a great solution for periods, and cramps, not to mention the convenience and effectiveness which are both terrific, and it's completely, and rapidly reversible, but what do we know about these IUDs and sexuality? Reports were filtering in to me from patients expressing various responses: some had a fairly rapid resolution of their sexual OC complaints when switching to a medicated IUD, others had no different response, and some who hadn't had prior problems with sexual function reported new complaints of low libido and arousal from the use of Mirena. Digging into the literature, there's not much to go on in the medical research files to give my patients firm answers on this. First some facts on how it works, then lets talk SEX.

Getting more into the physiology I can tell you more about the interaction of your hormones and your sexual function. Sex may require the interaction of several hormones and brain chemicals to function naturally. Most women become desirous of sex then begin to get aroused when stimulated. Others can respond in the opposite order. Hormones that affect the amount of desire as well as the amount of arousal have some impact on our sexuality. Progesterone's exact role in sexuality is not known, but it may have some adverse effects by lowering estrogen or testosterone. The these medicated IUD has a synthetic type of progesterone, that is a male hormone derivative called levonorgesterel. It is a safe and effective contraceptive agent which has been used for decades. Mirena leaks about 15 to 20 ug of levonorgesterel (LNG) daily into the uterus, this varies among women and will be the strongest in the first 6 months of IUD use. The IUDs do not cause miscarriages, they prevent fertilization of eggs, and the LNG thickens cervical mucus so sperm cannot even penetrate. The pregnancy rate the first year is 0.2%! About 60% of women will eventually dry up their periods and not bleed at all the way the dose is designed. Hormonal side effects are reported by some as about 1% of the hormone gets into your blood stream. And about 1/10 users will stop the Mirena in the first year due to complaints of the various hormonal side effects.

Sex should improve if you have had a low sex drive on the pill and now are using an IUD. With a medicated IUD, in most women, estrogen levels stay normal, and vaginal lubrication should be normal. Polish researchers from the Medical University of Silesia in 2007 reported that Mirena users as a group had better sexual desire and arousal than control groups studied. When you discuss your sexual symptoms with your gyno, here's what you should bring to the discussion: facts about: desire, arousal, lubrication, orgasm, sexual satisfaction and pain with sex (dyspareunia). And the other thing to consider: what is your normal sexuality, there are women that have heightened awareness of sexuality and place more interest in sexuality. We have this issue with sexuality studies. Women who participate in a sexuality study are suddenly more interested in sex! And yes, if you're tangoing with a partner, what issues are there between you two? That affects sexuality too, and that's a whole different discussion.

And if you just want a boost to spice up your sex life, there are many new therapies available including MonaLisa Touch and Magellan PRP. 


  1. I've had my Mirena IUD for coming up to 5 years now and I've been pretty happy with it, other than some hormonal-type side effects in the first few months that then went away. My sex drive feels good and it is certainly convenient not to have periods.

    However, I'm wondering now that my 5 years are almost up if there are any risk to consider in getting another one? Long term effects of hormones on my system and that kind of thing? I will hopefully not use it for the entire next 5 years but that would depend on me being able to find Mr. Right and finally have kids, haha.

  2. Women should consult with their individual gynecologist to determine when and if they should replace their Mirena IUD. Yes, it has been shown in studies to be safe for repeat insertions after the time of expiration of this device. There are studies that show the Mirena IUD device is likely good for 7 years of use, not just 5, and many physicians have begun to recommend their patients go the extra two years. the non-contraceptive benefits women will see from their IUD will continue with the second IUD and this it is recommended that women using Mirena successfully should continue with a reinsertion after their current IUD expires.


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