Can the levonorgestrel-releasing intrauterine device (Mirena) cause hair loss?

Can Mirena IUD Cause Hair Loss?

Yes, the Mirena (levonorgestrel-releasing intrauterine device) can cause hair loss, though this is an uncommon side effect that should be discussed during pre-insertion counseling.

Evidence and Incidence

Hair loss is a recognized systemic side effect of the levonorgestrel IUD, though it occurs infrequently. The estimated cumulative incidence of alopecia with Mirena use is approximately 0.33% (95% CI 0.07-0.95) based on postmarketing surveillance data 1. A clinical review identified hair loss as one of the possible side effects of levonorgestrel-releasing IUDs 2.

Mechanism and Clinical Context

The hair loss associated with Mirena relates to the systemic absorption of levonorgestrel, despite the device being designed for local intrauterine effects. The progestin component can have androgenic effects that may trigger alopecia in susceptible individuals 3. However, it's important to note that levonorgestrel actually decreases serum androgens (total testosterone, androstenedione, DHT, and DHEAS) in most users 4, which makes the mechanism of hair loss more complex and likely multifactorial.

Clinical Management Algorithm

Pre-Insertion Counseling

• Inform patients that systemic side effects, including the possibility of hair loss, can occur with Mirena 1
• Document this discussion as part of informed consent
• Assess personal or family history of androgenic alopecia

If Hair Loss Develops During Use

1. Rule out other causes first:

   • Thyroid disorders
   • Nutritional deficiencies (iron, zinc, biotin)
   • Other medications
   • Telogen effluvium from stress or recent pregnancy
   • Underlying dermatologic conditions

2. Assess timing and severity:

   • Document when hair loss began relative to IUD insertion
   • Evaluate extent of hair loss and patient distress
   • Consider dermatology referral if severe or atypical pattern

3. Management options based on patient preference:

   • If mild and acceptable to patient: Provide reassurance and monitor
   • If moderate to severe or unacceptable: Remove the IUD and offer alternative contraception 1
   • Hair loss typically resolves after IUD removal, though recovery time varies

Alternative Contraceptive Options

If removal is necessary, consider:

• Copper IUD (ParaGard): No hormonal component, eliminates progestin-related effects 5
• Barrier methods: Condoms provide STI protection
• Other hormonal methods: Though these may also affect hair, individual responses vary

Important Caveats

• The French pharmacovigilance database reported increased awareness of various side effects including hair loss after media coverage in 2017, with 42.3% of post-media reports mentioning weight increase and various other symptoms 6
• Side effects like bloating, weight gain, fatigue, and hair loss were comparable between levonorgestrel IUD and oral progestins in comparative studies 7
• Patient satisfaction remains high: In extended use studies through 8 years, 98.7% of women who completed the study remained satisfied with continued Mirena use 8

Key Takeaway

While hair loss can occur with Mirena, it affects less than 1% of users. The decision to continue or remove the device should be based on the severity of hair loss, patient distress level, and availability of acceptable alternative contraception. The IUD can be removed at any time if the patient finds the side effect unacceptable, and alternative contraceptive methods should be offered immediately 9.