Can Mirena (levonorgestrel) cause decreased libido?

Mirena (Levonorgestrel IUD) and Decreased Libido

Yes, Mirena can cause decreased libido in some women, though this effect varies significantly between individuals and is not experienced by the majority of users.

Hormonal Effects of Mirena on Sexual Function

Mirena is a levonorgestrel-releasing intrauterine device (IUD) that provides highly effective contraception with a failure rate of less than 1% 1. While it primarily works locally within the uterus, there are systemic effects to consider:

• Levonorgestrel is a progestin that can potentially affect hormonal balance
• Hormonal contraceptives, including progestin-only methods like Mirena, can influence female sexual function in various ways 2
• Sexual side effects of hormonal contraceptives are not well studied, particularly regarding impact on libido 2

Evidence on Mirena and Libido

Research shows mixed effects on libido with hormonal contraceptives:

• A small percentage of women experience decreased libido
• Some women report increased libido
• The majority of women experience no significant change 2

A study specifically examining Mirena's effects on sexual functioning found:

• Women using the Mirena system showed improved sexual functioning parameters compared to other IUD users and women using no contraception
• Specifically, Mirena users demonstrated better sexual desire and arousal
• Sexual dysfunctions were diagnosed in only 9.6% of Mirena users compared to 20.8% of other IUD users and 34.7% of women using no contraception 3

Factors That May Contribute to Decreased Libido with Mirena

If decreased libido occurs, several mechanisms may be involved:

1. Hormonal changes affecting the hypothalamic-pituitary axis
2. Potential changes in sex hormone-binding globulin levels
3. Individual sensitivity to progestin exposure
4. Psychological factors related to contraceptive use

Management Approaches for Decreased Libido

If a patient experiences decreased libido with Mirena:

1. Rule out other causes of decreased libido:

   • Relationship issues (most common factor in decreased desire) 4
   • Psychological factors (stress, anxiety, depression)
   • Medical conditions (thyroid disorders, chronic illness)
   • Medications (antidepressants, antihypertensives)

2. Consider alternative contraceptive options if libido issues persist:

   • Non-hormonal copper IUD (ParaGard)
   • Barrier methods
   • Natural family planning methods

3. Discuss benefits of continuing Mirena despite libido concerns:

   • Extremely high contraceptive efficacy (>99%)
   • Reduced menstrual bleeding with many women experiencing amenorrhea
   • Improvement in painful menses 1
   • Long duration of action (approved for up to 8 years) 5
   • High user satisfaction rates (98.7% at 8 years) 5

Clinical Considerations

• Decreased libido is a relative concept that depends on the patient's definition, not an absolute standard 4
• The benefits of Mirena (high contraceptive efficacy, positive effects on menstrual cycle) may outweigh potential sexual side effects for many women 3
• For women with sexual concerns, referral for psychoeducational support, sexual counseling, or therapy may be appropriate 1

Remember that while decreased libido is a possible side effect of Mirena, research suggests that most women either experience no change or may even have improved sexual function with this contraceptive method.