What are the benefits of an intrauterine device (IUD) for perimenopausal women?

Benefits of IUDs for Perimenopausal Women

The levonorgestrel-releasing intrauterine device (LNG-IUD) offers significant benefits for perimenopausal women, including effective contraception, reduction of heavy menstrual bleeding, and management of dysmenorrhea, making it an excellent option during this transitional period. 1

Contraceptive Benefits

• Perimenopausal women remain potentially fertile and face increased risks with unintended pregnancy, including higher maternal mortality, spontaneous abortion, fetal anomalies, and perinatal mortality 2
• Both copper and levonorgestrel IUDs provide highly effective long-term contraception with failure rates less than 1% 3
• IUDs can be safely used until menopause is confirmed (cessation of menses for 1 year after age 50 or 2 years prior to age 50) 1
• The reduced fertility in women over 40 allows for extended use of IUDs beyond the standard term, potentially up to 1-2 years beyond menopause without replacement 4

Management of Perimenopausal Symptoms

• The LNG-IUD significantly reduces heavy menstrual bleeding, a common concern during perimenopause 3
• Evidence from studies examining treatment effects of LNG-IUD among women with heavy or prolonged bleeding reported no increase in adverse effects and found the LNG-IUD to be beneficial in treating menorrhagia 3
• Approximately half of LNG-IUD users experience amenorrhea or oligomenorrhea by 2 years of use, which can be beneficial during the perimenopausal transition 5
• LNG-IUD use has been associated with reduction of dysmenorrhea, which may worsen during perimenopause 3, 6

Treatment of Specific Conditions Common in Perimenopause

• The LNG-IUD is effective for treating endometriosis symptoms, decreasing dysmenorrhea, pelvic pain, and dyspareunia 3
• For women with uterine fibroids (more common in perimenopause), the LNG-IUD helps improve serum levels of hemoglobin, hematocrit, and ferritin, as well as reduces menstrual blood loss 3
• The LNG-IUD can be used for endometrial protection in women with endometrial hyperplasia, with evidence showing disease regression in most women 3
• For women with severe thrombocytopenia, the LNG-IUD can be a useful treatment for menorrhagia 3

Transition to Hormone Therapy

• The LNG-IUD can be combined with estrogen therapy to provide a smooth transition through menopause 7
• This combination provides endometrial protection while treating menorrhagia and hyperplasia if present 7
• The intrauterine progestogen delivery with systemic estrogen therapy is highly practical for symptomatic perimenopausal women 7
• High patient compliance and satisfaction rates have been reported with this combined approach 7

Practical Considerations

• Initial irregular spotting or light bleeding is common during the first 3-6 months of LNG-IUD use but generally decreases with continued use 5
• The LNG-IUD is safe for most women, including those with contraindications to estrogen-containing contraceptives 1
• Expulsion rates may be higher in women with uterine fibroids (approximately 11%) compared to women without fibroids (0-3%), though these findings were not always statistically significant 3
• Women with anatomical abnormalities that distort the uterine cavity may not be good candidates for IUD placement 3

Comparison to Other Methods

• The LNG-IUD is superior to copper IUDs for improving dysmenorrhea 6
• The LNG-IUD is equal or superior to systemic progestins or oral contraceptives for treatment of dysmenorrhea 6
• Unlike combined oral contraceptives, IUDs do not increase cardiovascular or thrombotic risks, making them safer options for many perimenopausal women 1