Can an Intrauterine Device (IUD) cause recurring yeast infections?

IUD and Recurrent Yeast Infections

IUDs themselves do not directly cause recurrent yeast infections, but biofilm formation on copper IUDs may contribute to persistent candidiasis and antifungal resistance in some women.

Relationship Between IUDs and Yeast Infections

Copper IUDs

• Copper IUDs may be associated with an increased incidence of vaginal Candida infections compared to non-IUD users, though the intensity is lower than with combined oral contraceptives 1
• Biofilm formation on copper IUD strings can serve as a reservoir for Candida species, potentially contributing to persistent or recurrent infections 2, 3
• In women with biofilm-forming Candida species on copper IUDs, removal of the IUD resulted in significant reduction of symptoms, physical findings, and Candida positivity (95.8% vs 4.2%, p<0.01) 3
• Copper IUDs may increase the virulence of non-albicans Candida species, enhancing their proteinase production and resistance to antifungal medications 4

Hormonal IUDs

• Hormonal IUDs (like Mirena) appear to have a lower association with Candida species compared to copper IUDs (22.95% vs 29.57% colonization after 3 months of use) 5
• The levonorgestrel-releasing IUD may have different effects on the vaginal microenvironment compared to copper IUDs 6

Mechanisms and Risk Factors

• IUDs may cause changes in the vaginal ecosystem that can disrupt normal microflora, potentially leading to increased colonization by opportunistic pathogens like Candida 2
• Biofilm formation on IUD strings is a significant factor in persistent infections:
  • Biofilm formation rate is significantly higher in IUD string isolates (44.7%) compared to vaginal isolates (25%) 2
  • Biofilm-producing Candida strains show higher resistance to antifungal medications like fluconazole (39.5% vs 10.6%, p=0.002) and itraconazole (52.6% vs 29.8%, p=0.03) 2

Management Recommendations

For Women with Recurrent Yeast Infections and IUDs

• Consider removal of the IUD in cases of persistent or recurrent yeast infections, especially if biofilm-forming Candida species are identified 3
• If symptoms persist despite appropriate antifungal treatment, IUD removal may be necessary to achieve symptom resolution 3
• For women who wish to continue using long-acting reversible contraception, consider switching from a copper IUD to a hormonal IUD, which may have lower rates of Candida colonization 5

Antifungal Treatment Considerations

• Be aware that biofilm formation on IUDs may contribute to antifungal resistance, particularly to fluconazole 2, 4
• Non-albicans Candida species isolated from IUD users show higher resistance rates to fluconazole and may respond better to alternative antifungals like nystatin 4
• Consider extended or maintenance antifungal therapy in women with IUDs who experience recurrent infections but wish to retain their IUD 2

Prevention Strategies

• Regular follow-up of IUD users to monitor for signs of vaginal infections 2
• Consider periodic screening for Candida in symptomatic women with IUDs, particularly those with copper IUDs 5
• Proper hygiene practices and avoiding potential triggers for yeast overgrowth (such as unnecessary antibiotic use) 6

Special Considerations

• IUDs remain safe and effective contraceptive methods with failure rates less than 1% 6
• The small risk of infection with IUDs is primarily in the first 21 days after insertion 6
• Current or recent pelvic infections are contraindications to IUD placement, but past history of pelvic inflammatory disease is not 6