Can Mirena Cause Hair Loss in Females?
Yes, the Mirena (levonorgestrel-releasing IUD) can cause hair loss in females, though it occurs infrequently with an estimated cumulative incidence of approximately 0.33% based on postmarketing surveillance data. 1
Evidence for Hair Loss Association
The most direct evidence comes from postmarketing surveillance:
The New Zealand Intensive Medicines Monitoring Programme identified 5 cases of alopecia associated with levonorgestrel IUD use, with a cumulative incidence of 0.33% (95% CI 0.07-0.95) among users. 1
The World Health Organization spontaneous reporting database contained an additional 68 reports of alopecia associated with the levonorgestrel IUD. 1
The study authors concluded that counseling prior to Mirena insertion should include information about the possibility of alopecia as a systemic side effect. 1
Mechanism and Context
The biological plausibility relates to the progestogenic effects of levonorgestrel:
Levonorgestrel is a synthetic progestogen that can have androgenic activity, and female pattern hair loss can be androgen-dependent in many cases. 2, 3
While the levonorgestrel IUD primarily acts locally in the uterus, systemic absorption does occur, which explains why systemic side effects including hair loss have been documented. 1
Clinical Implications
When a patient using Mirena presents with hair loss, consider the IUD as a potential contributing factor, particularly if the hair loss began after insertion and follows a diffuse pattern. 1
Key considerations include:
The hair loss typically manifests as diffuse thinning rather than a specific pattern. 1
Onset timing relative to IUD insertion is important for establishing causality. 1
Other causes of female hair loss should be evaluated, including thyroid dysfunction, iron deficiency, and other hormonal imbalances. 2, 4
Management Approach
If Mirena-associated hair loss is suspected:
Discuss IUD removal with the patient, as this addresses the underlying cause. 5 Fertility returns immediately after removal with no waiting period required. 6
Alternative contraceptive methods should be offered that may be less likely to cause hair loss. 5
If the patient wishes to continue the Mirena for its contraceptive or therapeutic benefits (such as heavy menstrual bleeding management), topical minoxidil 2-5% can be considered as treatment while maintaining the IUD. 2, 3, 4
Important Caveats
The incidence is low (less than 1% of users), so hair loss should not be assumed to be IUD-related without proper evaluation. 1
The benefits of Mirena for contraception and menstrual management are substantial, so the decision to remove should be individualized based on severity of hair loss and importance of the IUD's benefits. 5