Is endometriosis a contraindication to an Intrauterine Device (IUD)?

From the Guidelines

Endometriosis is not a contraindication to an IUD, and in fact, hormonal IUDs are often recommended as a treatment option for endometriosis. The levonorgestrel-releasing IUD (Mirena, Kyleena, Liletta) is particularly beneficial as it delivers progestin locally to the endometrium, which can help reduce endometriosis symptoms by thinning the endometrial tissue and reducing menstrual flow 1. This local hormone delivery typically causes fewer systemic side effects than oral medications. For patients with endometriosis, the hormonal IUD can provide both contraception and symptom management, potentially reducing pelvic pain, dysmenorrhea, and heavy menstrual bleeding.

Key Considerations

• The copper IUD (Paragard) is also an option, though it doesn't offer the therapeutic benefits for endometriosis symptoms that hormonal IUDs do 1.
• Some patients may experience increased cramping or heavier bleeding with the copper IUD, which could potentially exacerbate endometriosis symptoms.
• The insertion process is the same as for patients without endometriosis, though some patients with severe pelvic pain might benefit from pain management during insertion.
• IUDs can remain effective for 3-10 years depending on the type, providing long-term contraception and, in the case of hormonal IUDs, ongoing symptom management.

Contraindications to IUD Placement

• Current purulent cervicitis, gonorrhea, or chlamydia
• Current PID and other current pelvic infections
• Note that past PID is not a contraindication to IUD use, and HIV infection and immunosuppression are also not contraindications to IUD use 1.

Recommendation

Hormonal IUDs are a recommended treatment option for patients with endometriosis, providing both contraception and symptom management, and can be used in patients with endometriosis without any additional contraindications 1.

From the Research

Endometriosis and IUDs

• Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, leading to pain and other symptoms.
• The use of a levonorgestrel-releasing intrauterine device (LNG-IUD) has been studied as a potential treatment for endometriosis symptoms.

Effectiveness of LNG-IUD for Endometriosis

• Studies have shown that the LNG-IUD can reduce the recurrence of painful periods in women with endometriosis 2, 3, 4.
• The LNG-IUD has also been shown to improve quality of life and patient satisfaction in women with endometriosis 5.
• However, the evidence is not consistent, and some studies have found no significant difference in outcomes between the LNG-IUD and other treatments 5.

Comparison to Other Treatments

• The LNG-IUD has been compared to other treatments for endometriosis, including gonadotropin-releasing hormone analogues (GnRHa) and laparoscopic ablation or excision 3, 4, 6.
• The LNG-IUD may have fewer adverse events compared to GnRHa, but more studies are needed to confirm this 3, 4.

Conclusion on Contraindication

• Based on the available evidence, endometriosis is not a contraindication to the use of an IUD, and the LNG-IUD may be a viable treatment option for some women with endometriosis 2, 3, 5, 4, 6.