Is it my IUD or am I just crazy?

April 22, 2008 5:17 PM

Has anyone else had weight and/or emotional problems that they attribute to hormonal birth control, specifically the Mirena IUD? I know there have been several IUD threads – one of them helped convince me to get one. But most of them dealt with questions about getting one, and now, I'm wondering if removing mine would be a good idea. (more inside)

I got a Mirena IUD about a year and 1/2 ago. It's worked well, as far as the whole not-breeding-anymore thing, and I love having no periods. But in the past 16 months or so, I've gained about 20 pounds with no noticeable change in diet and an increase in physical activity. I know that metabolism slows down with age (I'm in my late 30s), but I really don't think I should be this heavy. And exercise – 3 mile runs 3/4 times a week, all I have time for – doesn't seem to have any effect.

I'm also crazier than normal. I've always been depressed, and I've recently switched to bipolar meds because of increased mania, but I have daily crying jags (usually on the drive to work) and an increasingly short temper. I just feel like my emotions are not under my control, and I don't know how long I can maintain a sane facade before I just turn into a permanent puddle of woe. And there's no reason for my despair either – I have a good job, a supportive family, great kids. I'm just . . . crazy, I guess.

I am going to shoot all credibility into space with this next comment, but – I went to visit my hair stylist last month, and since my last appointment about 6 months ago, she had gained about 40 pounds. She attributed it to her Mirena IUD and was going to get it removed. I know that there are all sorts of reasons that people gain weight quickly, but she's been trim for years, and her appearance was somewhat of a shock.

I know that the official documentation on the Mirena says it has a low rate of any side effects. I've also seen boards online where women blame all their woes on their IUDs, but I've seen boards where people blame all their woes on alien abductions. I also know that people rarely form internet groups to extol the virtue of pharmaceuticals. I guess I'm trusting the Metafilter community to have a more balanced perspective on this issue. Has anyone else had problems with this IUD or that have gotten better after removing one? Or am I fixating on it as a magic bullet and just have myself to blame for turning into a fat, crazy bitch?

posted by anonymous to health & fitness (20 comments total)

My wife has been using the Ortho Evra patch for a while now. She has two normal weeks, one period week, and one mood week. I've replaced her phrase "mood week" with "completely nutty woman week." And it was definitely the OE patch that started this cycle. The mood swings on that week have been pretty bad - enough so that I started talking to her seriously about switching birth control. She wasn't happy with the situation, either.

Ultimately she learned how to tone down her mood swings and be aware of when they were going to hit before they hit. And I've accepted that I have to tone down my normal horrible personality on those weeks, so we've worked it out.

But all that strayed from the point - yes, we have first hand experience with birth control causing emotional issues. But that's anecdotal evidence, so take it for what its worth.
posted by krisak at 5:41 PM on April 22, 2008

I have the Mirena IUD twice (first one removed to have a baby, second one for almost a year now) and haven't experienced any of the problems you've mentioned (well, weight gain but I became pregnant right after I had it taken out). I may be a bit more emotional but I think it may be to weird hormones from breastfeeding.

I did have the depo-provera shot for about a year and I definitely was a little crazy while on that, crying daily, severe mood swings, and big weight gain. That cleared up when the last shot wore off.

Hope you can get some help on this, I feel for ya sister.
posted by kelrae3 at 6:05 PM on April 22, 2008

I can't really help you because I still have mine in, but I've definitely gained weight since it went in. I've also gained weight for other reasons, but yeah... i'm pretty darn sure I can contribute at least some of the blame to the Mirena. That being said - i'm keeping mine, if only because the extra weight is worth not having periods (and all the mood swings/bloating/cramping/etc that accompanies them).
posted by cgg at 6:05 PM on April 22, 2008

What about switching to the ParaGard, which is not hormonally based? I used that for the last three years and I have no complaints--no apparent emotional impact, no noticeable physical changes. And no pregnancy. You wouldn't have to give up the efficacy of the IUD but you could at least stop the hormonal impact. My periods are shorter, and not as heavy, though that may be due to childbirth or the IUD.

My last experience with hormonal birth control was the pill, 10 years ago, but I went off it because of unwanted emotional side-effects. In my case, I had a really flattened affect, and it was just...bizarre. No ups, no downs. There was some weight gain, but it was hard to pin it on the pill and the emotional impact was more noticeable, and less desirable, than the weight gain. (This was the lowest-dose pill out there at the time and, since I was already wary of non-stop, long-term hormonal pharmaceuticals, I went off it).
posted by cocoagirl at 6:08 PM on April 22, 2008

Krisak, you're comparing apples to oranges with Mirena versus Ortho Evra. Different hormone makeup (both estrogen and progestin for the patch but only progestin for Mirena) and different methods of delivery (systemic for the patch and local intrauterine release for Mirena).

So, Anon:

I'd be extremely surprised if it was indeed the Mirena causing weight gain and exacerbating depression. The hormones in the Mirena are released locally, and if I remember correctly, the level of progestin found in the blood with Mirena is about 1/10 of a progestin-only "mini pill".

On preview, if you do go for a Paragard, note that cocoagirl's lighter and shorter periods are atypical. A more likely side effect will be heavier and longer periods.

When I had my Mirena inserted, I lost weight and recovered from a bad depression. I don't credit Mirena with that. Nor did I blame Mirena when I later gained the weight back and went through a subsequent bout of depression.

Please stop calling yourself a fat crazy bitch, though.
posted by Stewriffic at 6:51 PM on April 22, 2008 [1 favorite]

Yeah, Stewriffic beat me to it - one of the "good things" about the Mirena is that it's locally released so you don't get anywhere near the hormone spike you do with conventional pills. I have the same device and have zero side effects other than the no periods thing. There is a possibility that you are reacting to the hormones, but all things considered, I'd imagine the probability is fairly low. My first reaction would be to go back to the psychiatrist and talk to him/her about the possibility of the BC interacting with whatever you are on (I would imagine this is low) and about how to manage the issues you're facing. My understanding based on some friends' experience with psychological meds is that they can make you gain weight and clearly, since the point is to do so, effect your moods. Sometimes just not the way the doc intends.
posted by Medieval Maven at 7:03 PM on April 22, 2008

The hormones in the Mirena are released locally

I was told this about Nuvaring, and it was a big fat lie. I definitely had major mood changes - it made me (more of a) psycho bitch. Just cranky and unpleasant as hell.

I am wanting to get an IUD and I've been leaning heavily towards the Paragard for just this reason (fear of adverse mental effects from the hormones in Mirena). I don't trust them when they say the hormones are only local. Maybe I'm hypersensitive (and I'm also bipolar, that probably has a lot to do with it), but I'm not alone in having adverse mental / emotional effects with things that aren't supposed to cause them.

Good luck to you.
posted by marble at 7:09 PM on April 22, 2008

If you want it out, get it out. That's the obvious easiest way of testing/answering your question. Just don't get preggers in the off period (unless you wanted to).
posted by Phalene at 7:26 PM on April 22, 2008

You didn't say what birth control you were using previously. One possibility is that hormonal changes are from the lack of that other BC, rather than the mirena itself. (Which isn't to say that the mirena might not be causing these effects in you -- just something else to consider.)

I definitely had some emotional shifts going on mirena, but it had been a long time since I'd not been on any hormonal birth control, so I wasn't sure if this was just back to the "normal me" or not. I didn't have any weight gain.

(In regards to marble's point about the Nuvaring and local release of hormones: the Nuvaring contains less hormones than other birth control, but mainly because they get absorbed directly into the bloodstream and don't have to make it through your digestive system first, where a lot would normally get lost. The end result, the amount of hormone in your blood, should be roughly the same as with conventional birth control. With the IUD, on the other hand, the hormone is released literally where it needs to be; levels found in the bloodstream are significantly lower than with the pill.)
posted by wyzewoman at 7:43 PM on April 22, 2008

YMMV but i gained roughly 75 pounds in the two years i used depo-provera. i was also insane, with frequent crying jags over stupid things like cracked eggs and lifetime movies. clearly, i no longer use depo. i have been thinking of an IUD, though (tired of pills) and i'm glad you posted this askme.
posted by kerning at 7:49 PM on April 22, 2008

There is some systemic absorption with Mirena, but the levels of hormone are minimal:

The intrauterine release of levonorgestrel results in the absorption of the drug into the systemic circulation. The drug can be detected in plasma within 15 minuites of insertion and maximum concentrations are seen within a few hours. Plasma levels of levonorgestrel stabilize after the first few weeks of use at between 150-200 pg/mL.
posted by amarynth at 7:50 PM on April 22, 2008

Thanks for the data, amarynth. In my quick searches, it seems like levonorgestrel levels that you get from the pill are on the order of 1-2 ng/mL, which is about 10 times higher than the number for mirena. Still, 10% of the hormones as the pill seems like it could be enough to mess with you!
posted by wyzewoman at 8:28 PM on April 22, 2008

I would check out other things in your life before pinning the mood swings and weight gain on the Mirena. I'm basing this on that I am really sensitive to hormones (Nuvaring, which is supposed to be free from ups-and-downs and fairly low-dose, made me sleepy and sad) and Mirena hasn't really affected me too much other than the random light cramps/bloated feelings here and there.
posted by mustcatchmooseandsquirrel at 8:30 PM on April 22, 2008

Weight gain is not a common side effect of Mirena. That said, just because it's uncommon does not mean it's not happing to you. Managing Contraception answered a similar question:

Does the Mirena IUD cause weight gain?

I've always been depressed, and I've recently switched to bipolar meds because of increased mania...

It's unclear from your question if the weight gain occurred before or after the switch to bipolar meds, but bipolar meds are notorious for causing weight gain, and if you haven't found the right drug yet that could be causing your emotional issues.
posted by Violet Hour at 8:52 PM on April 22, 2008

Depending on which study you look at between about 8% and 45% of women using MIRENA report some weight gain. The magnitude of the average weight gain is definitely less than for depo provera though.

We don't know what other medication you are taking, but all sorts of anti-psychotics and mood stabilisers can also cause weight gain. I would talk carefully to both your psychiatrist and your gynaecologist before making a decision to remove the MIRENA.
posted by roofus at 2:03 AM on April 23, 2008

You should check out the LJ community IUD Divas. I read there for a while before I got mine. There were definitely women who experienced weight gain and acne with their mirenas, and every time they would write about it, people would write back saying that the mirena isn't *supposed* to have any effect on weight, and are they sure they didn't start eating more and exercising less, because surely it's a lifestyle thing.

I don't know, where there's smoke there's fire, and I have little enough confidence in medical testing and particularly publication of medical testing, that I believe that mirena can impact weight and acne, and that was part of the reason I didn't get it (also just generally preferring not to mess with my hormones, even a little).

That said, there were many many more women who had only good experiences with the mirena, and there are definitely times when I am jealous about the lightening and loss of periods (which of course also doesn't happen for *everybody*).

If you can afford to take it out and replace it with a hormone-free IUD, why not take it out?
posted by Salamandrous at 2:16 AM on April 23, 2008

I take bipolar meds (have for years) and I've had the Mirena IUD in for over a year. I recently went to go see my shrink to discuss mood swings. I also mentioned eating patterns (I have been eating more). She asked if I was taking birth control, I told her I had the Mirena, and she went on about how great IUDs are, didn't mention removing it (which is great because I don't have periods!) and switched my other meds.

I'd go back to see the doc, if you just started bipolar meds then it's possible you have the wrong ones, the wrong dose, or have not titrated up to the full dose. You should also get your blood drawn, I got the blood draw for TSH (thyroid) and vitamin D levels as well.

My shrink also pushes fish oil (she writes scrips for Lovaza, you could look for something with similar composition over the counter) and Vitamin D supplements (2000 ius a day) to improve mood.
posted by crazycanuck at 5:24 AM on April 23, 2008

Here are two of my previous comments on this issue. hate, hate hate hormonal birth control. madly in love with my Paragard IUD.
posted by peep at 9:52 AM on April 23, 2008

Seconding wyzewoman on the possibility that it may be the change in BC, not the Mirena itself. I had some mood swings when mine was first put in, mostly due to discontinuing hormonal BC. Those have since evened out, and I haven't had any weight gain.

Also, yes, check with your doctor about the bipolar meds! It could easily be those.
posted by dizziest at 1:53 PM on April 23, 2008

I have problems with homronal BC and went to talk to my doc about Mirena and she told me about a new non-surgical permanent procedure called Essure that I am ~seriously~ considering. If you're all done baby-making I'd look into it.
posted by fshgrl at 6:11 PM on April 23, 2008