I’m 23 and have been married for a year and a half. I went on the pill at 18 and had no sex drive, as well as problems with vaginal dryness resulting in painful sex for years. I finally switched to the Mirena IUD two months ago hoping it would help, but I haven’t noticed any change. Should I give Mirena more time? Or should I give up on birth control altogether? I feel like I’m missing out and I know my husband feels that way too. Thank you for any advice! – Katie
I love this question because I struggled with the same issues when I was in my twenties, and it’s part of what led me to where I am today. At the time, I didn’t know where to turn – which was frustrating and confusing because I was an OB/GYN and thought I should have all the answers!
When I first started out as an OB/GYN, I prescribed the pill for many, many women. At the time, I didn’t understand the devastation hormonal birth control can wreak on a woman’s body.
The birth control pill contains oral estrogen, which increases the level of a hormone called sex hormone binding globulin (SHBG). SHBG does just what it sounds like it does, it binds up sex hormones, particularly testosterone. So taking the pill raises SHBG, which lowers the levels of free testosterone in a woman’s bloodstream. This lowered free testosterone can lead to low sex drive, vaginal dryness and sexual pain, as Katie found out the hard way.
Unfortunately, studies have found that this effect can persist for even years off of the birth control pill and may even be permanent for some women. While that’s kind of a grim thing to hear, the good news is this doesn’t happen to everyone, and many women can benefit from bioidentical hormone therapy, especially testosterone therapy.
The Mirena IUD
So what about the Mirena IUD? Well, the Mirena IUD contains progestin, which is an artificial form of progesterone. It’s the same artificial form of progesterone that has been shown to have an increased risk of strokes, clots, heart disease, and breast cancer, so I recommend avoiding the Mirena IUD as a birth control method whenever possible.
Part of the reason why I recommend avoiding it is that in 20-30% of women who get a Mirena IUD, the progestin hormone does not stay contained in the uterus, which is what most GYNS are led to believe by the representatives from the Mirena company.
When I did some deeper digging about Mirena, I found that 20-30% of women with the Mirena will become what’s called anovulatory, meaning they will no longer release an egg, meaning that they’re no longer releasing their normal hormones throughout the cycle. And so what does that do?
It basically makes you menopausal. So it can increase your risk of osteoporosis, as well as all the other issues we come up with in menopause. I’ve seen very many women have all kinds of different side effects from the artificial progesterone going throughout the body in women who’ve had Mirena IUDs, so I’d say, don’t give up on birth control, just try something else – something without the hormones.
Alternative Forms of Contraception
So what else do I recommend? I like the ParaGard IUD, which is the hormone-free, copper IUD. Apart from the IUD, I recommend barrier methods, such as condoms or the diaphragm. And by the way, if you’re worried about it, a great way to be spontaneous with the diaphragm is just to put the diaphragm in every night. If you wind up having sex, awesome! If not, no big deal. Either way, you’re protected and you can leave it in overnight and take it out in the morning.
Thanks for the great question, Katie!