According to the latest figures published by INSEE, nearly 26% of women aged 15 to 49 in France use an IUD as a means of contraception. A recent epidemiological study suggests the existence of a link between the use of an IUD highly dosed with levonorgestrel and the onset of depressive disorders. Explanations.
Hormonal IUD and Depressive Disorders
In France, the IUD or intrauterine device (IUD) is currently the second method of contraception most widely used female medicine, after the contraceptive pill. There are several categories of IUDs:
- IUDs or copper IUDs;
- IUDs or hormonal IUDs.
Hormonal IUDs consist of a reservoir containing a derivative of progesterone, the levonorgestrel, which diffuses slowly over a total period of three to five years depending on the device. Currently, two strengths of levonorgestrel are available, a 19.5 mg strength and a higher 52 mg strength. Previous studies have already revealed that birth control pills may be associated with a small increase in the risk of depression or mood disorders. What about hormonal IUDs? French researchers from the Scientific Interest Group EPI-PHARE looked into this question in the context of a recent epidemiological study.
A slight increased risk of depressive disorders with the IUD dosed with 52 mg of levonorgestrel
This cohort study aimed to compare the use of psychotropic drugs (antidepressants, anxiolytics and hypnotics) in the two years following the insertion of a hormonal IUD, dosed either at 19.5 mg or at 52 mg. A total of 45,736 women aged 13 to 40 received an IUD containing 52 mg of levonorgestrel, and an equal number of women an IUD containing 19.5 mg of levonorgestrel. The results of the study reveal that women with 52 mg levonorgestrel IUDs had a slightly increased risk of receiving antidepressant therapy within two years of contraceptive insertion compared with women using lower-dose IUDs.
This low-intensity link between the IUD with a high levonorgestrel dose and the prescription of antidepressants was not observed for the other two categories of drugs taken into account, anxiolytics and hypnotics. This large-scale study is the first to reveal an impact of a high levonorgestrel dose in an IUD on the risk of depressive disorders requiring drug treatment. However, the excess risk appears to be very low, and requires additional studies to clarify.
Special attention to signs of depression in women with hormonal IUDs
This study suggests that the use of a lower dose hormonal IUD, at 19.5 mg, could have less impact on women’s mood, by reducing progestogen impregnation. Pending the arrival of additional data, the ANSM issues recommendations for women and health professionals. At the time of insertion of a levonorgestrel IUD, women should be informed of the side effects and the need to contact their physician if mood disorders or depressive symptoms occur.
Healthcare professionals should also plan a follow-up consultation between 4 and 6 weeks after the insertion of the IUD, then once a year. These follow-up consultations are an opportunity to take stock of contraception by IUD and in particular to discuss the adverse effects, including changes in mood and the occurrence of depressive disorders.
Estelle B., Doctor of Pharmacy
Sources
– Association between levonorgestrel intrauterine devices and subsequent use of psychotropic drugs in France. epi-phare.fr. Accessed February 15, 2023.