Response to recent questions about mood and the levonorgestrel IUD
The SOGC endorses this letter written by Dr. Jocelyn Bérubé and Dr. Édith Guilbert, clarifying the recent questions about mood and the levonorgestrel IUD. This letter originally appeared on Dr. Jocelyn Bérubé's website, in response to an article published in the Journal de Montreal in June 2017 (http://www.journaldemontreal.com/actualite/societe/mirena).
An article about the “omerta,” or the “code of silence” around the side effects of the Mirena IUD, and in particular those relating to mood, was published recently and has caused many women to worry.
The following data is provided for your information:
- The Canadian monograph of the product (Mirena) reports the frequency of side effects found in the studies conducted prior to the approval of the product. Cited is a frequency of between 1% and less than 10% for psychiatric disorders, such as depression, decline in libido, and nervousness.
- Several studies have been published concerning the possible risk of depression associated with Mirena; here are the findings:
+ JAMA Psychiatry 2016 September; 2387: Slight increase in risk of depression among users of Mirena, in particular during adolescence. Study included numerous methodological biases. (Level II)
+Arch Gynecol Obstet. 2014 Sep; 290(3):507-11: The quality-of-life scores increased whereas those relating to depression did not change after 6 months of using Mirena. (Level II)
+ Contraception. 2012 Nov; 86(5):470-80: No association was found between the use of Mirena, the length of its use, and higher scores on the Beck Depression Inventory. (Level II)
+ Hum Reprod. 2011 Nov; 26(11):3085-93: The use of Mirena seems to be associated with a positive effect on mental health. (Level II)
+ J Sex Med. 2012 Apr; 9(4):1065-73: No difference in sexual function or symptoms of depression between users of the copper IUD and those of Mirena. (Level II)
+ Int J Behav Med. 2007; 14(2):70-5: The use of Mirena compared to hysterectomy in women with menorrhagia is associated with more symptoms of depression. (Level I)
+ JAMA. 2004 Mar 24; 291(12):1456-63: The use of Mirena compared to hysterectomy in women with menorrhagia does not change quality-of-life elements or psycho-social well-being. (Level I)
In response to this short scientific review, I think we can say that the risk of mental health problems specifically linked to the Mirena IUD seems difficult to determine. However, it is possible that some women are particularly sensitive to progesterone (Levonorgestrel in Mirena) and that symptoms increase in women with a tendency for depression or anxiety.
It is important that physicians who prescribe the Mirena IUD warn their patients about possible side effects, including mood-related ones. However, in no case is the use of this IUD contraindicated for those with a history of depression or current depression. With these patients, it may be prudent to follow-up their side effects and to ensure that a depressive mood is not exacerbated.
It is important to always put side effects in perspective along with the beneficial effects of a contraceptive method. The Mirena IUD is the most effective reversible method of contraception on the market (let’s not forget the devastating consequences of an unplanned pregnancy) and reduces excessive menstrual bleeding by 75% to 80% (let’s also not forget the devastating effects of menorrhagia).
We hope this information will be useful.
Jocelyn Bérubé and Édith Guilbert