Is my father's extreme fatigue linked to medications?

Question

Hello doctor,

I am a 34-year-old female who has been using a copper IUD for birth control for the past two years. My periods have become heavier since insertion, and lately I experience prolonged bleeding lasting nine to 10 days with clots.

My recent hemoglobin is 9.6 g/dL, hematocrit 30 percent, and ferritin 11 ng/mL, which my doctor said indicates iron deficiency anemia. Along with this, I have also had hypothyroidism for the past five years, and my latest TSH is 7.2 µIU/mL despite taking Levothyroxine 75 mcg daily. My BMI is 29.1 with a weight of 167.6 pounds and a height of 5 feet 4 inches.

I often feel fatigued, dizzy, and short of breath with exertion. My blood pressure averages around 134/86 mmHg. I am worried that my IUD is worsening the heavy bleeding and anemia, while my thyroid imbalance is making fatigue worse. I also fear whether continuing the copper IUD is safe or if I should switch to another form of contraception.

Can you please explain how my anemia and hypothyroidism may be linked to heavy bleeding with IUD use?
What safer alternatives could I consider?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query and understand your concern.

Your symptoms and lab results suggest that both your copper IUD (intrauterine device) and undertreated hypothyroidism (when your thyroid gland does not make enough hormone) are contributing to your heavy menstrual bleeding and iron deficiency anemia. Copper IUDs are highly effective for contraception, but a well-known side effect is heavier and longer periods, which, in your case, has led to significant blood loss and anemia.

At the same time, hypothyroidism, especially when not fully controlled as shown by your elevated TSH (thyroid-stimulating hormone), can also cause menstrual irregularities and heavier bleeding, compounding the problem. The low hemoglobin, hematocrit (a blood test measuring the percentage of total blood volume occupied by red blood cells), and ferritin levels confirm iron deficiency anemia, which explains your fatigue, dizziness, and shortness of breath.

In this situation, addressing both causes is essential. First, your Levothyroxine dose may need adjustment to bring TSH back into the normal range, which could help regulate your periods and reduce bleeding.

Second, if bleeding remains problematic, switching from a copper IUD to a hormonal option, such as the Levonorgestrel-releasing IUD, for example,a T-shaped hormonal intrauterine device or a similar device, will be safer and more beneficial, as it often makes periods lighter or may even stop them, helping correct anemia while still providing reliable contraception.

Other hormonal methods, such as pills, the patch, or the implant, can also help reduce menstrual flow, but the hormonal IUD is especially effective for heavy bleeding. Along with these changes, you will need iron supplementation to rebuild your iron stores.

By optimizing thyroid treatment and choosing a contraceptive method that decreases rather than worsens bleeding, you should see improvement in both your anemia and overall energy levels.

I hope I have answered your question.

Let me know if I can assist you further.

Thank you.