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 last 2 years. Since insertion, my periods have become heavier, and recently I have had prolonged bleeding lasting nine to 10 days with clots.

My recent haemoglobin is 9.6 g/dL, haematocrit 30 percent, and ferritin 11 ng/mL, which my doctor said is iron deficiency anaemia. In addition to this, I have also been suffering from hypothyroidism for the last 5 years, and my latest TSH is 7.2 µIU/mL, although I am taking Levothyroxine 75 mcg daily. I weigh 167.6 pounds and am 5 feet 4 inches tall.

My BMI is 29.1. I get tired, dizzy, and short of breath on exertion a lot. My average blood pressure is around 134/86 mmHg. My IUD is making the heavy bleeding and anaemia worse, and my thyroid imbalance is making the fatigue worse.

I also worry if it is safe to continue with the copper IUD or if I should switch to another form of birth control. Please explain how my heavy bleeding with IUD use may be related to my anaemia and hypothyroidism? What safer alternatives might I explore?

Please help.

Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

Based on your symptoms and lab work, it appears that you are suffering from heavy menstrual bleeding and iron deficiency anaemia due to both your copper IUD (intrauterine device) and undertreated hypothyroidism (when your thyroid gland does not make enough hormone). Copper IUDs are very effective for birth control, but a common side effect is heavier and longer periods . In your situation, this has caused a lot of blood loss and anaemia.

At the same time, hypothyroidism, especially when not fully controlled, as evidenced by your elevated TSH (thyroid-stimulating hormone), can also cause menstrual irregularities and heavier bleeding, compounding the problem. Your low haemoglobin, haematocrit (a blood test that measures the percentage of total blood volume occupied by red blood cells) and ferritin levels confirm iron deficiency anaemia, which is why you’re feeling fatigued, dizzy and out of breath.

In this case, it is important to deal with both causes. You may need to have your Levothyroxine dose adjusted to bring your TSH back into the normal range, which may help to regulate your periods and decrease bleeding.

Second, if bleeding continues to be a problem, then switching from a copper IUD to a hormonal method, for example, a T-shaped hormonal intrauterine device or a similar device that releases Levonorgestrel, will be safer and better. It often makes periods lighter or may even stop them, helping correct anaemia while still providing reliable contraception.

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

Optimizing your thyroid treatment and choosing a birth control method that reduces rather than increases bleeding should improve your anaemia and overall energy.

Thank you.