Are my menstrual disorders due to the IUD or oophoritis?

Question

Hello doctor,

I am a 30-year-old woman who had a hormonal intrauterine device (IUD) placed about a year ago for contraception and to help with heavy menstrual bleeding. Initially, it worked well, but over the past few months, I started experiencing irregular spotting, hot flashes, and significant fatigue. After several tests and doctor visits, I was diagnosed with autoimmune oophoritis, which has been affecting my ovarian function and causing symptoms similar to early menopause. I am now confused because I cannot tell if the symptoms are from the IUD, the autoimmune condition, or a combination of both.

My cycles are unpredictable, my mood has been unstable, and I have also noticed decreased libido and vaginal dryness. This has impacted my relationship and overall well-being. My gynecologist mentioned removing the IUD might be considered, but I’m worried about losing what little hormonal balance I still have. Could the IUD be worsening my autoimmune oophoritis symptoms, and should I consider having it removed?

Kindly advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Autoimmune oophoritis is a rare condition where your immune system attacks the ovaries, leading to ovarian dysfunction (disrupted estrogen and progesterone production), irregular or absent periods, menopausal symptoms at a young age, and possible infertility. It is often associated with other autoimmune disorders, such as thyroiditis and adrenal issues.

It releases local Levonorgestrel (a progestin), thins the uterine lining, and reduces bleeding. In some women, it can suppress ovulation to a degree, but less consistently than combined pills or implants. It does not cause autoimmune conditions. It does not directly affect ovarian immunity. It does not provide enough estrogen to counteract menopausal symptoms.

However, the hormonal intrauterine device (IUD) might worsen symptoms in some cases. Progestin dominance plus low estrogen (from your impaired ovarian function) can worsen mood swings, vaginal dryness, low libido, and fatigue. It can mask cycle changes, making it harder to monitor ovarian reserve. If your ovaries are already compromised, you might not be producing enough estrogen to counterbalance the IUD’s progestin effects.

You are showing signs of estrogen deficiency, and the IUD cannot provide that. It may be contributing to a relative hormonal imbalance. You are considering systemic hormone replacement therapy (HRT), which might work better without the added progestin from the IUD. You want to monitor your ovarian function more clearly. Due to these reasons, you should remove the IUD.

Your symptoms are most likely due to autoimmune oophoritis and resulting estrogen deficiency, not the IUD alone. However, the IUD may be amplifying symptoms by adding progestin without needed estrogen. Trial removal and switching to systemic HRT may help rebalance hormones and improve quality of life. Make decisions with your gynecologist and ideally, an autoimmune specialist, involved in the plan.

Investigations to be done:

FSH ( follicle-stimulating hormone).
LH (luteinizing hormone).
Estradiol (to confirm menopausal levels).
AMH (anti-müllerian hormone) – ovarian reserve.
Thyroid panel.
Adrenal antibodies.
Cortisol (to check for other autoimmune overlap).

After these tests, we can discuss it after a week.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.