Does the hormonal IUD worsen PCOS/PMOS symptoms or regulate them?

Question

Hi doctor,

I am 27 years old and was diagnosed with PCOS/PMOS last year. I have had a hormonal IUD for birth control for about one year. Recently, I have noticed irregular spotting, mood swings, and the return of mild acne.

My recent hormone profile showed LH at 12.4 mIU/mL, FSH at 5.2 mIU/mL, and slightly elevated testosterone levels at 85 ng/dL. I am confused about whether these changes are due to my IUD or if they are a result of PCOS/PMOS itself.

Does the hormonal IUD worsen PCOS/PMOS symptoms, or does it actually help to regulate them? Additionally, I have gained around 8.8 pounds in the last six months despite eating healthily. Should I continue with this IUD or consider another contraceptive method that may be better suited for managing my PCOS/PMOS?

Please guide.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

The Rotterdam criteria have suggested a broader definition for PCOS (polycystic ovarian syndrome)/PMOS (polyendocrine metabolic ovarian syndrome), with two out of three of the following criteria, which, if met, can diagnose the condition:

1. Polycystic ovaries (either 12 or more follicles or increased ovarian volume).

2. Oligo-ovulation or anovulation.

3. Clinical or biochemical signs of hyperandrogenism, such as hirsutism, weight gain, and acne.

I would advise you to get the following investigations done:

Serum FSH (follicle-stimulating hormone) and LH (luteinizing hormone); Serum prolactin.
Serum TSH (thyroid-stimulating hormone) and free T4 (thyroxine).
Serum testosterone.
Serum AMH (anti-Müllerian hormone).
Pelvic examination.

The management would include the below:

Consult a gynecologist.
Lifestyle modifications like weight loss, exercise, and diet changes.
Medication: Metformin (250 mg, once daily).
Folic acid (5 mg, once daily for three months).
Inositol supplement (once daily for three months).

For contraception, an intrauterine device (IUD) is a good choice as it often leads to lighter menstrual bleeding compared to a copper IUD.

Consult a specialist and obtain their consent before starting the above medications.

I hope this answers your query.

Feel free to reach out anytime.

Thank you.