Copper IUD Side Effects, Heavy Bleeding & Ovarian Cysts (Episode 365)

Full Transcript: Episode 365

Lisa: Welcome to the Fertility Friday podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery charting journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health, and I’m so excited that you’re here with us today.

Lisa: Today I’m sharing a brand new episode in my Pill Reality series. This series has been a really important part of the podcast. It’s been a place where I’ve had the opportunity to really highlight the lived experiences of real women in the Fertility Friday community, my clients as well in the Fertility Awareness Reality series, and just provided the space to hear what women are saying about their own birth control methods. And I feel that this is extremely important. If we look at the stats, 50% of women come off of their combined oral contraceptives within a year because of side effects. So a lot of women are unhappy with the side effects associated with contraceptives. And to this day, most women who go on contraceptives really are not told about all the side effects. They may know about some of the major ones, but of course they don’t think that it would apply to them, and certainly they’re not necessarily told about the most common side effects, which are depression, anxiety, low libido, and other sexual side effects that a huge number of women experience.

Lisa: And so my hope for this series is that it really helps you to better understand the pill and the variety of side effects associated with it. But I hope that it also gives you pause when it comes to the overarching medical system. We should be asking some questions when it comes to how our medical system addresses a variety of medications. We should be asking why it is that most women who take hormonal contraceptives have never been fully counseled about all of the possible side effects — especially the most common side effects, including anxiety, depression, low libido, sexual side effects, painful sex. And why are the drug companies not being held accountable for that? Or why are the doctors not being held accountable for fully advising and informing their patients? Ultimately, this always comes back to the same thing, which is informed consent. And in order for us to have full informed consent, we must first listen to women when they share their personal experiences — when they tell you what their experiences were on birth control. And we shouldn’t be telling them that it’s not scientific and it’s just anecdotal and it doesn’t matter. We should be listening, because it’s those anecdotal stories, those real women’s experiences, that ultimately build up and inevitably lead to the research that we actually need to verify everything. So with that said, let’s go ahead and jump into today’s episode.

Lisa: I’m really excited to be here today with Christine. She’s a member of the Fertility Friday community. I felt compelled to invite her on the show. So welcome, Christine.

Christine: Thank you so much, Lisa. Your show has been really empowering for me in my fertility journey. And even just understanding that fertility isn’t necessarily getting pregnant, but it’s about being aware of your menstruation and your period and empowering you to make decisions.

Lisa: It’s so interesting that we learn about our cycles and our fertility in such a specific way — meaning that if you’re not actively trying to get pregnant right now, it kind of is irrelevant or doesn’t matter. And it’s also interesting and a bit sad that it’s a novel concept that the menstrual cycle is a sign of health and that being fertile and healthy is just a part of being in a female body. I would love to start by having you tell us a little bit about how old you were when you first started menstruating and how you managed your fertility, and if you’ve used hormonal contraceptives before.

Christine: My first experience with getting my period — I was 13, which at the time felt pretty late. Most of my friends had already started. And it was actually coming out of a bookstore, and it was my dad who was with me, and I was like, “Dad, I just got my period,” and we were all like, “Whoo!” It was kind of a celebration. Once I did get my period, there was no discussion around contraceptives at that point. When I became 15 and got into high school, a lot of my friends had been on the pill or were about to start. I really felt like going on the pill was going to be something positive — everyone else was doing it, it sounded great, no period, no acne. And it was just a flat-out no from my mom. Looking back, that was a really good call on my parents’ end. Their whole approach was that if my period was heavy, it was: Christine, you need to take iron because you’re probably losing a lot of blood. If it was for acne, it was: let’s go see a dermatologist or maybe it’s the sugar. It wasn’t “let’s do something to help her quick” — it was “let’s figure out what’s going on.”

Christine: When I got into a long-term relationship and decided I needed contraception, the first thing I looked into was the IUD — the same thing my mom had used. The whole concept of putting hormones in my body was a no from the get-go. But I didn’t really understand how the IUD would still affect me, even though there are no hormones involved. I went into it with really low iron to begin with. The copper IUD can increase your period and the amount of blood you lose — your period lasts a little bit longer. So for me, who was already really low in iron, adding an extra three days of bleeding was not good for me. I was fainting, I was really tired, I was lethargic. And during that time, I developed an ovarian cyst. So it was kind of just figuring out: what is this pain on my side, where is it coming from, and what can I do? The process of finding out what’s going on with you can be so stressful because you’re waiting months sometimes between ultrasounds and tests and answers. I remember asking for an ultrasound the first time, being told to wait a few months, going back and persisting, and finally getting the ultrasound. And the answer was simply: you should be on the pill and that’ll clear it up right away. I remember thinking, that’s really not what I want to hear.

Lisa: You’re not the first person I’ve spoken to who did all their research to avoid hormones, only to discover that there are side effects with anything — really any kind of foreign body. For anyone listening who may have had a similar experience: it’s not uncommon. It is one of the potential side effects of the copper IUD. Not all women experience ovarian cysts with a copper IUD, but it is a real thing. Could you describe what the pain was actually like? In terms of frequency, which side, what it felt like?

Christine: Before I actually knew what it was, it was really scary — when you Google these symptoms, the worst things come up. The pain was on the left side for me, and it was a sign that something was up because I hadn’t experienced pain before. It started to become something that happened even when I was exercising — running, jumping — and at some point it was even walking. The cyst had gotten big enough that I could feel it. I think a lot of people don’t know that our ovaries produce tiny cysts on a regular basis every time we menstruate, but when they stick and grow, that’s obviously something to be concerned about. Usually they would dissolve on their own, but this one got pretty big. And for sure it was painful.

Lisa: Were your periods heavy before the IUD? Did you have any pain?

Christine: Before the IUD, I never had painful periods. I never had cramps. But I did have generally really heavy periods that lasted a long time. My mom’s approach was that with time, as your body adjusts, it will lighten up. So I always had that in the back of my head. I always knew it wasn’t going to last forever and that it was just a process of my body transitioning.

Lisa: You had found yourself with low iron even before the IUD, and then your periods became three days longer. Can you take us through what the volume was like before versus after?

Christine: Before, I had pretty balanced periods — five to seven days, which I guess is a little on the heavy end, but it wasn’t disturbing my day. After the copper IUD, I went to periods that lasted up to nine days on most cycles. Every day for the first five days, filling maybe two cups — and before that it was several really heavy pads. Nothing was keeping the blood in. Even using a tampon and a pad it would still get through, and I’d be worried about it all the time. On top of being physically stressful on my body, it was mentally really stressful, and it made it hard to focus on my workday.

Lisa: That’s pretty significant — filling about two cups every day for five days. There are some women listening who maybe fill one or two cups their whole period. And there’s this interesting relationship: women who have low iron often bleed more, and heavy bleeding can contribute to low iron further. It’s worth noting for anyone who bleeds heavily — if you go to your doctor once a year, get your iron levels tested, your ferritin stores. That’s something you should be looking at. I talk about liver on the podcast all the time as a natural way to increase iron stores. And so I wanted to also ask about the insertion. Was it okay? Was it painful?

Christine: The insertion is actually a pretty funny story. My sister came with me into the room. I was 22 at the time. It was approached in a way like: it’ll be five minutes, it’ll be super quick. I didn’t take any painkillers or anything before. It was inserted pretty quickly, but the pain was pretty excruciating. From what I hear, the copper IUD is one of the bigger IUDs — typically something they don’t even put in women who haven’t had kids because their cervix is so small. I just remember seeing my sister’s face — she went really pale and looked like she was about to faint. Same for me, right after.

Lisa: On a scale of zero to ten — zero being no pain, ten being someone drilling a nail into you — where would you place it? And was it just for a moment, or did it last?

Christine: A strong six to seven. The pain felt really unexpected — catching me off guard made it worse. The next day was really, really painful. I was constantly feeling dizzy from the pain, taking several Advils, and that pain lasted throughout the next week and a half. Then every time I got my period, my periods were suddenly painful. I finally started experiencing what these really intense contractions felt like, and they were really debilitating because I had never had cramps before.

Lisa: I want to put it out there for anyone listening: it is actually possible to have a painkiller administered before IUD insertion. Of course it may not sound like the greatest thing to have a needle in the cervix to numb the area, but this is something you can ask your doctor about. I’ve heard strange things like some doctors don’t think we have nerve endings in the cervix. For the record, the cervix plays a really important role in the orgasm reflex, and women who’ve experienced damage to the cervix can go on to have difficulty achieving orgasm and experiencing additional pain. From what I’ve heard directly from women who’ve had IUDs inserted, it would actually be warranted as a standard for the doctor to offer painkillers — instead of just saying, “It’s just going to be a minute, it’s going to be totally fine.”

Christine: And the fact that I went from having no cramps to having these really long, really heavy, crampy periods was a total lifestyle change. No one really prepares you for how that’s going to change the way you do sports or whether you can do physical activity when you’re on your period.

Lisa: So then you had the copper IUD in for a while, you’re having cysts, you’re having these heavy periods that are also now painful, and you’re kind of getting to the end of your rope. What happened next?

Christine: The exhaustion every time I had my period — and even when I didn’t have my period — just became too much. I felt like this wasn’t a normal way to live, especially since I didn’t live like that before. The low iron had become anemia. For me it was just taking my exhaustion to another level — sugar cravings, needing to get my energy up, which changed my eating habits. Starting to look into ways to reduce the size of the cyst was really important. I looked into the correlation between sugar and hormone imbalance — how high testosterone or insulin resistance, common with PCOS, can contribute to cysts. So I removed refined sugar, increased cruciferous vegetables and fiber, and just ate well overall. And then I went back for the ultrasound and the cyst was pretty much gone. But I was still really struggling with the low energy and heavy period situation. It was interfering with my ability to even go out on the heavier days or do sports. So it was time for a change.

Christine: When I discussed a change with my doctor, she again told me the pill would be the best option for me and my iron. I told her I didn’t want the pill — that was an absolute no for me. So I ended up choosing the Mirena IUD. I had spoken with other women who had okay experiences with it. When I went to take the copper IUD out, I asked if I could have a few days without an IUD and just feel how I feel without anything. She told me it wasn’t a good idea, that it could happen really quickly, and that she didn’t want to take it out until I had made the decision to go with the new one. She said most women won’t even come back for the second IUD or they’ll get pregnant in between. So I didn’t really get a chance to be without an IUD in between.

Lisa: From the interviews I’ve done with doctors, that seems pretty in alignment with how they’re trained. It’s a very interesting idea that as a doctor you feel like a grown woman is incapable of using a barrier method for a period of time. How did you feel about that?

Christine: I was pretty excited at the idea of not having anything in my uterus for a quick minute and just being with myself. When you get something foreign put in your body, it’s so much a physical experience, but it’s also really like an emotional experience — your uterus isn’t just your uterus anymore; it’s got something inside of it and you’re so conscious of that. So I was pretty excited to give it a break. But when I got the new IUD, it was a game changer. As someone who had low iron and suddenly wasn’t bleeding at all — I went from having really heavy periods to essentially no periods with maybe light spotting. My energy levels are so much better and I feel better. But I’m at the point now where I feel really disconnected from the fact that I don’t have my period anymore.

Christine: We learn so much on your show — that a healthy period is a sign of good health in general. It can mean you’re treating your body right, eating right, moving right. And to not be able to see what’s going on with me in that physical way has been a little bit disconnecting. And even when it comes to moods or when I get emotional — you know, you still ovulate with this IUD. The way it was explained to me was that the hormones are very small and localized and don’t run through the bloodstream.

Lisa: There must be a pamphlet that the drug companies send to all the physicians, because they all say the exact same thing. They all say it’s low hormones, it’s a low dose, it’s only localized, it just stays in your uterus. The irony is that if you have hand lotion with perfume in it and you put it on your skin, those xenoestrogenic chemicals can actually go through your bloodstream from your arm and disrupt your menstrual cycle. So there is no such thing as localized hormones in an IUD. The only thing that could possibly mean is that they’re in your body and releasing from that local area. We have a circulatory system. When you have the IUD inserted, the progestins do not stay in the uterus. That’s absurd. They go into the bloodstream and they circulate throughout your entire body — just to be clear.

Lisa: They could argue it’s a lower dose. And I feel like there’s really creative language used around all types of medication. But ultimately, it’s enough to prevent you from conceiving. With the hormonal IUDs, they are progestin-releasing — not progesterone, the same hormone, but a synthetic version. The main mode of action is to prevent the development of a full endometrial lining, so the lining typically does become quite thin. Some women experience irregular bleeding or spotting for even the first three to six months, which typically subsides. Just to your point about ovulation: on that pamphlet the doctors read from, they say you get to keep ovulating and everything’s fine. It’s helpful to know that there are kind of three categories you may fall into. One is that you may actually ovulate regularly, similar to a regular cycle. Another is that you may continue to ovulate, but sporadically — and it can change over time. And then there are women who stop ovulating altogether. So not every woman is going to be ovulating regularly with the hormonal IUD, although some will. I think it’s important for us to understand the complexity instead of being told something that is kind of half true.

Christine: When you do read these pamphlets — honestly, if you’re not a doctor or in the science community, you’re not really going to understand what a lot of these progestin/progesterone terms mean. A lot of doctors don’t have the time to sit and explain it. So you’re left with a pamphlet that doesn’t really make sense, but you’re told by a doctor that you’ll ovulate and it’ll just be a tiny bit of hormone, so of course you’re going to go, okay, great. But it does say on the pamphlet that side effects can be acne, side effects can be weight fluctuations. So if these hormones were localized, a lot of these total body side effects wouldn’t be happening.

Lisa: That’s an excellent observation. If what they’re saying is true and it is localized, how could the insert — which is mandated and legally required to reflect what was found in their own trials — list full-body side effects? Drug inserts related to hormonal contraceptives are just fascinating things to read. Pick your favorite brand and search it now, because you will be fascinated to see what it says on there. The good news is that in your case, you have a positive experience with the Mirena, especially coming off the very negative experience you had with the copper IUD. And it’s kind of like this interesting double-edged sword — you don’t bleed anymore, which is helpful when you’re trying to restore iron levels, but at the same time you’re at the point where you’re thinking, maybe not forever.

Christine: No, definitely not forever. And when you no longer are menstruating, you really do feel this sense of disconnect. It makes sense because our bodies are meant to menstruate, and when that’s no longer a part of your cycle, it’s pretty strange and pretty foreign. I didn’t really expect to feel that way.

Lisa: I come across as very anti-pill and anti-hormones because I’m always talking about it. But I understand that people do all kinds of things. The role I see for having these conversations is really to get in there: so what is it doing? What’s it really like? Knowing that you can have a conversation with your doctor and request pain medication before insertion — that’s useful information. The purpose of sharing these stories is not to say no and never — it’s to say, many women experience this, and here’s what you should know going in. And similar to how you already know I’ve interviewed women who’ve had different experiences on the Mirena — the purpose of these conversations is just to help us all make informed choices.

Christine: It’s not empowering to make a decision when you’re not informed. And I think these kinds of discussions make women feel empowered because then they have these experiences to draw from when making their own decisions.

Lisa: As we wrap up, for someone who’s listening who’s thinking about getting an IUD or who’s been experiencing some of the things you have and is wondering if it could be related — what would you want them to know?

Christine: I would say: tune into your periods and be persistent with things like ultrasounds. If you feel like something’s wrong, I had to persist on two separate visits before getting an ultrasound. If you feel like something’s wrong, be your biggest health advocate. No one will look out for you like you do. Doctors are busy — they have five minutes with you. And I would say: don’t expect that getting an IUD is going to fix issues you were already having. The period that you go into getting an IUD with is likely going to be the period you come out with if you don’t make changes to make it lighter or to improve your symptoms. Knowing that the IUD, or hormonal birth control in general, isn’t going to fix your underlying fertility or menstruation issues is really important.

Lisa: That’s a really good point. And so certainly that’s probably one of the big factors hanging over your head because you don’t know: is it going to be like it was when I was on the copper IUD? Will it be better? Did the procedure make it worse? These are all the unknowns. Thank you so much for being on the show. This was really informative and I’m excited to share it.

Christine: Thank you so much, Lisa.

Lisa: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/365. These episodes always really tug at my heartstrings. There are so many women who have experienced such a variety of different side effects and reactions when using birth control. It’s such a divisive topic — women who have never experienced negative side effects are often the ones jumping in saying that I was fine. But on the other hand, you have women who’ve experienced moderate to severe or life-altering side effects. I will always err on the side of listening to and believing women. In my particular practice, the menstrual cycle is central to everything. When I’m working with a woman and she’s experiencing changes or disruptions showing up in her cycle, I don’t have the luxury of telling her it’s in her head — because we can actually see the changes on her chart. I hope that you take from this episode the importance of listening to women. And of course, if this episode really resonated with you and you can think of someone who would benefit from hearing it, please share it. Fertilityfriday.com/365. So with that said, I hope you have a wonderful week — and as always, until next time, be well and happy charting.