CAN A NON-HORMONAL IUD IMPACT YOUR HORMONES?
The Copper IUD, used by more than 150 million women worldwide, is over 99% effective at pregnancy prevention and even sometimes used as an emergency contraceptive [1]. As a non-hormonal birth control option, the appeal can arguably be better than oral contraceptives in terms of the long and short-term impacts of synthetic hormone alternatives. However, women using the Copper IUD often report heavy, painful periods and recurrent miscarriages after discontinuation [2]. So if the Copper IUD is non-hormonal, how does it create these seemingly hormone-related disturbances?
Research on the Copper IUD is extremely limited regarding its direct impact on hormones. However, given the significant impact minerals, such as copper, has on the body and hormone production a strong correlation can be drawn between Copper IUD usage and hormone imbalances. Most studies assessing serum copper levels in users show, without question, copper ions released from the IUD are not confined to the uterus but are able to seep their way through the endometrial lining into the bloodstream. Copper serum levels at 3 months post-insertion have shown to be significantly elevated while studies that looked at copper levels 24 months post-insertion show no statistical significance in serum copper levels [3]. It appears initially serum copper levels may rise and after years of subsequent usage the serum levels may decrease or balance out. So, where does the copper go?
Over two-thirds of copper in the body is stored in the tissues: the brain, eyes, kidney but mostly in the liver making it extremely difficult to accurately assess copper status in the body as serum blood work only accounts for circulating levels and not the amount stored in tissues [4,5]. It is hypothesized that serum copper levels initially rise in Copper IUD users and subsequently decrease as the copper moves from the bloodstream and deposits itself into tissues.
If you have been following any of our previous articles, it may jog your memory that minerals play a critical role in virtually every function of the body and copper is no exception. Copper is an essential mineral and regulates red blood cell production, iron absorption, energy production, connective tissue formation and neurotransmission (brain communication) but, as always, too much of a good thing is not ideal [6]. While the amount of copper ions released from the copper IUD is not thought to be toxic, the elevated levels and elevated storage form of copper do impact the balance of minerals, vitamins and other hormones throughout your body.
COPPER + ZINC
Copper and zinc are two essential minerals that function as antagonists to keep balance of one another. Elevated zinc causes copper deficiency and conversely, elevated copper causes a zinc deficiency [7]. When copper is stored in the liver, it is bound to a protein called metallotheonein [3]. This protein also binds multiple ions of zinc per one copper ion for stability. So when copper ions are deposited for storage, zinc stores are also utilized and deposited in the liver. The functions of zinc throughout the body are equally as important as copper. It has a significant role in immune function, protein production, wound healing, cell division, sex hormone production and thyroid hormone conversion [3]. The enzyme required to convert the inactive thyroid hormone (T4) to the active thyroid hormone (T3) requires zinc to enable your thyroid hormones to function optimally [7]. Zinc is also a key player in the reproductive system as it increases production of the Follicle Stimulating Hormone (FSH) which enables ovulation and subsequently the production of progesterone [8]. Zinc deficiencies have been shown to impair glucose metabolism leading to insulin resistance, contribute to oxidative stress and cause estrogen dominant states via its role in decreased ovulation and progesterone production thereby impairing a normal menstrual cycle [3,7,8]. The correlation could be drawn that excess copper ions from an IUD has the ability to create a zinc deficiency therefore with long-term usage this deficiency can have far greater impacts outside the confinement of the reproductive system.
COPPER + IRON
It is often argued that iron deficiencies are in fact not related to the need for more iron but the need for more copper. Copper is tightly bound to iron and when iron levels are low, copper accumulates in the liver [6]. Conversely, when copper levels are low, iron accumulates in the liver. But when copper and iron levels are high, both accumulate in the liver and studies have shown it to increase the size and weight of the liver [6]. This accumulation of copper and iron deposits can overburden the liver and interfere with other important processes such as estrogen metabolism [6,9].
COPPER + ESTROGEN
Estrogen metabolism primarily occurs in the liver [9]. An overburdened liver or inadequate detoxification impairs the metabolism and excretion of estrogens which can be caused by an over accumulation of minerals such as iron, copper and zinc deposits. The interference with estrogen metabolism may lead to development of an estrogen dominant state: when the amount of estrogen present is higher than normal and not balanced by sufficient progesterone. Common symptoms of estrogen dominance include PMS, painful periods, mood swings, fatigue, fertility struggles, anxiety, brain fog, anxiety and heavy or irregular periods (ironically, one of the most commonly reported side effects of the copper IUD) [10]. Conversely, chronic exposure to estrogen increases serum copper levels, as evidenced during pregnancy when circulating levels of estrogen are naturally increased [11]. Therefore, if an estrogen dominant state was present prior to Copper IUD usage whether due to a diagnosis such as PCOS, genetics or former oral contraceptive usage, this may only worsen estrogen dominance and further increase copper deposits.
COPPER + VITAMIN A
The goal of the body storing minerals and vitamins is to be able to access them in the event the body requires more. In order to access copper stores, a protein called ceruloplasmin is required to bind the copper and transport it throughout the body thereby making it bioavailable [11,12]. The synthesis of this protein is dependent on Vitamin A status. With adequate Vitamin A, the body is able to mobilize copper for more usage or excretion to regulate copper levels . Without adequate vitamin A, copper ions can continue to be stored, overburdening the liver and tissues while exacerbating all of the aforementioned conditions.
COPPER + THE REPRODUCTIVE SYSTEM
The vaginal microbiome is similar to that of the gut microbiome in that it houses essential bacteria and is extremely absorbable. The copper IUD has been shown to disrupt the vaginal microbiome, altering the bacteria and leading to increased incidences of bacterial vaginosis. The longer duration of usage of the Copper IUD has shown incidences of bacterial vaginosis reaching 49% [13]. The vaginal microbiome receives messaging from progestin and estrogen and similarly sends messaging back impacting the functions of progestin and estrogen (to what degree is not entirely known but regardless plays a role in hormone communication) [13]. Additionally, after Copper IUD removal deposits of copper have been seen on imaging scans leftover in the uterus which could potentially explain some recurrent miscarriages in some women [14].
All scenarios considered, the degree to which excess copper absorption impacts your body should be considered on an individual basis based on prior and current nutrition, lifestyle factors and genetics:
Do you have a gallbladder that functions optimally to store bile helping to excrete excess copper in feces? Is your gut health optimal with regular bowel movements to remove excess copper without allowing it to be reabsorbed? Do you have adequate zinc to balance out the increased copper? Do you consume a high iron diet that contributes to overburdening the liver with copper accumulation? Do you have low iron status that causes more copper to accumulate in the liver? Do you have adequate vitamin A to mobilize unbound copper? Were you pre-exposed to a high estrogen state from PCOS or low progesterone that has been intensified by copper overloading? (Please do not begin supplementing these minerals without a deeper look from a practitioner).
Nothing works in isolation; everything is intricately connected and a significant imbalance of one mineral has the potential to throw off a myriad of functions throughout the body. Choosing the Copper IUD to avoid exogenous hormones has shown benefit as compared to alternative, hormonal options. However, it’s time to be informed and educated that simply because the Copper IUD does not contain synthetic hormones does not mean it’s not impacting your hormones.
References
1. Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health. 2010 Aug 9;2:211-20. doi: 10.2147/ijwh.s6914. PMID: 21072313; PMCID: PMC2971735.
2. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009 May;79(5):356-62. doi: 10.1016/j.contraception.2008.11.012. PMID: 19341847; PMCID: PMC2702765.
3. Imani, S. et al. Changes in copper and zinc serum levels in women wearing a copper TCu-380A intrauterine device. The European journal of contraception & reproductive health care : the official journal of the European Society of Contraception, [s. l.], v. 19, n. 1, p. 45–50, 2014. DOI 10.3109/13625187.2013.856404.
4. Amtage F, Birnbaum D, Reinhard T, Niesen WD, Weiller C, Mader I, Meyer PT, Rijntjes M. Estrogen intake and copper depositions: implications for Alzheimer's disease? Case Rep Neurol. 2014 Jun 19;6(2):181-7. doi: 10.1159/000363688. PMID: 25076894; PMCID: PMC4105953.
5. Office of dietary supplements - copper. NIH Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Copper-HealthProfessional/#:~:text=Almost%20two%2Dthirds%20of%20the,amount%20is%20excreted%20in%20urine. Accessed October 21, 2022.
6. Ha JH, Doguer C, Wang X, Flores SR, Collins JF. High-Iron Consumption Impairs Growth and Causes Copper-Deficiency Anemia in Weanling Sprague-Dawley Rats. PLoS One. 2016 Aug 18;11(8):e0161033. doi: 10.1371/journal.pone.0161033.
7. Severo JS, Morais JBS, de Freitas TEC, Andrade ALP, Feitosa MM, Fontenelle LC, de Oliveira ARS, Cruz KJC, do Nascimento Marreiro D. The Role of Zinc in Thyroid Hormones Metabolism. Int J Vitam Nutr Res. 2019 Jul;89(1-2):80-88. doi: 10.1024/0300-9831/a000262. Epub 2019 Apr 15. PMID: 30982439.
8. Nasiadek M, Stragierowicz J, Klimczak M, Kilanowicz A. The Role of Zinc in Selected Female Reproductive System Disorders. Nutrients. 2020 Aug 16;12(8):2464. doi: 10.3390/nu12082464.
9. Tsuchiya Y, Nakajima M, Yokoi T. Cytochrome P450-mediated metabolism of estrogens and its regulation in human. Cancer Lett. 2005 Sep 28;227(2):115-24. doi: 10.1016/j.canlet.2004.10.007. Epub 2004 Nov 19. PMID: 16112414.
10. whitecoat Athe A. 15 signs of Estrogen Dominance. Chapel Hill Gynecology. https://chapelhillgynecology.com/signs-of-estrogen-dominance/. Published April 29, 2020. Accessed October 21, 2022.
11. Amtage F, Birnbaum D, Reinhard T, Niesen WD, Weiller C, Mader I, Meyer PT, Rijntjes M. Estrogen intake and copper depositions: implications for Alzheimer's disease? Case Rep Neurol. 2014 Jun 19;6(2):181-7. doi: 10.1159/000363688. PMID: 25076894; PMCID: PMC4105953.
12. Copper toxicity: A common cause of psychiatric symptoms. Psychology Today. https://www.psychologytoday.com/us/blog/holistic-psychiatry/201709/copper-toxicity-common-cause-psychiatric-symptoms. Accessed October 21, 2022.
13. Sharon L. Achilles, et al., Impact of contraceptive initiation on vaginal microbiota,
American Journal of Obstetrics and Gynecology, Volume 218, Issue 6, 2018. Pages 622.e1-622.e10
14. Dubovis M, Rizk N. Retained copper fragments following removal of a copper intrauterine device: Two case reports. Case Rep Womens Health. 2020 Apr 24;27:e00208. doi: 10.1016/j.crwh.2020.e00208. PMID: 32337163; PMCID: PMC7180360.