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Mirena and copper IUD – pros and cons from a naturopath's perspective

In this episode, I discuss the main differences between the Mirena and the copper IUD - and what exactly both is doing within your body.


Topics mentioned:

- My favourite form of contraception and why, and what I personally use
- Hormonal vs non-hormonal contraception methods
- Copper IUD permitting natural ovulatory cycles
- Which of the two methods increase and decrease your menstrual blood flow
- What side effects are associated with the Mirena (contraceptive drug levonorgestrel)
- Mirena suppressing ovulatory cycles some of the time
- How I would rank each contraception method on least to most impactful on the body

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TRANSCRIPT

Melanie (00:00.93)
Hi and welcome to another episode of the Natal Naturopath Podcast. I'm your host Melanie and thanks for joining in again. So this episode is being released on a Tuesday and today we are flying to Cairns with the girls. So obviously I record episodes in advance but I know when I'm releasing this episode. So today we are flying to Cairns.

Melanie (00:25.066)
spending a few nights in Palm Cove and then we're spending a few nights in Fitzroy Island, on Fitzroy Island. So an island close to the coast of Cairns, which I'm so excited about because the last time we went to Fitzroy Island, I was pregnant with the twins. So it's kind of special to come back when they're four and a half and do that with them. And Fitzroy Island is one of the most beautiful places I've been, such a special island. It has this beautiful beach that's been voted like number one.

Melanie (00:54.55)
best beach in Australia a few times and it's called Nudie Beach. There's no nudes, don't know why it's called that. Last time we went to Fittsor Island I couldn't get to Nudie Beach because it involved so much physical activity going through like a forest hiking up rocks and I was like 28 weeks pregnant with the twins and I couldn't barely even walk five meters so I remember looking at the path getting there and I was like there's no way this will take me so long and I'll be in so much pain.

Melanie (01:23.198)
And then there was a really, really long walk to get there if we went a different way and would miss our ferry. So I remember I was like, Oh my God, is this the last time I'm going to be first and last time on Fitzroy Island? And I'm not even going to get to Gordon Rudy beach. Um, this time I'm so excited to do that with Willow Hunter and River and Scott. And then we are also then going off Fitzroy Island and staying a few nights in Port Douglas because of course you have to stay in Port Douglas when you're up that way.

Melanie (01:52.542)
I've been there a few times so I wasn't that fussed about going to Port Douglas again but it's just the most family friendly place to be and I know the kids will have so much fun. We're going to go to the Daintree Rainforest, we're going to do the croc tours of course, lots and lots of resort time and yeah just excited for the weather. That's all I'm for is just heat. Give me the heat please God. Now on to the episode. So we are going through...

Melanie (02:21.454)
Copper IUD and the Marina. So that's what I'm outlining today. Now I did do another podcast episode on the pill. So this was, I don't know what number episode it is, but it was released last July. So if you just scroll back to my latest, my episodes in 2022, the episode is called the Power of Ovulation, Magic of Pagestivirn and Breaking Up with a Pill.

Melanie (02:49.29)
So that's more to do with the pill, explaining what the pill is doing and talking about suppressing ovulation, why we need ovulation, what does progesterone do and why does our body need it even if we are not interested in having a baby. So this episode is just focused on copper IUD, pros and cons, marina pros and cons, and my favorite contraceptive methods because I do get asked this question a lot on Instagram, like, what do you think of the copper IUD? What do you think of the marina? If you had to rate them, what would you pick is?

Melanie (03:18.742)
best comparison comparing to the pill things like that. So I thought I would just go through and outline everything and then you can make your own informed decision of course. So if I start on the copper IUD so the copper IUD is non-hormonal whereas the marina is a hormonal contraception like the pill. So the copper IUD is non-hormonal meaning it doesn't affect

Melanie (03:45.526)
your hormones, which is a really huge pro. It's the biggest pro I think that it has because it permits normal and healthy ovulation. And that's a really bloody good thing because ovulation is how we make progesterone and we need progesterone. Hence why I suggest you do listen to that episode that I mentioned before, because it gives a little bit of context about why we need to ovulate even when we don't want a baby. So this is why I do not mind the copper ID as much as the marina.

Melanie (04:14.518)
which I'll go through. Now the non-hormonal copper interuterine device, IUD, is a small T-shaped plastic device wrapped up in copper with two little strings. Now the copper IUD keeps sperm from fertilizing an egg. It does affect how sperm travels in the area and it produces an inflammatory reaction locally that is toxic to sperm and eggs, preventing pregnancy, can also change your endometrial lining.

Melanie (04:42.134)
and I was reading and it did say that it slowly releases copper into the uterus which is how it keeps sperm from fertilizing an egg. Okay so that's how it's working. It's a very local, if we think about where it's affecting us, if we think about the marina that's a whole systemic body being affected, your whole hormonal system is affected, same as the pill. The copper AUD is much more of a local

Melanie (05:10.43)
What am I going to say? A local, it's only affecting you in that area. Does that make sense? I hope that makes sense. Now, so like I said, the copper AD is toxic to both egg and sperm, which then stops sperm from fertilizing the egg. Also can slow the transport of the egg, too delays sperm and egg meeting and also changes the lining of your uterus to make it unable to support a fertilized egg. Now,

Melanie (05:38.386)
It does permit natural ovulatory cycles, which I love, and it is very, very effective. So it states that the failure rate is just 0.6%. So highly effective. So that's a 99.4% success rate or effectiveness. So after insertion, you don't need to do anything, take anything, nothing, and it can last up to 10 years. So it's much longer lasting than the Marina. And it's completely different to the pill that you need to take every day.

Melanie (06:08.23)
Now fertility returns to normal as soon as you remove it. So they say, I don't know whether that's been definitely tested as such, like in a, at a clinic sense, they say the same about the pill. They say the same about the marina. Yet we know that these things do sometimes affect your fertility initially until your cycle sort of regulates and things like that. However, because the copper IUD is non hormonal, this would absolutely.

Melanie (06:37.802)
be less impactful on your fertility and your hormonal cycle because it doesn't have an effect. I was just thinking that it might take a little bit of time once the copper IUD has been taken out to potentially have your uterine lining come back to that way it was and things like that, especially because the copper IUD does change the lining of your uterus. So maybe that would be the only thing it does. I don't have any evidence or proof of that. That was just my thought process there.

Melanie (07:05.286)
It's the most popular method of birth control in the world and it can be used while breastfeeding. So that's really good. It doesn't carry the risk of side effects such as blood clots or anything like that, which are just related to hormonal birth control methods. So it's less risk. And it also states, sort of when I was researching, it has the highest rate of user satisfaction of any contraceptive method. And it also can be used as emergency contraception. So if you have an OOPSIE, I think I was saying you can be having an ACOPRA-UD-inserted

Melanie (07:34.958)
five days post-upsy and this could be effective. So that was pretty amazing. All right, so now onto the cons. Sorry, insertion can be painful and uncomfortable. I've heard it can absolutely be painful, but it's like an in-office procedure. It's not surgery, it takes a few minutes. So that might be well worth it, you know, if we're looking at how little it can affect your body. Now,

Melanie (08:03.67)
They say that the cramping, you do initially get some cramping after copper IUD and it can continue for a couple of weeks after insertion. And then you may experience more pain with your periods. So more than 30% of copper IUD users report more period pain at first, but then they do say it reduces over 12 months, okay. Your periods might also very, very likely, this is well supported,

Melanie (08:32.918)
your periods will probably be heavier and you might experience spotting between periods. So copper IUDs increase your blood flow by about 20 to 50% for the first 12 months after insertion. And then periods can return to normal in some women, but not all. This is so important to weigh up for you. If you are someone that has iron deficiency on and off, or you already have heavy periods, or you have like adenomyosis, endometriosis, things like that,

Melanie (09:02.63)
this will not be a good choice for you because we do not want to increase your blood flow of course if you're already suffering from extreme blood loss and if you're someone that's constantly iron deficient on and off and you're trying to work on it I don't think this would be a good choice if it's going to potentially increase your blood loss even more.

Melanie (09:22.19)
Copper IUD has also been shown to be impactful on the vaginal microbiome, and it actually doubles your risk of bacterial vaginosis. So that's something really significant to consider. If you're someone that suffers from vaginal microbiome concerns like recurrent thrush, BV, it might actually worsen this or leave you at more risk of the, well, it does leave you at more risk of bacterial vaginosis. So it's just something to consider if that's you.

Melanie (09:50.706)
Although in bearing in mind, you can book a consultation with us to work on your vaginal health. We do have access to sending you off to get a vaginal microbiome swab done a kit, which tests all the different levels of bacteria, good bacteria, bad bacteria, and we can really figure out what we need to work on and personalised treatment towards you for you. So there is just know there are things you can do to minimise that.

Melanie (10:16.002)
The copper AED might also come out and if it does come out and you didn't realize then obviously you could become pregnant. But signs of expulsion includes pain spotting and then the absence or the lengthening of that string that hangs below your cervix. Now there's a higher risk of developing pelvic inflammatory disease but only if you have gonorrhea or chlamydia already. So just get an STD check prior to getting your copper AED inserted. Now,

Melanie (10:45.346)
The thought there is thoughts that it could cause copper excess. Okay. But from what I found, the amount of copper that potentially is released from the IUD is really small compared to the amount we would obtain from foods like dark chocolate. Copper excess is going to be much more likely if you have a problem with your zinc levels. If you're deficient in zinc, your copper levels could already be in excess and are more likely to become excessive. So that's something to note.

Melanie (11:14.198)
that you might want to check in on your zinc levels, maybe take a zinc supplement so often. But it also isn't suitable for you if you do have a disorder that causes too much copper to accumulate in your liver, brain and vital organs, which is called Wilson's disease. So if you have Wilson's disease, you are not eligible to get the copper AED, okay? So then that obviously leads me to believe that there is that risk of copper being released from the area going systemically.

Melanie (11:41.802)
So that's something to consider whether you want to go down that path. Also, it doesn't protect against STIs and it is not suitable if you have a pelvic infection like pelvic inflammatory disease, and it is not suitable. If you have any uterine abnormalities like large fibroids. So it would be something I would be getting a full health check prior to getting, um, the copper AD, just even an ultrasound to check that everything's okay. A blood test.

Melanie (12:09.914)
check your copper levels are okay things like that might just put your mind at ease that it's for you okay so that's the copper iud now let's go on to the marina so i'm gonna go with pros first this time okay so pros it dramatically decreases menstrual flow which is the opposite of the copper iud so the copper iud increases your menstrual flow

Melanie (12:35.41)
Marina dramatically decreases it. So this is fantastic for people that are suffering with unexplainable heavy bleeding or they don't have the time or energy to be investigating their heavy bleeding. I personally do lack a root cause approach and trying to understand what is driving your heavy bleeding, but sometimes it's unexplainable or sometimes the cause is very hard to be treating and it takes finances and energy and all of that. So

Melanie (13:03.126)
you know, then the marina could be really beneficial to you. It can also relieve symptoms of endometriosis. So if you have really significant endo, the pill or the marina will be recommended to you because it can really impact your, it can be so, so beneficial for your symptoms if they're debilitating. Now, unlike the pill, which shuts down ovulation and your hormones,

Melanie (13:30.402)
chemical menopause, okay, that Marina does not completely do this. So it does not completely shut down ovulation and hormones. Officially it doesn't suppress ovulation at all. But then there was a study found that it does suppress ovulation in 85% of cycles during the first year when the dose of that drug is higher. So the drug, the active drug is called Levin or Dress Trill, sorry, tongue twister.

Melanie (13:59.954)
And then in 15% of cycles after the first year, it can suppress ovulation. So remember, ovulation is so beneficial because it's the only way we make progesterone as women. So remembering that this is going to impact your cycles and your ovulation far more than the copper-IUD, which doesn't at all, okay? Now, the Mirena has a lower dose of the contraceptive drugs other than in comparison to the pill.

Melanie (14:29.662)
and it's more, it's very, very effective. Okay. The Marine has got a really high success rate. Now let's go through the cons because there's a few, so each releases that contraceptive drug I spoke about called Levonadesterole, which is not to progesterone. Okay. So don't be fooled into thinking that just because it's got something that is like progesterone that it is progesterone. Now the systemic effects of this

Melanie (14:57.858)
that have been well documented include the potential for acne, hair loss on your head, excessive hair growth on your face, depression, anxiety, headaches, breast pain, yeast infections and weight gain. Now it absolutely damages the vaginal microbiome and it does increase the risk of yeast infections like thrush and BV. Okay, so this is really important.

Melanie (15:23.03)
This is really important to talk about that there are side effects of the marina in some women. And I hate the gaslighting that comes with taking the pill or the marina where women are like, Oh my God, I don't feel right since I've been on this. I've gained all this weight. I've got really like headaches constantly or I'm really moody. I feel like I'm going psycho. I don't feel it myself. And they go to the GP and it's like, Oh no, no, no.

Melanie (15:47.53)
that couldn't be the Marina or the pill. That's, that's not going to be happening. That's absolutely unrelated. It's like, this is just gaslighting because it's, it's been shown that this does have potential side effects. So you need to read through these side effects and go, okay, am I willing to risk that? Um, cons again, like I mentioned, it suppresses ovulation some of the time. So you're going to be ovulating less, which means less progesterone longterm, which isn't good. And why it's not good is in that previous podcast episode, I spoke about.

Melanie (16:16.394)
It can also cause irregular bleeding and spotting during the first three to six months of use. And then after that, it might completely suppress bleeding or just permit a light period. If you actually do get a period on the marina, it is a real period. Unlike the peel when you bleed, that is a fake period. It's not a period at all. So if you do bleed on the marina, that means that you've ovulated that cycle. That's a real period. That means your hormones are going well. Okay. The marina is risky if you're breastfeeding.

Melanie (16:44.546)
So there's a greater chance of IUD expulsion and uterine perforation when breastfeeding. So that's something to note because the copper IUD doesn't carry that risk. So chance of perforation is 0.5%, but it is, sorry, sorry, I got that wrong. Chance of perforation is 0.1%, but it is much more likely during breastfeeding.

Melanie (17:09.026)
then the chance of expulsion is 5%, but more likely immediately following childbirth and during breastfeeding. Now that active drug I spoke about in the marina, it actually does enter breast milk and it can reach baby. So that's something very important to note as well. Hormonal IUDs can be painful, same as copper IUDs, and they can cause ovarian cysts in 5% of users. Hormonal IUDs marina can cause pelvic inflammatory disease,

Melanie (17:37.026)
but only during the first three weeks after insertion. And again, only if you have a preexisting infection like gonorrhea or chlamydia. Again, they cannot protect against STIs, STDs, and they must be removed and inserted by a doctor. So bottom line, hormonal IUDs are going to be affecting hormones slightly. However, they don't suppress ovulation all of the time.

Melanie (18:06.858)
So that impact is a bit more minimal than the pill, which is suppressing ovulation all the time. So the marina can permit natural cycling, which is good. And then overall, you know, they're very convenient, highly effective, and the best benefits that I can see is that they dramatically reduce menstrual blood flow and pain, therefore very beneficial for those with endo. However, I don't, what was I, sorry,

Melanie (18:36.67)
What I wanted to go on actually to say is that compared to the pill, the marina delivers a lower dose of contraceptive drug. The blood level of levinadestrol in marina users is about the one tenth of pill users. So that's a lot less of that of that drug there, which is better. The less the better. Hey, unfortunately, even that low dose can cause side effects. So don't be fooled in thinking that it couldn't. It still can.

Melanie (19:06.582)
but it's a better option than the pill in my opinion. Okay. Now, the bottom line, I love the advantages of reducing the menstrual flow and help relieving the pain of endo and adenomyosis. So in those circumstances, this could actually be the best choice.

Melanie (19:26.946)
but I don't love how it is hormonal and that it can suppress your menstrual cycle because I don't think it's okay to suppress your menstrual cycle unless there is a medical reason that we need to, like endo, like adenomyosis, okay? So remembering the best reason to ovulate monthly is because ovulation is how we women make our hormones.

Melanie (19:56.114)
So I do want to encourage you to consider picking contraceptive method that does allow for that. But obviously there are circumstances where we don't want to have a menstrual cycle anymore and that's okay too. So I do prefer non-hormonal methods of contraception. Okay, so like the copper AUG. My favorite picks, my top picks, these have the least impact on your body. They're gonna be condoms, cycle tracking.

Melanie (20:26.082)
Things like doing, there's the daisy contraceptive device, temp drop, there's so many in Australia now. These are little devices that are gonna be tracking your temperature to measure your fertility on particular days based on the fact that our temperature increases ever so slightly after we ovulate. So it's gonna know, there's gonna be a temp change prior to ovulation and then after. So it's really, really quite accurate actually.

Melanie (20:55.722)
So I don't personally have one of those. They're really expensive and I know my cycles. My cycles are the same every single month. I know what are my fertile days, what are my fine days. So we use condoms on my fertile days and we don't use condoms on my non-fertile days. I've got that down pat. If you don't have your cycle down pat, cycle tracking is very, very difficult because you have no idea when you're ovulating. So if you are an irregular ovulator or an irregular period.

Melanie (21:26.09)
person, this wouldn't be a good choice for you. And I would say condoms all the time, or the copper AD or the Marina. It's totally up to you. But those, I hope that sort of cleared up the things that they do, the pros and cons and what I personally feel is best. I would really rank things. If I had to, if I had to rank them, I would say, um, from least impact to most impact on the body, the least impact is cycle tracking condoms, the Daisy.

Melanie (21:56.582)
then the copper AD, then if I move up the letter into more impactful on the body we've got the marina and then the most impactful on the body is the pill. That's my opinion. But remember it's all about making an informed decision for you and we're all so different. I can't tell you what's best and neither can a doctor. You just need to weigh up all of those differences and pick what's best for you. I hope you liked this episode and I hope it was helpful. Please share it with a friend.

Melanie (22:25.362)
or a family member that you think could really benefit, especially teenagers. Teenagers need to be educated on what are different types of contraceptions, what are they doing? Because I remember when we were going through high school, all of us were on the pill and none of us knew what it was doing. I honestly can confidently say none of my girlfriends and I, I know I didn't, none of my girlfriends knew what the pill was doing to their body, that it was suppressing ovulation, suppressing your hormones. And you know what, even if we knew, I don't think we would have cared.

Melanie (22:55.222)
because we were not explained properly why we need to ovulate. What is progesterone doing? What are these hormones doing for you long-term? Why do we need them every month? And if someone had have actually outlined that, then potentially we would have been making different choices with our contraception. All right, now I just wanted to highlight, if anyone looking for more education from me, head over to my website, www.thenedornaturepath.com.au forward slash pages.

Melanie (23:24.258)
forward slash resources. Okay, hop onto that page. That's my resources page. That's where I have a range of webinars, eBooks and digital downloads that are gonna help support you and your health. So I've got a PCOS webinar that I just did. These are all re-recorded. They're all already, the live version's already been done and these are recorded replays. You can access them anytime. So I've got a PCOS one. I've got a post-plenum depletion webinar. I've got a preparing for pregnancy webinar.

Melanie (23:53.102)
preparing for postpartum webinar, and then an underactive thyroid's webinar. So there's those, and then I have a few eBooks and digital downloads like my blood test cheat sheet, a pregnancy care eBook, a sperm and egg quality eBook. So have a look over there. And then of course I've got so many blogs on my natal journal. So if you go on my website, up the top there's a little link that says natal journal, and I've got heaps and heaps of blogs on different topics up there as well. And of course you can always book a consultation.

Melanie (24:21.586)
with either myself, Alexis and Bella. I just wanted to outline that because a couple of people have said like, oh, how do we work with you? And there are so many different ways to work with us. There is very inexpensive ways with low cost, which is my eBooks. We've got the webinars, like I mentioned, appointments, supplements, and then there's so much free advice on my Instagram and my natal journal. All right. Thank you so much for tuning in and I will be coming to you next

Melanie (24:51.022)
pre-recorded because I'm so organized lately. Okay, have a lovely week!