Could an IUD Alter the Vaginal Microbiome?

There are new numerous birth control options available today, and it only makes sense that intrauterine devices (IUDs) are becoming one of the most popular. An IUD can prevent pregnancy for several years, and, compared to other methods, they are fairly low touch. While design flaws in 70s-era IUDs gave the device a bad rap, today’s models are safe, highly effective at preventing pregnancy, easy to insert, and often covered by health insurance. In fact, the number of people using IUDs continues to rise. 12% of those who used contraceptives chose IUDs in 2014, up from 2% in 2002 and 9% in 2009.

In addition to the benefits of IUDs, serious side effects are exceedingly rare. There is, however, one potential effect of IUDs that researchers are still studying: their impact on the vaginal microbiome. Some research suggests that copper IUDs may raise the risk of bacterial vaginosis (BV), while others have found that IUDs can support colonies of potentially harmful bacteria in the uterus.

If you currently use an IUD, or are considering getting one, it’s important to consider how to keep your vaginal microbiome happy and healthy as you choose the birth control method that’s right for you. Here’s what you need to know:


How Do IUDs Work?

An IUD is a plastic or metal device that is shaped like a T. A doctor inserts this device into your uterus through your vagina and cervix in a simple, outpatient procedure.

Plastic IUDs release small amounts of hormones into your uterus which thicken cervical mucus and prevent fertilization. Copper IUDs have the same effect, but they release small amounts of copper instead of hormones. Copper IUDs may be safer for those who are unable to use hormonal birth control.

The protective effects of IUDs last longer than most other forms of birth control. After insertion, hormonal IUDs provide protection for three to six years, while copper IUDs can provide pregnancy protection for up to a decade. IUDs are 99% effective in preventing pregnancy – more effective than condoms or the pill.

While an IUD is excellent at preventing pregnancy, it cannot protect against sexually transmitted infections (STIs). For a completely safe sexual experience, a condom must also be worn with an IUD.


How Do IUDs Affect Your Vaginal Microbiome?

While IUDs are generally a safe and effective way to prevent pregnancy, copper IUDs may increase the risk of developing bacterial vaginosis (BV).

BV is a kind of dysbiosis—that is, an imbalance of bacteria in your microbiome. BV occurs when the proportion of helpful Lactobacillus in your vagina decreases and various other genera of bacteria – including Gardnerella, Mycoplasma, or Prevotella – increase.

BV usually goes away on its own, but some cases may require treatment with antibiotics. The CDC recommends that those who are pregnant and experiencing symptoms of BV always be treated, since the infection can increase the risk of pregnancy complications like preterm birth. BV can also increase the risk of contracting an STI and even lead to pelvic inflammatory disease.

Several studies have found that those with copper IUDs were more likely to experience BV. In one study, 49% of patients with a copper IUD had bacterial vaginosis after 180 days of insertion, as compared to 27% of patients without IUDs. People who used copper IUDs for over a year were also significantly more likely to have Mycoplasma and yeast infections. By contrast, hormonal (plastic) IUDs have not been found to increase the risk of BV.

Why might copper IUDs increase BV risk? Research has found that copper IUDs are often covered in biofilms, thin layers of bacteria that grow on the surface of the IUD in the uterus and that can contribute to dysbiosis. Scientists also speculate that increased menstrual flow and spotting, common side effects of the copper IUD, can change the vaginal microbiome, leading to a decrease in Lactobacillus and eventually BV .


What Can I Do to Lower My Risk?

If you’re suffering from any symptoms of BV, including itching and “fishy” smelling discharge, it’s a good idea to talk to your doctor. If you have an IUD (and even if you don’t!), you can take proactive steps to help lower your risk of BV by maintaining a healthy microbiome.

  • Support your microbiome through a healthy diet that includes pre- and probiotics. Prebiotics are substances that encourage the growth of helpful bacteria. They include fiber-rich foods like whole grains and vegetables like onions, garlic, soybeans, and artichokes, among others. Probiotics are foods that contain helpful bacteria, including fermented foods like yogurt, sauerkraut, buttermilk, and kombucha.
  • Ask your doctor about taking a Lactobacillus reuteri or Lactobacillus rhamnosus probiotic supplement. Orally taken probiotics have been shown to help reduce the occurrence of BV.
  • Avoid behaviors that can be harmful to your vaginal microbiome, like douching or using harsh, perfumed soaps. A simple, unscented soap (or just water!) is best for washing the vulva, the area around the vagina. The vagina, on the other hand, cleans itself and shouldn’t be washed or douched at all. Smoking can also harm the vaginal microbiome, so, if you smoke, here’s yet another reason to quit.
  • Use condoms or other barrier methods of birth control. Studies show that unprotected sex is especially likely to mess with your microbes. Whenever you have sex with a new partner, it introduces new bacteria into your vagina, which can increase your risk of developing BV.


Finding the Birth Control that Works for You

While some may experience negative side effects from IUDs, many prefer IUDs as a safe and extremely effective means of birth control. Ultimately, the best form of birth control for you depends on your needs and is something only you can decide in consultation with your doctor. Whichever method you choose, knowing the facts can help you keep your vagina healthy, happy, and full of friendly microbes.

Want to learn more about your vaginal microbiome? uBiome’s SmartJane vaginal health screening test measures the levels of 23 different microorganisms in the vagina and screens for HPV and four other common STIs.