Approximately 160 million women worldwide use intrauterine devices (IUDs), making up 14% of the total number of contraceptive users [1]. While hormonal IUDs are 99% effective in preventing pregnancy [2], they can also produce side effects in some users, including alopecia [3]. Since it is one of the most popular such devices on the market, many women wonder if the Mirena IUD causes hair loss. While producers and researchers suggest this side effect is uncommon, Mirena IUD hair loss is possible in some users who are already predisposed to hair thinning.
This article will tell you all you need to know about the relationship between the Mirena IUD and hair loss. We will present the available scientific data regarding alopecia side effect reports, comparisons to other hormonal and non-hormonal IUDs and other possible reasons your hair may be falling out. We also provide helpful hair growth tips in case you experience hair loss while using a Mirena IUD.
Key takeaways
Yes, rarely, the Mirena IUD can cause hormonal hair loss in some of its predisposed users. The medication leaflet lists alopecia as an uncommon side effect that can occur in fewer than 3% of the women who use this medical device [4] (as few as 0,33%, as per clinician reports [3]). However, user-reported LNG IUD hair loss cases are significantly more frequent: up to 15-20% [5][6].
The substantial difference in LNG IUD hair loss incidence reported by users vs clinicians may be due to patients failing to mention hair loss to their doctor as a side effect. Alternatively, doctors may not find their patients’ hair loss serious enough to report.
However, the much higher self-reported hair loss rate (which increased considerably with media coverage [7]) may also mean users have become increasingly aware and anxious over time regarding this potential side effect. This may have led to autosuggestion (i.e. anxiety-induced hair loss) or to misattributing signs of coincidental alopecia to the Mirena IUD.
A cohort study performed on patients who had levonorgestrel (LNG) IUDs inserted in 2000-2001 confirmed this, revealing a cumulative hair loss incidence of 0.33% [3]. The scientists used data submitted by medical professionals to the New Zealand Intensive Medicines Monitoring Programme (IMMP).
A mail survey filled in by almost 18,000 Finnish LNG IUD users revealed that 15% reported hair loss among experienced side effects [5].
A smaller survey of 51 LNG IUD users found that 20% of the respondents experienced more pronounced hair loss after device insertion [8].
In 2017, French researchers performed an analysis of all case reports recorded in the French national pharmacovigilance database from 1995 to 2017 [7]. Mirena IUD-induced hair loss was reported in 9% of patients who reported side effects before media coverage peak and in 28.5% of users after this exposure.
An intrauterine device (IUD) is a contraceptive medical device placed directly into the uterus. There are 2 main types of IUDs: copper-containing and hormonal [9] (hormonal devices are sometimes called intrauterine systems). Copper-containing IUDs work by impairing sperm movement, preventing it from reaching the womb [10]. Hormonal IUDs alter the physical properties of the womb, preventing ovulation and egg fertilisation.
The Mirena IUD is the brand name for one of the most commonly used types of hormonal IUDs [1]. It is a small, T-shaped device made of soft plastic that contains and gradually releases a synthetic progesterone called levonorgestrel (LNG). When released inside the uterus, LNG thins out its lining, while thickening the mucus on your cervix [6][11]. This inhibits ovulation, makes the uterus inhospitable for pregnancy and prevents sperm from entering the womb.
The Mirena IUD is MHRA and FDA-approved for contraceptive use. Once placed in your womb by your gynaecologist, this device can provide over 99% effectiveness against pregnancy for up to 8 years (recently increased from 5 years [12] [9]. After this period, it needs to be removed and replaced.
The Mirena IUD gradually releases progestin (levonorgestrel) with androgenic properties, which can reduce oestrogen production. While normally only small quantities of this hormone are absorbed into your bloodstream, causing systemic side effects, continuous low-dose progestin use can still slightly lower the estradiol levels in some users. [1]. This can cause an imbalance between your male and female hormones, triggering or worsening female pattern baldness in women already predisposed to this condition [13][14].
Also known as androgenetic alopecia, female pattern baldness is caused by a mix of age, genes and hormones. It occurs when excessive amounts of a male hormone called dihydrotestosterone (DHT) bind to androgen receptors on your hair follicles. This leads to hair miniaturisation and, eventually, to balding.
While it is not as potent as DHT, LNG can also bind to androgen receptors in the hair follicles of women who are particularly sensitive to it. This means that LNG IUDs can also play a role in triggering or worsening female pattern baldness.
Source: Fabbrocini et al, 2018
Most women who are genetically predisposed to androgenetic alopecia develop this condition after the age of 50. This means it is commonly reported in post-menopausal patients, who no longer need to use an IUD. However, 37% of women who experience this condition start seeing symptoms before age 49, while many of them are still in their reproductive years [15]. This means that it can be easy to misattribute the onset of naturally occurring female pattern baldness to the Miranda IUD, especially if the timing coincides.
Female pattern baldness manifests with diffuse hair thinning, alongside a widening of the midline parting and a Christmas tree pattern. If left untreated, this hair loss can progress towards a growing bald spot on the crown.
Unlike male pattern baldness, which often starts with a receding hairline and temple hair loss, women are normally spared frontal balding.
Since diffuse hair loss across the scalp is among the first signs of hair thinning and balding in women with androgenetic alopecia, it can easily be mistaken for telogen effluvium. So if you notice hair thinning that doesn’t improve within 3-4 months, it is best to see a trichologist to rule out female pattern baldness.
At this time, there is insufficient data to provide an accurate onset timeline for LNG-induced or worsened hair loss. One study shows that in 4 out of the 5 cases of women who reported this side effect, the hair thinning started within 10 months of having their LNG IUD inserted. However, the time frame varied widely (immediately after insertion, <4 months, 6 months, respectively, <10 months after insertion) [3]. And the very small number of cases makes them statistically insignificant.
Since LNG can, rarely, produce or worsen female hair loss by causing imbalances between your male or female hormones, you can likely expect a few weeks or months to pass before you start experiencing this side effect.
The type of alopecia associated, in rare cases, with the release of LNG into your bloodstream from your Mirena IUD is female pattern baldness. This means that it will predominantly affect women who are already predisposed to this condition [16]:
All hormonal IUDs have a small chance of causing hair loss. However, some of them contain lower doses of levonorgestrel (e.g. the Mirena IUD contains 52 mcg LNG [12], while the Kyleena IUD contains 19.5 mcg LNG and Jaydess only contains 13,5 mg [17][18]). This means they may pose a lower risk of worsening your alopecia.
Copper IUDs pose no risk of hair loss, as they do not influence your hormone levels. They release copper ions, which interfere with sperm movement, so they cannot reach the egg and fertilise it.
There isn’t much you can do to prevent Mirena IUD hair loss, as it occurs in people who are already predisposed to female pattern baldness (and in most cases, who are already experiencing this condition). However, you can try to improve your hair health to prevent unnecessary hair breakage.
Certain lifestyle changes can reduce your chances of worsening your androgenetic alopecia. For example, smoking can cause hair loss and worsen the symptoms of androgenetic alopecia [19]. Cutting back on cigarettes can lower your chances of your alopecia worsening while using a Mirena IUD.
The best thing to do if your hair is falling out more than usual is to see a hair doctor. They can diagnose your condition and rule out other types of alopecia unrelated to your IUD. If your trichologist confirms that your Mirena device is worsening your alopecia, they might recommend one or more of the following hair growth options:
If your Mirena IUD is causing or worsening your female pattern baldness, it is theoretically likely that removing the device will lead to improvement. However, there is little research to show whether this actually happens. One study [3] follows 5 reports of Mirena-induced alopecia over time, and the outcome of just 3 of them is known. Two patients made a full recovery after removing their IUD, while one did not recover.
However, if your hair loss is not very advanced, it can often be curbed and sometimes even reversed with hair loss treatment despite keeping your Mirena IUD. And should it be too advanced for non-surgical hair restoration treatments, you can always get a hair transplant for women.
Mirena IUDs are generally safe to use for most healthy women. However, they can also produce some adverse reactions. These are some of the most commonly reported Mirena IUD side effects [23][14][4]:
In very rare situations, using this device has also caused serious complications, such as uterine haemorrhage (heavy bleeding) [24], extrauterine migration of the device, or uterus perforation [25].
Several types of alopecia could be responsible for hair loss misattributed to the Mirena IUD. Here are some of the most common:
If you are experiencing hair loss and are unsure whether it is related to your Mirena IUD, it is best to get a professional diagnosis. Book a consultation with one of our experienced hair specialists at your most convenient clinic location.
Our trichologists will examine your hair thoroughly, and if needed, they will order hair loss blood tests to determine your hormone levels. Based on the results, they will recommend the best hair loss treatment for women with your specific hair problem. Whatever the cause of your alopecia, you can rest assured you will receive the best advice to restore your hair’s fullness, health and radiance.
If you still have questions about the relationship between the Mirena IUD and hair loss, you may be able to find the answers you need below.
Some birth control pills can cause hair loss as well. However, the prevalence of this side effect is hard to determine, since there are many kinds of oral contraceptives, with different active ingredients in varying doses. Individual response to androgens and oestrogens also differs.
So it is safe to say that both the Mirena IUD and oral birth control have a very small chance of making your hair fall out more than usual. However, more comparative studies are needed to say which one carries a greater risk.
Hypertrichosis (excessive, unwanted hair growth on the face or body) is one of the most commonly reported side effects of hormonal IUDs. According to the Electronic Medicines Compendium (EMC) and the Mirena product leaflet, hypertrichosis is a common Mirena side effect, occurring in 1-10% of patients. However, one survey performed on 206 patients revealed that 41% of participants reported excessive facial hair after IUD implantation [14].
The reason the Mirena IUD causes hirsutism in some users is likely the hormonal imbalance it can produce. The same androgens that can trigger or worsen female pattern hair loss can also stimulate thicker face and body hair growth.
Only very few cases of alopecia areata have been reported in association with Mirena IUD use [14]. And so far, no causal relationship has been scientifically established between the Mirena IUD and patchy hair loss. Since alopecia areata occurs in 2% of the world’s population [27], some women may coincidentally experience a flare-up within a few months after inserting their IUD.
Mirena IUD side effects normally start to occur within the first few months of insertion [28]. The peak blood concentration of levonorgestrel is usually achieved in approximately 2 weeks and then the body takes some time to adjust to the hormonal changes. So it can take some time to see side effects in terms of hair fullness.
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Dr Meena Zareie (GMC number 7722917) is the first female member of Wimpole Clinic’s Hair Transplant Surgeons team.
Dr Meena started her journey in the hair transplant industry 8 years ago, where she worked closely with leading surgeons to hone her skills, having conducted more than 1,000 FUE hair transplants.
Starting as a technician and nurse while working simultaneously for the NHS, she decided to take her passion for helping patients with hair loss further.
Her qualifications include an MD doctorate from the prestigious Medical University of Warsaw, and a Master’s degree in Drug Toxicology with the institute of cancer therapeutics. She has previously completed a bachelor’s in Biomedical Science, and is qualified in minor aesthetic and dermatological procedures for the face and body. She is a member of the British Medical Association and is a registered doctor on the General Medical Council.
Her passion for perfection and attention to detail is what drew Dr Meena to the aesthetic industry. She has completed additional FUE Hair transplant training with renowned hair transplant doctors in Georgia and Iran, and has developed a fine motor skills which serve to produce outstanding results, as each procedure is carried out with ultimate care and meticulous attention to the detail. Dr Meena’s care for her patients and work shows in her results is a real credit to the hair transplant industry.
