Changes in hair cortisol concentration in intrauterine device initiators: a prospective cohort study.

OBJECTIVES: Prior studies found increased hair cortisol concentration (a surrogate marker for hypothalamic pituitary adrenal axis activation) in users of the levonorgestrel intrauterine device (LNG 52mg IUD). We evaluated change in hair cortisol and psychometric tests in women initiating a copper (CuT380 IUD) or LNG 52mg IUD.

STUDY DESIGN: We prospectively enrolled healthy women initiating a LNG 52mg IUD or CuT380 IUD. Participants provided hair and blood samples and completed psychometric inventories [Patient Health Questionnaire-9; Positive and Negative Affect Schedule; Psychological General Well-Being Index] after IUD insertion and at six and 12 months. We used liquid chromatography with tandem mass spectrometry to measure hair cortisol concentrations. We compared hair cortisol concentrations and psychometric test changes from baseline to 6 and 12 months using independent two-sample t-tests.

RESULTS: We enrolled 39 of our targeted 86 participants (LNG 52mg IUD 26, CuT380 IUD 13). Thirty-eight subjects (LNG 52mg IUD 25, CuT380 IUD 13) completed six months of follow-up. We found no difference between cohorts in the mean change in hair cortisol concentrations at six months [LNG 52mg IUD n = 21 (-0.01 pg/mg (95% confidence interval -1.26, 1.23); CuT380 IUD n = 13 (- 1.31 pg/mg (-3.36, 0.73))]. While psychometric inventory results remained within normal ranges, LNG 52mg IUD users reported a trend toward more favorable changes over time.

CONCLUSION: We did not find clinically important differences in hair cortisol concentrations following initiation of a CuT380 IUD or LNG 52mg IUD; psychometric inventories demonstrated no adverse effect of hormonal IUDs on mood.

IMPLICATIONS: Our findings of similar hair cortisol concentrations following initiation of either the LNG 52mg IUD or CuT380 IUD suggest that hormonal IUDs do not increase cortisol concentrations or alter stress reactivity, and favorable effects on psychometric inventories provide further reassurance that the LNG 52mg IUD has no adverse impact on mood.

TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03499379.