Does the IUD cause HS?

If you got diagnosed with hidradenitis suppurativa (HS) around the same time that you had an IUD (intrauterine device) inserted, then you are not alone and it’s not “in your head.”

As a doctor who’s treated many women with HS over the years, I’ve had several patients tell me that they never had HS until they went on birth control pills or had a hormonal IUD inserted (Mirena®, Kyleena®, Liletta®, or Skyla®).

And as it turns out, this phenomenon has been documented in the medical literature for decades.

In 1989, researchers shared a case study of 7 women who noticed a timed correlation with starting birth control pills and developing HS. The timing from when they started the pill to when the HS developed ranged from 1 month to 24 months. Two women got complete resolution of their skin lesions when they stopped the pill. One woman who stayed on the progestin-only pill continued to relapse.

Recently, a case report was published of a 20-year-old woman who went into total remission from HS after having her Mirena® IUD removed. So far, her remission has been sustained for five years.

It’s commonly knowledge among obstetricians, gynecologists and dermatologists that women can develop HS, acne, hair loss, and other troubling symptoms after using certain types of hormones.

Specifically, the androgenic progestins like medroxyprogesterone acetate, ethynodiol and levonorgestrel found in certain birth control can trigger or worsen HS. The Depo-Provera® injection (“depo shot”) is a perfect example of an androgenic progestin that can trigger HS, hair loss, and acne, because it contains medroxyprogesterone acetate.

On the other hand, birth control methods with a higher ratio of estrogen to progestin can actually improve HS by increasing sex hormone binding globulin (SHBG).

Notably, levonorgestrel is the hormone used in Mirena®, Kyleena®, Liletta®, and Skyla® IUDs, and it happens to be extremely androgenic. When the receptors in your hair follicles get stimulated by these androgens, it causes an overproduction of skin cells (keratinocytes) that can lead to a new HS lesion.

So this is why you may have developed HS after getting an IUD: Levonorgestrel is very androgenic, acting like “male hormones” in the body, which can cause or worsen HS in some women.

The PCOS and HS Connection

Many women with HS also suffer from PCOS, or polycystic ovary syndrome. Both HS and PCOS are rooted in genetic susceptibility, insulin resistance, sex hormone influences, and inflammation.

Because women with PCOS often have absent or irregular menstrual periods, they may be prescribed birth control pills as a treatment option. However, birth control pills do not actually “treat” PCOS or regulate cycles – it’s the opposite.

The synthetic hormones in birth control pills suppress ovulation, which shuts down the true menstrual cycle. As the woman takes the non-hormonal placebo or “sugar pills” included in the pill pack, it can induce a withdrawal bleed that mimics a period (but it’s not).

Like the hormonal IUD, birth control pills and other contraception like the Nuvaring can contain androgenic progestins that trigger or worsen hidradenitis suppurativa.

It makes you wonder: How many women were initially diagnosed with PCOS, then given the birth control pills to “regulate” their cycles, only to develop HS down the road because of the androgenic hormone exposure?

Take Steps Towards Healing

If you’re an HS sufferer and you have an IUD, or if you’re using any form of hormonal birth control, here’s what to consider next:

  • Educate yourself about your body and the different forms of birth control that are available to you. We highly recommend Dr. Lara Briden’s excellent book, The Period Repair Manual.
  • Speak with your doctor about getting your IUD removed (or changing or discontinuing your birth control) if appropriate
  • Watch our video about hormones and HS so you can understand these mechanisms
  • Sign up for our Help for HS newsletter to get free actionable tips and information you won’t find anywhere else
  • If you’d like our 1-on-1 help to heal from HS and put it into remission, you can check out our clinic programs here. Tricky cases are our specialty, and even complex conditions like HS can be surprisingly manageable when we identify your triggers.