Hormonal contraceptives can help people treat acne, sickle cell disease, gastrointestinal issues, and uterine anomalies.
The noncontraceptive benefits of the levonorgestrel intrauterine device (IUD) and other hormonal contraceptives are much more than just reducing menstrual pain and bleeding, says Robert A. Hatcher, MD, chairman of the Contraceptive Technology Update editorial board and professor emeritus in gynecology and obstetrics at Emory University.
“They minimize or completely eliminate a number of symptoms women have related to their reproductive cycle,” Hatcher notes. “The benefits are really quite dramatic.”
For example, an important benefit of Depo-Provera, the contraceptive injection, is a reduction in sickle cell crises.1 “It’s reduced by 70% in women who use Depo-Provera,” Hatcher adds.
Birth control pills can reduce symptoms and joint pain in patients with rheumatoid arthritis, says Mitchell Creinin, MD, a professor and director of the Complex Family Planning Fellowship at University of California, Davis Health.
Research shows that oral contraceptive pills can improve rheumatoid arthritis activity and severity, providing an additional benefit to women diagnosed with the condition who also want contraception.2
An outside-the-box benefit to hormonal IUDs is how they can help women with uterine anomalies. For example, people with uterus didelphys — a duplicated uterus and two cavities — could benefit from using two hormonal IUDs, new research shows.3
“We found, according to the CDC’s medical eligibility for contraception, that it is contraindicated to place an IUD for these women for either heavy periods or contraception because of the shape of their uterus,” explains Monica Woll Rosen, MD, study co-author and an assistant professor at the University of Michigan department of obstetrics and gynecology. “But we found you can easily place two IUDs — one in each cervix. All anomalies are grouped as one category, but there are hundreds of different kinds of uterine anomalies, so it should be broken down and evaluated on a case-by-case basis. It’s hard to quantify, but anomalies are, in total, 1% to 3% of the population, on average.”
In a case report, Rosen and colleagues noted a patient was using a contraceptive implant, which was causing abnormal bleeding. “She wanted something else long-lasting,” Rosen says.
Someone with uterus didelphys is at risk of double the amount of bleeding most women experience. Anemia also is a risk. IUDs can reduce bleeding for people with this condition.
“We [placed the IUDs] in the operating room,” Rosen says. “[The patient] was having another procedure at the same time and was undergoing anesthesia, so we placed both IUDs at the same time.”
The patient’s vagina was separated into two halves, which was corrected during the same surgery, making it easier for the woman to engage in sexual intercourse, wear tampons, and deliver a baby.
“I saw her afterward and up to a year later, and she was doing quite well with the IUDs,” Rosen says. “There was no bleeding, and she was tolerating the IUDs very easily and without any issues.”
They used the Skyla levonorgestrel IUD. “We chose it because it’s slightly smaller [than other levonorgestrel IUDs]. When you have a double uterus, both cavities are slightly smaller than when you have just one,” Rosen explains.
The authors of a different study found that Nexplanon, a contraceptive implant, can reduce symptoms of gastroesophageal reflux disease (GERD). Nexplanon is etonogestrel, a progesterone-based form of a long-acting reversible contraceptive (LARC).4
Investigators used the Explorys database of 50 million people to identify adult women younger than age 50 years with records since 1999. They divided data on premenopausal women using Nexplanon, those taking combined oral contraceptives, and women using no contraceptives.
“We wanted to see the effect of combined oral contraceptives vs. Nexplanon, which is a progesterone-related compound,” says Ronnie Fass, MD, MACG, study co-author and a professor of medicine at Case Western Reserve University in Cleveland. “Combined oral contraceptives were associated with an increased risk for GERD. It compares to the risk of development of GERD to other known risk factors: obesity, smoking, alcohol, and others.”
But Nexplanon had some protective effect. It appears to reduce the risk of GERD in premenopausal women by 45% and 10%, depending on confounding variables.
“It reduced the risk patients will develop GERD, compared to what you would expect to see in patients not treated at all,” says Fass, director of the division of gastroenterology and hepatology and the head of the Esophageal and Swallowing Center at MetroHealth Medical Center in Cleveland. “That was a surprising finding.”
Based on the study’s findings, Fass says he would recommend that women use Nexplanon for contraception if they also have concerns about GERD. “We also did a study [about] postmenopausal women and found the same protective effect as in premenopausal women,” he says. “I would definitely use this information at this point and provide Nexplanon as an option.”
OB/GYNs could mention Nexplanon’s protective effects against GERD to a patient with reflux who is looking at contraception options, Fass notes.
Patients could consider a contraceptive implant if they want to improve their mood swings and emotional cycles associated with periods, including premenstrual dysphoric disorder (PMDD),5 says Sarah Pitts, MD, co-director of the adolescent/young adult LARC program in the division of adolescent/young adult medicine at Boston Children’s Hospital. Pitts also is professor of pediatrics at Harvard Medical School.
“For people who have that as a primary problem, any hormonal agent that suppresses ovulation can be helpful,” Pitts explains. “The implant could help to minimize some of those perimenstrual mood symptoms.”
Various contraceptive devices can alleviate symptoms of mood swings, premenstrual syndrome, and acne, says Stephanie Delkoski, DNP, APRN, WHNP-BC, a clinical assistant professor at the University of Minnesota School of Nursing.
“If someone was desiring to improve mood swings, I’d suggest something with estrogen in it, or they could consider Nexplanon and the [estradiol adhesive] contraceptive patch,” Delkoski says. IUDs are not a good option for management of PMDD or premenstrual mood swings, she notes.
Other contraceptives that could relieve premenstrual syndrome symptoms are hormonal patches, rings, Depo-Provera contraceptive injection, and combined birth control pills.
“What causes premenstrual symptoms is a decrease in estrogen that happens around the time of someone’s period, and that’s what causes those mood swings,” Delkoski explains. “Either preventing ovulation so they don’t have big peaks and valleys of hormones, or giving estrogen could decrease mood symptoms.” Providers could prescribe a mental health medication, such as a selective serotonin reuptake inhibitor, to manage a patient’s mood changes or use a combined hormonal contraceptive method, she adds.
One option would be to use the contraceptive continuously but be prepared for intermittent spotting. Or they could use the method for 21 days and withdraw it for seven days.
One birth control pill brand, Yaz, is approved by the FDA to treat PMDD as well as acne.6 Contraceptives with estrogen also can help patients manage acne.
“Commonly, what I see is people are really happy with their contraceptive pills as their primary management plan for acne, Delkoski says. “If they come off their pills, they notice their acne [usually] will come back. A combined hormonal pill, a combined hormonal patch, or a combined hormonal ring can help with acne. They’re really nice options, and some people ask for those contraceptive options if they have acne and want to use them as part of a management plan.”
Many different combination pills could work for this purpose. “There is a type of progesterone in the pills, and one type has anti-androgenic effects,” Delkoski explains. “We know that adult female acne is caused by male hormones in the body — androgens.”
The combined hormonal pill works against those androgens. “That antiandrogen is drospirenone, which is a type of progesterone that is found in some of the contraceptive pills, and it helps with acne because of the anti-androgenic properties,” Delkoski says. “The most effective option [in treating acne] are the drospirenone-containing contraceptive pills.” Another option for reducing acne symptoms is a combined hormonal ring that is inserted in the vagina. These options include the NuvaRing and the Annovera birth control ring, she notes.
The drawback for use of some of these methods is insurance coverage, which may not include the newest contraceptives, even if they are better options for alleviating some symptoms or conditions. For example, the NuvaRing is well covered by insurers, but the Annovera birth control ring is newer and more challenging to obtain insurance coverage, Delkoski notes.
REFERENCES
- Hatcher RA, Nelson AL, Trussell J, et al. Contraceptive Technology. 21st Edition. Ayer Company Publishers, Inc. 2018.
- Amini L, Kalhor M, Haghighi A, et al. Effect of oral contraceptive pills on rheumatoid arthritis disease activity in women: A randomized clinical trial. Med J Islam Repub Iran 2018;32:61.
- O’Brien K, Russell C, Fei YF, Rosen MW. Use of two levonorgestrel intrauterine devices in a patient with a uterus didelphys: A case report. J Pediatr Adolesc Gynecol 2022;35:718-721.
- Saleh S, Liu BD, Trujillo S, et al. The effect of combined oral contraceptives and Nexplanon on gastroesophageal reflux disease in premenopausal women: A nationwide database analysis. Neurogastroenterol Motil 2023;Feb 5:e14542. doi: 10.1111/nmo.14542. [Online ahead of print].
- Mayo Clinic. Premenstrual syndrome (PMS). Feb. 25, 2022.
- Phan R. Yaz (drospirenone and ethinyl estradiol) — oral. Verywell Health. Updated Feb. 8, 2023.
The noncontraceptive benefits of the levonorgestrel IUD and other hormonal contraceptives are much more than just reducing menstrual pain and bleeding. Hormonal contraceptives can help people treat acne, sickle cell disease, gastrointestinal issues, and uterine anomalies.
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