Unfortunately, we don’t have any scientific studies testing whether the hormonal UID is helpful for treating PMDD. However, the science we do have indicates that the hormonal IUD does not consistently prevent ovulation. Since we know that ovulation is what triggers PMDD symptoms, the hormonal IUD doesn’t make much sense as a PMDD treatment.
There are also other reasons to be careful with using the mirena IUD in women with a documented emotional hormone sensitivity. A handful of studies have presented concerning evidence that the progestin in hormonal IUDs probably does not stay as “local” as we once thought, meaning that women who have an adverse reaction to progestin-containing oral contraceptive pills might also have a negative reaction to hormonal IUD. The studies have found that hormonal IUDs alter biological reactions (for example, cortisol, heart rate) during stress, whereas a copper IUD does not. Anecdotally, many women with PMDD say that they cannot tolerate the hormonal IUD because it makes their emotional symptoms much worse.
Therefore, the hormonal IUD does NOT seem like a good place to start for PMDD treatment. Instead, the best scientific evidence indicates that it’s best to start with SSRIs for treatment of PMDD, since 60% of women improve with this treatment.
Updated 22 December, 2018 by Tory Eisenlohr-Moul, PhD