Hormonal and copper intrauterine devices and hair loss: a single-center retrospective study

Introduction Hormonal intrauterine devices (H-IUD) are contraceptives designed to exert predominantly local effects through the intrauterine release of levonorgestrel, a progestin that inhibits endometrial growth. Methods We conducted a single-center retrospective chart review comparing adult patients (>18 years) using hormonal IUDs with patients using copper IUDs as controls. Cohorts were propensity score–matched by age, race, and ethnicity. Diagnoses of TE (ICD-10 L65) and AGA (ICD-10 L64) were assessed. Comparative analyses between groups were performed using Fisher exact tests, with P < 0.05 considered statistically significant. For each cohort, we assessed alopecia subtype and temporal relationship to IUD placement (before versus after insertion), relevant comorbidities (including polyendocrine metabolic ovarian syndrome, thyroid disease, hyperprolactinemia, and uterine fibroids), and laboratory abnormalities at diagnosis (low ferritin levels and high testosterone levels). Results We identified 47 patients with H-IUDs (mean age, 40.6 ± 9.8 years) and 21 patients with Cu-IUDs (mean age, 42.0 ± 10.5 years). The occurrence of AGA was significantly higher in the H-IUD group than in the Cu-IUD group at 44.7% compared to 33.3% (P = 0.01), whereas no significant difference in TE prevalence was observed between groups (P = 0.89). All patients in the H-IUD group developed either AGA or TE after IUD insertion. In contrast, in the Cu-IUD control group, a significant association was observed between alopecia subtype and temporal relationship to IUD placement, with AGA more commonly preceding insertion and TE occurring more frequently after insertion (P = 0.043). Low ferritin levels at the time of diagnosis were identified in 5 patients in the Cu-IUD group with TE. In the H-IUD group, low ferritin levels were observed in 9 patients, including 6 with TE and 3 with AGA. Conclusion Our cohort study finds that H-IUD, unlike Cu-IUDs, was temporally associated with the development of AGA and TE. Although causality cannot be established, clinicians should consider H-IUDs as a potential contributing factor in patients presenting with new-onset hair loss after insertion.