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Intrauterine devices (IUDs) continue to be one of the most effective and reliable reversible contraceptive methods, according to experts, even as new research suggests certain hormonal IUDs may slightly increase breast cancer risk. For many, the benefits of IUDs far outweigh the risks, say specialists at Northeastern University.
“I think it’s still a very effective and very safe method overall,” said Kathy Simmonds, a clinical professor at Northeastern’s School of Nursing in the Bouvé College of Health Sciences. Simmonds highlights that while a recent Danish study found a 40% higher chance of breast cancer in women using levonorgestrel-based IUDs, the absolute risk remains low.
The Danish study tracked 78,595 women using levonorgestrel IUDs and 78,595 women who did not use these devices. While the increase in breast cancer risk may sound concerning, experts caution that it translates to an actual risk increase from 1 in 204 women to 1.4 in 204 in the United States, underscoring the importance of perspective.
“The essential piece is people who have been using birth control pills over the last three decades have already been living with that kind of risk-taking,” Simmonds explained. “We don’t think of birth control pills as wildly dangerous. It’s not causing a lot of cases of breast cancer, but you should be aware of that.”
Elyse Watkins, a women’s health expert and associate clinical professor at Northeastern, noted that certain factors—such as whether participants had hormonally driven cancers or genetic predispositions—were not accounted for in the data. “It’s not a randomized control trial. They’re looking at retrospective data,” Watkins said. “There are problems with that kind of data and certain factors weren’t controlled for.”
Both Watkins and Simmonds emphasized that nearly all medications carry some risk, and the potential for hormonal birth control to influence cancer risk has long been documented. However, hormonal dosages in birth control have decreased over the years, and most doses are now considered relatively low.
“One of the questions you always need to ask is, ‘Is this going to potentially increase my risk?’” Watkins added. “Any kind of hormone can increase risk. But there are benefits to using the IUD. It’s long-acting, it’s reversible, and it ultimately comes down to informed, shared decision-making between the patient and their healthcare provider.”
Hormonal birth control has even been associated with a reduced risk of certain gynecological cancers, such as ovarian and endometrial cancers. Ultimately, the decision should reflect a patient’s individual health profile, especially if there is a personal or family history of breast cancer. Other risk factors, such as alcohol and tobacco use, are also important to consider.
For patients who want to avoid the potential risks of hormonal IUDs, Simmonds points to non-hormonal options like the copper IUD, which is highly effective but does not contain hormones. Patients can also explore barrier methods like condoms or discuss alternative options with their healthcare provider.
Experts also stress the importance of considering the risk of an unintended pregnancy when evaluating contraceptive risks. “It’s important to contextualize any contraceptive risk in the context of pregnancy,” Simmonds said. “Pregnancy carries risks, often more than many contraceptive methods. Understanding what risks you are willing to take to prevent pregnancy is critical.”
The new research underscores the need for patients and healthcare providers to engage in open, personalized conversations about contraception, weighing individual health factors and lifestyle to make informed choices about birth control.
