I'm a 35-year-old woman living in Scandinavia and I wonder if I should have my Mirena IUD removed. In 1995, six months after the IUD was inserted, I began to experience dryness and fungal infections. The infections go away when treated, but seem to reappear right after sex and after longer sex-free periods. I have to be very sexually excited in order to achieve acceptable vaginal lubrication. Is vaginal dryness a common side effect of IUD use?

As with all progesterone-only methods, vaginal dryness can be a significant side effect, especially as estrogen levels begin to fall in women of your age. The use of a lubricant (AstroGlide, KY gel or a newer product called Slippery Stuff) is often necessary.

Adding a small amount of oral estrogen every day may also be a good idea. Fungal infections could be related to the vaginal dryness, and the estrogen may help with this. Some women use an applicator of anti-yeast cream after intercourse on a routine basis.

The decrease in menstrual flow, even progressing to no menses at all, is a good side effect of the levonorgestrel IUD, so this is to be expected.

Talk to your care provider about the addition of some estrogen, which can promote bone density and cardiovascular health, too.