Hormonal (progestin) intrauterine devices

What is an intrauterine device (IUD)?

• An IUD is a type of birth control.
• It is a small, T-shaped device that your provider puts in your uterus by going through your vagina and cervix.
• These are made of flexible plastic and have 2 thin plastic strings that hang out of the cervix.
• They may be called LARC devices, a long-acting reversible contraceptive method of birth control.
• Many women who use progestin-releasing IUDs have lighter, less painful periods than they had before getting the IUD.
• Some women stop getting a period at all. This is not harmful and does not need to be treated.
• Your normal periods and fertility come back when the IUD is taken out.

There are 3 hormonal IUDs, called Mirena, Skyla/Kyleena, and Liletta.

Your provider can help you choose the right IUD for you.

A progestin IUD might be a good choice if you:

• Have heavy, painful periods. Progestin IUDs can make your periods lighter and less painful.
• Want birth control for at least 1 year. It will last up to 5 years.

IUD benefits

• IUDs are very safe and effective. Less than 1 in every 100 women who use these devices get pregnant during the first year of using them.
• You do not need to take birth control daily.
• Few side effects. Most of the hormone stays in the uterus.
• It does not have estrogen.
• Take the IUD out when you want, if you want to get pregnant.
• If you use an IUD for many years, it can cost less over time than many other types of birth control.
• That is because there are no costs after you have it put in.
• For women with heavy periods, bleeding may be reduced. Most people have an 80% reduction in bleeding as early as 3 months and a 90% reduction at 6 months.

Downsides of an IUD

• Very rarely the IUD will come out by itself (expulsion).
  • You will need a new IUD if this happens.
  • Call your provider if you are worried that it has come out.
• The first cost is higher than the cost of other methods. Many IUDs are covered by insurance.
• IUDs do not prevent sexually transmitted infections (STIs).
• Use condoms with new partners.
• Only a provider can put in or remove an IUD.
• IUDs do not prevent ovarian cysts. Ovarian cysts can disappear on their own, but they can be painful.

You should not use a hormonal IUD if you:

• Are or might be pregnant.
• Have a pelvic infection, called pelvic inflammatory disease (PID), or get infections easily.
• Have certain types of cancer, such as breast cancer that is sensitive to progestin.

If you become pregnant while using an IUD

While very unlikely, you can get pregnant with IUDs. If you miss any periods and feel like you may be pregnant, take a urine pregnancy test. If you have a positive pregnancy test, please call your doctor at once. They will need to see you right away.

After your IUD is put in, you may experience:

• Some temporary pinching or period-like cramping
• Bleeding:
  • Can last for a few days
  • Can be irregular for a few weeks, may last up to 3 to 6 months
• Dizziness
• Nausea
• Feeling faint
• Women who have not had a baby often feel more discomfort than women who have had a baby, but each person is different.
• Lighter periods

Call your health care provider if:

• Heavy menstrual bleeding
• Severe abdominal pain
• Temperature of 100.4° F (or 38° C)
• IUD falls out

Now that you have had your IUD put in, you may notice some changes to your period. Here is what you may be able to expect.

In the first 1 to 3 months, as your body adjusts, you may have:

• Irregular bleeding, anywhere from random spotting to bleeding like a period
• For cramping you may take:
  • Take Ibuprofen 600 mg every 6 hours and/or acetaminophen (Tylenol) 650 mg every 4 to 6 hours

Keep your follow up appointment about 6 weeks after insertion.

In the first 3 to 6 months:

• You may have frequent spotting or light bleeding that will get better.
• Your period may be irregular.
• Few women may find that their periods are heavier than normal. Call your provider if your period stays heavier than normal for a while.

Most side-effects get better after 3 to 6 months. The longer you leave the IUD in place, the more likely any side-effects will lessen or go away, such as spotting or irregular bleeding.

After your body has adjusted to your IUD

• Your period may be shorter and lighter than before.
• Your period may stay irregular.
• Your period may stop.

You may have these effects for as long as you have your IUD in place. Your period will go back to normal once your IUD is removed.

Checking your strings

Some providers suggest people check their IUD strings each month. You can check your strings if you want to, but it is not needed.

If you do check your strings and are not able to feel them when you used to be able to feel them:

• Use condoms for back-up.
• Make an appointment for an IUD string check.
• Most of the time, they are there. They can be tucked up where you cannot find them.