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Hormonal (progestin) intrauterine devices

Patient Education
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What is an intrauterine device (IUD)?

  • An IUD is a type of birth control. 
  • It is a small, T-shaped device. Your provider puts in your uterus by going through your vagina and cervix. 
  • These are made of flexible plastic. They have 2 thin strings that hang out of the cervix.  
  • They may be called LARC devices. This is a long-acting reversible contraceptive method of birth control. 
  • Many people who use progestin-releasing IUDs have lighter, less painful periods than they had before getting the IUD. 
    • Some people stop getting a period. 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®.

Hormonal IUDs
Name Levonorgestrel amount Lasts for
Liletta® 52 mg 8 years
Mirena® 52 mg 8 years
Kyleena® 19.5 mg 5 years

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

Liletta® and Mirena® are approved longer for birth control. If you have problems with irregular bleeding, it can be replaced before to 6 to 7 years though. Talk with your provider about your bleeding.

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 8 years.

  • IUDs are very safe and effective. Less than 1 in every 100 people get pregnant during the first year using them.
  • You do not need to take birth control daily.
  • Few side effects. Nearly all the hormone stays in the uterus. 
  • It does not have estrogen.
  • Take the IUD out:
    • When you want
    • If you want to get pregnant (Fertility returns right away after the IUD is removed.)
    • If you do not like the IUD
  • If you use an IUD for many years, it can cost less than many other types of birth control over time. This is because there are no costs after it is put in.
  • For people with heavy periods, bleeding may lessen.  Most people have an 80% reduction in bleeding in the first 3 months. Most people have a 90% reduction at 6 months.
     

  • 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 it has come out. 
  • The first cost is higher than the cost of other methods. Many IUDs are covered by insurance. 
  • Does not prevent sexually transmitted infections (STI’s).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.

  • 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.

While very unlikely, you can get pregnant with IUDs. If you miss any periods and feel you may be pregnant, take a urine pregnancy test. If you have a positive pregnancy test, call the clinic right away. Your care team needs to see you right away.

  • Some temporary pinching or period-like cramping. 
  • Bleeding:
    • Can last for a few days.
    • Can be irregular for a few weeks. It may last 3 to 6 months.
  • Dizziness.
  • Nausea.
  • Feeling faint. 
  • People who have not had a baby often feel more discomfort than people who have had a baby. Each person is different though. 
  • Lighter periods (see below).

  • Heavy menstrual bleeding
  • Severe abdominal pain
  • Fever of 100.4° F (or 38.0° C)
  • IUD falls out

After the IUD is put in, it takes a few days to start working. Please use a backup method of birth control for at least 7 days.

Now that you have had your IUD, you may notice 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. It can be random spotting to bleeding like a period.
  • Cramping. You may 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. This will get better.
  • Your period may be irregular.
  • Few people may find 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 side-effects 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. Your period will go back to normal when your IUD is removed. 

Checking your strings:

  • Some providers suggest checking the IUD strings each month. You can check your strings if you want, but it is not needed.  
  • If you do check your strings and are cannot 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. 

IUDs do not protect against sexually transmitted infections (STIs) or human immunodeficiency virus (HIV). Use a condom.