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Hormone Releasing Intrauterine Devices (IUDs)

Written on . Posted in Sexual & Reproductive Health.

What are hormone releasing IUDs?

Hormone releasing intrauterine devices (IUDs) are small plastic devices which are inserted into the uterus (womb) and are used to prevent pregnancy. They contain a hormone called levonorgestrel in the stem. Levonorgestrel is a type of progestogen. A very small amount of this hormone is released continuously over a period of time. There are two types of hormone releasing IUDs: the Mirena® and the Kyleena®. The Kyleena® is slightly smaller and releases a lower dose of hormone than the Mirena®.

How do they work?

The hormone releasing IUDs work mainly by preventing fertilisation. They do this by thickening the mucus in the cervix to prevent sperm penetration, interfering with sperm movement, and thinning the lining of the uterus. The Mirena® IUD can be also used to assist in the control of heavy menstrual bleeding and can be used as a part of menopause hormone therapy (MHT).

How effective are they?

The hormone releasing IUDs are over 99% effective.

How long do they last?

The Mirena® lasts up to 8 years when used for contraception. When the Mirena is used for other reasons (such as heavy menstrual bleeding or as part of menopause hormone therapy) then the time it is used for may be different, so please discuss this with your doctor.

The Kyleena® lasts for 5 years.

What are the advantages of hormone releasing IUDs?

  • They are highly effective contraceptives.
  • They do not require any day to day action.
  • They are long acting.
  • The effect is rapidly reversible after removal.
  • They are a very cost-effective method over time.
  • They can be used when breastfeeding. 
  • They decrease menstrual bleeding and pain. (Very light or no periods are common when using the Mirena®).

What are the disadvantages? 

  • They must be inserted and removed by a doctor.
  • As with any procedure there is always a small risk of complications.
  • The insertion procedure can be uncomfortable.
  • It is common to experience light bleeding and spotting for 3 to 6 months after insertion.
  • Your periods may be irregular and some occasional light spotting can continue longer term.
  • Occasionally there are factors in the shape of your uterus that prevent IUD insertion, and this may not be apparent until insertions attempted.

Who can use a hormone releasing IUD?

The hormone releasing IUDs are suitable if you are looking for a very effective, long-acting, reversible contraceptive method. It is suitable regardless of whether or not you have had children. As with most contraception, it is suitable for use when breastfeeding.

What are the possible problems which may occur with hormone releasing IUDs?

  • There is a small risk of pregnancy occurring with an IUD (less than 1 in 100). If pregnancy does occur there is a slightly increased risk of it occurring in the fallopian tube.
  • Infection: There is a small risk of infection at the time of insertion (about 1 in 500).
  • Expulsion: In about 5% of cases the uterus will expel the device. You need to check that the IUD is still in place by feeling for the IUD string after each period. If the string is not present this may indicate that the IUD has moved or been expelled.
  • Perforation: This is a rare event (approximately 2 in 1000 insertions) which occurs when the IUD passes through the wall of the uterus into the pelvic area. This will require surgery under a general anaesthetic to remove the IUD.
  • Some people report weight changes, reduced desire for sex, and mood changes, however, there is no scientific evidence to show that the hormone releasing IUDs cause these effects, other aspects of life may be contributing factors.

How is an IUD removed?

Removal of an IUD is done by a doctor. It is a relatively quick and straightforward procedure.

Who do I go to for IUD insertion?

IUDs are only inserted by doctors who have done IUD training. The clinic at SHFPACT provides IUD insertion services. Some GPs and most gynaecologists also provide this service.

What happens in the IUD insertion process at SHFPACT?

Initial consultation appointment

  • You will need an initial consultation with a doctor to see if a hormone releasing IUD is a suitable option for you.
  • At your first appointment the doctor will discuss the IUD and explain the insertion procedure. You may also need a vaginal examination at this time.
  • It is best to ask any questions or raise concerns about the procedure at this point.
  • A prescription for the IUD will be given to you. You will need to go to the chemist and have this filled, then you need to bring the IUD with you at the time of your insertion appointment.
  • Following your initial consultation, you will need to make an appointment for the insertion.
  • The doctor will discuss with you the best timing of your insertion appointment, taking into consideration your menstrual cycle, and contraceptive use.

Insertion appointment

  • You will be at the clinic from 1 to 1 ½ hours. If parking, please ensure you leave enough time.
  • The doctor will talk with you about the procedure and make sure the process is clear.
  • You will be asked to go behind the screen, take your clothes off from the waist down, and lay on the examination table. You will be given a privacy sheet.
  • The doctor will do a quick vaginal examination, then a speculum will be inserted into the vagina. The IUD will then be inserted using a special device. The IUD strings are trimmed, and the speculum is then removed.
  • An uncomplicated insertion procedure takes about 15 mins. A nurse will also be with you throughout the procedure.
  • You will be asked to stay at the clinic for a minimum of 20 minutes following the procedure. If you are not feeling well, you will be asked to remain until the staff caring for you think that you are well enough to leave.

Will the IUD insertion be uncomfortable?

  • The IUD insertion procedure can be uncomfortable for some people and can be quite painful for a small number of people(15%). The pain is similar to bad period pain.
  • It is recommended that you take oral pain relief (two paracetamol and two ibuprofen) an hour before your appointment.
  • While we offer local anaesthetic to numb the cervix at the time of insertion and can provide an anti-anxiety medication beforehand if needed, we are unable to provide sedation. If you would like to have your IUD insertion under sedation there are clinics that do provide this service, please ask our staff about this option.
  • A small number of people may feel faint or nauseous following the procedure. If this happens you may be asked to remain at the clinic a little longer.
  • If you are concerned about possible discomfort please discuss this with the doctor at your initial appointment.

After your IUD insertion

  • You will be encouraged to arrange to be driven home and rest up after the procedure for the remainder of the day. You may need to organise care for children, time off work, etc.
  • You will probably be fine to return to normal activities the following day.
  • There may be cramping and/or bleeding in the first few days afterwards.
  • We advise that nothing should enter the vagina for 72 hours afterwards to reduce infection risk– no tampons, no sex, no water (showering is ok).
  • There is no further appointment needed unless you are experiencing problems. Your doctor will discuss this with you at the time of your insertion. 

You should contact the doctor if:

  • You suspect you might be pregnant.
  • You experience excessive pelvic pain or tenderness, fever or chills, offensive discharge, or deep pain with intercourse.
  • You can’t feel the string or can feel the plastic of the device.

References: Contraception: An Australian clinical practice handbook 4th Edition. Contraception: Intrauterine Devices/ Family Planning QLD Hormone-Releasing IUD (Mirena) Fact sheet, Family Planning NSW. Guillebaud, J & MacGregor, A. 2013. Contraception: Your questions answered. 6th Edition. Churchill Livingstone.TGA tga.gov.au

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Contraception, IUD

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