Considering a hormonal IUD?
What is a hormonal IUD?
A hormonal IUD is a small device that is inserted into the uterus (womb) by a trained doctor or nurse. It releases the hormone progesterone into the cavity of the uterus. The hormonal IUD is used as a form of birth control (contraception) but can also an effective treatment for heavy periods. In addition, it’s sometimes it is used as the progesterone component of HRT, during menopause.
Because it’s a long-term option, women often have quite a few questions before they have it inserted. Here are some of the most common issues that doctors get asked about.
How is the hormonal IUD inserted? And does it hurt?
The doctor or nurse will put a speculum in the vagina (like when you’re having a cervical smear). Antiseptic solution is applied, and then the device is passed into the uterus through the cervix, using a special tube. The IUD has threads which pass from the uterus and sit in the vagina- these are usually cut to a length of about 2cm from the opening of the cervix. There can be some discomfort as the IUD is inserted, but it’s usually minor. Some women get cramps just after insertion, or less commonly may feel light-headed or faint. These symptoms usually settle down quite quickly.
Do you still get your period with the hormonal IUD?
About 16% of women with an IUD get no periods at all. About 50% will get a very light monthly bleed or spotting, while others get a “normal” period or irregular bleeding. Studies have shown that women who get a hormonal IUD to treat heavy periods tend to get around 90% reduction in blood loss.
Can you get pregnant with a hormonal IUD?
It’s very rare for a woman to become pregnant if she has an IUD in place- it’s one of the best forms of contraception. If a thousand women use a hormonal IUD for a year, only 1 or 2 will become pregnant- this makes it as effective as having tubal ligation (female sterilisation). However, if a woman does become pregnant with an IUD, there’s a higher chance of that pregnancy being ectopic (developing outside the uterus).
Can a hormonal IUD fall out?
Yes, sometimes a hormonal IUD can fall out, but it’s very unlikely. If it has started to move out of place, you may feel more of the threads in your vagina, or your partner may feel the threads or even part of the device during sex. If it’s fallen out completely, you may not be able to feel the threads at all (though this might just be because the threads are short). You may also notice a change or increase in your vaginal bleeding. If you had stopped getting periods since getting the hormonal IUD, you may start to get regular periods again. Pelvic cramps can also occur. If you think your hormonal IUD has moved or fallen out, you should see a doctor. They can check if the threads are visible and may send you for an ultrasound scan if there’s any doubt.
How long does a hormonal IUD last?
A hormonal IUD will continue to work for several years after it’s inserted- there are different IUDs available, depending on the brand this may be between 5 and 7 years. At this point it should be replaced if ongoing contraception is required.
Can you feel an IUD during sex?
You and your partner should be completely unaware of the IUD during sex. If this is not the case, and one or both of you feel discomfort, you should get your doctor to have a look and make sure it’s in the correct location. Sometimes the threads may be too long and simply need to be trimmed.
How can you check your hormonal IUD is in place?
It’s recommended to check your hormonal IUD each month, after your period. You do this by inserting a finger into the vagina and feeling for the threads. Sometimes it can be hard to feel the threads because they’re curled up or are sticking to the wall of the vagina. If in doubt, your GP can check for you.
Does the hormonal IUD make you gain weight?
So far, studies show that women who have a hormonal IUD are not more likely to gain weight. While some women who have an IUD may report weight gain, this is probably unrelated and caused by some other issue.
What are the side effects of the hormonal IUD?
Though the hormonal IUD is very well tolerated by most women, like any medication it can cause unwanted side effects. Side effects of the hormonal IUD include:
- Unscheduled or irregular vaginal bleeding
- Heavy bleeding or heavy periods
- Light periods or no periods (though many women consider this an advantage!)
- Headaches
- Pelvic or tummy pain
- Changes in vaginal discharge
- Irritation or inflammation of the vagina and vulva (vulvovaginitis)
- Hormonal side effects are uncommon because only very tiny amounts of progesterone are absorbed into the body
There are other less frequent side effects, which are listed on the drug information leaflet that comes with the pack.
How is the hormonal IUD removed?
The process of removing a hormonal IUD is usually very quick and straight-forward. The doctor or nurse will use forceps to pull firmly on the threads, and it will usually come out immediately. There may be a moment of discomfort just as it passes through the cervix.
If the threads are not visible or the hormonal IUD does not come out when the threads are pulled, you may need to see a specialist to get it removed.
Anything else you should know?
If you’ve more questions about the hormonal IUD, how it works or the side effects, speak to your GP or gynaecologist.
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