Hormonal intrauterine devices (IUDs) are a type of birth control method to prevent pregnancy. They can work for up to 7 years, depending on the brand that doctors recommend. Some people may also find them effective in reducing menstrual cramps and flow.
This article describes hormonal IUDs in more detail, some advantages and disadvantages, and how they differ from a nonhormonal device. It also looks at the four brands available and what to expect during insertion.
A hormonal IUD is plastic and T-shaped. It releases the hormone progestin into a person’s body, helping prevent pregnancy for several years.
According to the advocacy group Planned Parenthood, hormonal IUDs have two functions. Firstly, they can thicken the cervical mucus and reduce the lining of the uterus, so an embryo is unable to implant. Secondly, some IUDs prevent ovulation, so the body does not release eggs for fertilization.
Other IUDs work differently. For example, the Mirena IUD does not shut down ovulation and hormone production immediately. A
If individuals plan to become pregnant, a medical professional can remove an IUD at any time.
Those who live in the United States can find four brands of the hormonal IUD:
Nonhormonal IUDs use copper instead of hormones to prevent unintentional pregnancy, as copper is toxic to sperm.
Planned Parenthood states that copper IUDs can also act as emergency contraception. If a person has a copper IUD inserted within 120 hours, or 5 days, of having sex without contraceptive methods, the IUD is more than 99% effective against pregnancy.
However, IUDs do not protect against sexually transmitted infections (STIs). A person should also use barrier methods, such as an external condom, to reduce the risk of transmitting or contracting infections.
There are differences between hormonal and nonhormonal IUDs:
Hormonal IUDs
These release hormones into the body at regular intervals to reduce a person’s chance of becoming pregnant. They also stop the ovaries from releasing eggs and prevent sperm from attaching to the uterine lining.
Nonhormonal IUDs
These contain copper that is toxic to sperm, and they do not allow a fertilized egg to implant in the uterus.
A
During an IUD insertion appointment:
- The doctor performs a pelvic exam to determine the position of the uterus.
- They open the vagina and clean the cervix.
- They then use a device that helps them measure the length and direction of the person’s cervical canal and uterus.
- Finally, they place the IUD inside the uterus and cut the ends of the strings, so they do not bother individuals during sexual activity.
Learn more about IUD insertion.
Removal
The Center for Young Women’s Health (CYWH) explains that IUD removal depends on the brand that a person uses. However, a doctor can remove the device at any time — they can even insert a new IUD on the same day.
Alternatively, people who wish to remove their IUD but still reduce the chances of getting pregnant may consider using a condom.
The American College of Obstetricians and Gynecologists (ACOG) says that people who get a hormonal IUD may experience side effects, including frequent spotting, more bleeding days, and heavier menstrual flow during the first month.
Menstrual flow, length, and pain can decrease over time, while some people may stop menstruating altogether.
Other side effects of hormonal IUDs may include:
- headaches
- nausea
- breast tenderness
- mood changes
The ACOG explains that people rarely experience complications from an IUD, but these mainly occur during or after their insertion appointment.
Some of these difficulties include:
- Expulsion: This occurs when an IUD dislodges and may fall out. It is more common in young adults and people with heavy bleeding. Learn more about IUD expulsion.
- Pelvic inflammatory disease: This can occur mostly in those who have an undiagnosed STI and receive an IUD. Therefore, a person may benefit from taking an STI test before insertion.
- Pregnancy: Doctors should remove an IUD if an individual becomes pregnant and would like to continue with their pregnancy. In rare instances, not removing an IUD could lead to an ectopic pregnancy. Learn more about pregnancy and IUDs.
Health experts warn that hormonal IUDs may not be the best birth control method for individuals who:
- have a pelvic infection
- have severe liver disease
- have received breast cancer treatment
- have an atypical uterus shape
Doctors can provide a prescription for people who would like a hormonal IUD.
Under the Affordable Care Act, most health insurers must provide coverage for Food and Drug Administration (FDA)-approved birth control methods, including hormonal IUDs, with no copayment, coinsurance, or deductible applied, providing a person visits an in-network healthcare professional.
If an individual must pay for their IUD, they can expect to pay around $1,100. They also need to consider other fees, such as medical exams and follow-up visits.
Some questions a person may wish to ask before booking an appointment to get an IUD may include:
- Is a hormonal or nonhormonal IUD right for me?
- How painful is inserting or removing an IUD?
- Do any health conditions affect which form of birth control is right for me?
- How long is an IUD effective at preventing unintentional pregnancy?
- How may an IUD affect my periods?
- What are the potential side effects of an IUD?
- When will I need to remove the IUD?
- Can I remove the IUD early?
- What happens if I have an IUD and become pregnant?
Healthcare professionals may recommend certain steps a person should take before arriving at an appointment for an IUD insertion. People should always follow their healthcare professional’s instructions.
On the day of an appointment to insert an IUD, a person should ensure that they have eaten. Planned Parenthood states that this can reduce the chances of a person fainting during the insertion.
People may also wish to take some over-the-counter pain relief before their appointment. If a person is concerned about the pain of insertion, they should contact the clinic performing the procedure and ask if they offer further pain medication.
There are several advantages and disadvantages of hormonal IUDs.
Pros
- The procedure is reversible.
- The devices have no age requirement.
- A person may have shorter or less painful periods.
- They require fewer visits to the doctor.
- They may relieve some endometriosis symptoms.
- They may be ideal for those who forget to take birth control pills.
Cons
- There may be some pain or discomfort during insertion.
- A person may experience irregular bleeding or spotting during the first few months.
- They may sometimes cause ovarian cysts.
- There may be possible complications if a person becomes pregnant while the IUD is still in place.
- They offer no protection from STIs.
Below, we look at some of the questions that people frequently ask about hormonal IUDs.
Do hormonal IUDs cause weight gain?
A
Learn more about IUDs and weight gain.
Can you feel the IUD during sexual intercourse?
The CYWH states that individuals should not feel their IUD during intercourse. If they do, they should contact their doctor, as it may mean that the device has become dislodged. Sexual partners may also feel an IUD’s strings, but these should not cause pain.
How do I know that the IUD is in its place?
A person can insert their fingers in their vagina to check if they can feel the IUD’s strings. If they do not feel the strings but intend to have sex, they should consider other birth control methods, such as condoms, to prevent pregnancy.
However, sometimes the strings can curl up, so the individual may not be able to feel them.
Learn more about the common reasons why the IUD strings may appear to be missing.
Do IUDs provide STI protection?
The United Kingdom’s National Health Service (NHS) states that IUDs do not protect individuals from STIs.
Those who believe they have an STI or wish to limit the spread of infections can also consider using a condom.
How effective are IUDs?
Hormonal IUDs are more than 99% effective for up to 7 years, while nonhormonal IUDs can be effective for up to 12 years. This means that fewer than 1 in 100 women may become pregnant during the first year of IUD use.
Does getting a hormonal IUD hurt?
The advocacy group Planned Parenthood explains that some individuals may experience cramping during IUD insertion, which can last for a few minutes.
Doctors may recommend taking pain medications before the appointment, and they may also inject a local numbing drug around the person’s cervix.
There are four brands of hormonal IUDs available in the U.S.: Mirena, Kyleena, Liletta, and Skyla.
Hormonal IUDs can prevent pregnancy for up to 7 years, and a person can request a doctor to remove it at any time.
However, they do not protect against STIs, so doctors may recommend barrier methods, such as condoms, to limit the spread of infections.