Hormone Releasing Intrauterine Device (IUD)

WHAT ARE HORMONE RELEASING IUDS?

Hormone releasing IUDs are small plastic devices which are inserted into the uterus (womb) by a doctor 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 5 years. 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?

Both the Mirena® and the Kyleena® last 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.
IUDs provide no protection against sexually transmissible infections (STIs).

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.

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

There will be an initial consultation with a doctor to determine if a hormone releasing IUD is a suitable option for you. The method and insertion procedure will be explained, a Cervical Screening Test will be offered if it is due, and swabs may also be collected if required.
It is best to ask any questions or raise concerns at this point.
A prescription for the IUD will then be given to you. You will need to go the chemist and have this filled, then you need to bring the IUD with you to the clinic on the day of insertion.
Following your initial consultation, you will need to make an appointment for the insertion.
A hormone-releasing IUD needs to be inserted on day 1 to 7 of your menstrual cycle (day one being the first day of your period) or at any time if you are currently using the oral contraceptive pill or another reliable method of contraception.

INSERTION APPOINTMENT

You will be encouraged to arrange to be driven home and to rest up after the procedure and for the remainder of the day (you may need to organise care for young children, time off work etc.). You will probably be fine to return to normal activities the following day.
You will be at the clinic for an hour to an hour and a half. If parking please ensure you have left enough time.
The doctor will run through the procedure and make sure the process is clear.
An uncomplicated insertion procedure takes about 15 mins. 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 feel that you are well enough to leave.

AFTER YOUR IUD INSERTION

There may be cramping and/or bleeding in the first few days afterwards.
Spotting may occur for up to 3 to 6 months after insertion.
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.

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Tags: Contraception, IUD