Information Sheet

Hormonal IUD

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The hormonal IUD (intrauterine device) is a small T-shaped plastic device. It is inserted into the uterus (womb) by a trained doctor and can stay in place for up to five years. The hormonal IUD differs from the copper IUD by slowly releasing a progestogen hormone directly into the uterus to prevent pregnancy. There are two types of hormonal IUD available in Australia which contain different amounts of hormone but are otherwise very similar.

How does it work?

The hormonal IUD stops a pregnancy by thickening the mucus at the cervix (neck of the uterus/womb) so that sperm cannot get through to meet an egg. It also makes it difficult for the egg to stick to the lining of the uterus to start a pregnancy. It may also stop the ovaries from releasing an egg in some users.

How effective is it?

The hormonal IUD is 99.8% effective – that is, if 1,000 people used it for a year, two of them might become pregnant. It is slightly more effective than the copper IUD, and much more reliable than the contraceptive pill (also known as “the Pill) as there is no need for you to remember to take a pill every day. No contraceptive is 100% effective.

Will it work immediately?

If a hormonal IUD is put in within the first 7 days of the menstrual cycle (where day one is the first day of your period), or within the first 5 days after an abortion or miscarriage, then it is effective immediately. If put in after this time another type of contraception (such as condoms) should be used for the next seven days to avoid unplanned pregnancy. Your doctor will discuss with you the best time to have a hormonal IUD inserted, as they firstly need to check you are not already pregnant. It can also be inserted immediately after an abortion.

How long will it last?

The hormonal IUD is a good method for those who want a long term, reversible, convenient contraceptive, as it lasts up to five years (although it can be removed at any time). It is very important to have it removed and/or replaced after this time. You should keep a record of the date that replacement is due and arrange for replacement no later than this date.

What are the side effects?

The hormonal IUD can cause irregular spotting (light bleeding) in between periods or unpredictable bleeding, during the first few months of use. This almost always settles down.

Most people using a hormonal IUD have less bleeding and fewer bleeding days, and less painful periods. It is particularly helpful for those who normally have heavy or long periods or get heavy or long periods when using a copper IUD.

Around 1 in 5 people will have no periods at all while using a hormonal IUD. This is more likely with the higher dose hormonal IUD and is not harmful or anything to worry about.

Other side effects are uncommon, but may include, acne, headaches, moodiness and weight gain. In most cases these are usually mild and often settle down after the first few months.

If you are worried about any symptoms you think may be caused by your hormonal IUD, contact us on 1300 888 022 or your doctor.

What if I want to stop using the hormonal IUD? Is it reversible?

The hormonal IUD is easily removed by a doctor and there is no delay in being able to get pregnant. It is important that you start using another form of contraception immediately if you don’t want to become pregnant.

Who should not use a hormonal IUD?

Before having a hormonal IUD inserted, you need to let your doctor know if you:

• May be pregnant
• Have had a history of any unusual vaginal bleeding
• Have or have had cancer of the breast or reproductive tract
• Have fibroids or other abnormalities in the uterus
• Have an existing Sexually Transmitted Infection (STI) or pelvic infection
• Have had an abnormal Cervical Screening Test and are waiting for treatment
• Have had previous problems using an IUD.

Your doctor will talk with you about your contraceptive options and help you decide whether a hormonal IUD is the best method for you.

What if I am breastfeeding?

The hormonal IUD is a safe method of contraception if you are breastfeeding and can be inserted 4 weeks after birth.

Will my partner or I feel the device during sex?

Neither you nor your partner should feel the IUD during sex. If you experience any pain or discomfort, you should have the position of the IUD checked by your doctor.

What else should I consider?

If you experience pain during sex, continuous lower tummy pain, fever and/or unusual and persistent vaginal discharge, you may have an infection. Please see your doctor if this occurs. Infections are uncommon (around 1 in 300).
An IUD can sometimes fall out, with this happening in around 1 in 20 users (usually in the first year of use) and is more common in those who have very heavy periods.

It is very unlikely that you will get pregnant with a hormonal IUD. If you do get pregnant, there is a higher chance of an ectopic pregnancy. This means that the pregnancy forms in the fallopian tubes (thin tubes that transport the egg from the ovary to the uterus) rather than in the uterus. If you suspect you may be pregnant, it is important to seek medical attention as soon as possible.

Although rare (1 in 500), there is a possibility that an IUD may cause a small hole in the uterus (womb) at the time of insertion. This risk is increased if you are breastfeeding or have recently had a baby. This may require surgery under general anaesthetic to remove the IUD.

Hormonal IUDs offer no protection against STIs.

How is an IUD inserted?

A medical instrument called a speculum is placed into your vagina to view the cervix (the same process as having a Cervical Screening Test).

A thin, flexible plastic tube is then used to place the IUD into the uterus. The tube is then removed and threads cut. In some cases, a small amount of local anaesthetic may be used to numb the cervix. The insertion procedure usually only takes a few minutes.

Some people may find getting an IUD put in uncomfortable or feel slightly faint. You may feel strong cramps. This is normal and should pass within a few minutes. You can take a mild pain killer before or after the insertion if you prefer.

To avoid infection, do not put anything into the vagina for 48 hours following the IUD being put in. Avoid sex and use pads instead of tampons for two days after the insertion.

A routine check-up is not usually necessary, if you don’t have any concerning symptoms.

How do I check the IUD hasn’t moved?

The IUD has two fine nylon strings attached to it which come out through the cervix. The strings don’t hang out of the vagina, but if you feel high up inside your vagina you can feel for the strings to check the IUD is correctly in place. As the strings are very fine they usually stick together, so you will probably feel only “one” string.

First, wash your hands and get into a squatting position (as you would to insert a tampon) so you can put one or two fingers deep into your vagina. By reaching right up inside the vagina you will feel the cervix at the far end (which feels like the tip of your nose). You should be able to feel the strings coming through the cervix. Checking for the strings may sometimes be difficult.

If you cannot feel the strings at any time or if you feel anything unusual such as a hard piece of plastic, you should contact your doctor and use an alternative method of contraception until the placement of the device has been checked. You may require an ultrasound to check the position of the device.

An increase in the amount of bleeding during your period may also indicate that the device may have moved or has fallen out.

You should check for strings once a month after each period, as the device won’t be effective if not correctly placed.

How is the IUD removed?

Always see a doctor for removal of an IUD and never try to remove it yourself! Taking out an IUD is usually easier and less uncomfortable than putting one in. It usually only takes a few minutes. The hormonal IUD can be removed at any time, but if you don’t want to get pregnant you should avoid unprotected sex in the 7 days before removal.

Can I get a new one inserted when I have the old one removed?

Yes, if you want ongoing, reliable contraception a new IUD can be put in at the same time the other one is removed.

Where can I get it?

A doctor’s prescription is required to obtain the hormonal IUD, or you can purchase the device from us at the time of insertion.

The hormonal IUD must be inserted by a trained doctor, and is available at one of our centres, a gynaecologist, some GPs or a family planning centre.

This page last edited: March 2023
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