Table of ContentsView All
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Table of Contents
What Is It?
Hormonal vs. Nonhormonal
Side Effects
Risks
Brands
Alternatives
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What Is a Hormonal IUD?
A hormonal IUD is a small, T-shaped contraceptive device healthcare providers insert into the uterus to prevent pregnancy. A hormonal IUD releases small amounts of levonorgestrel (progestin) each day, a synthetic version of the hormoneprogesteronethe body naturally produces.Progestin released from a hormonal IUD prevents pregnancy in several ways, such as:
Hormonal IUDs are a long-acting, reversible contraception (LARC), offering a convenient, reliable form of birth control that can last three to eight years, depending on the brand. One of the advantages of a hormonal IUD is its reversibility—if you decide to become pregnant, you can have an IUD removed at any time to restore your fertility.
How Is the Hormonal IUD Different from Nonhormonal IUDs?
Ability to Prevent Pregnancy
Hormonal IUDs release progestin, which thickens cervical mucus, making it difficult for sperm to reach an egg, and thins the uterine lining to make implantation less likely to occur.
Nonhormonal IUDs contain copper, which creates a hostile environment for sperm. With a copper IUD, sperm cannot move well enough or survive long enough to reach and fertilize an egg.
Effect on Menstrual Bleeding
Hormonal IUDs help reduce heavy menstrual bleeding and ease painful menstrual cramps. Many users notice decreased bleeding within the first few months of use, and up to 20% of people with a hormonal IUD stop having periods entirely while using a hormonal IUD.
Treatment for Specific Conditions
Specific hormonal IUDs (those containing 52 milligrams (mg) of levonorgestrel) are also an effective treatment for atypicalendometrial hyperplasia(AEH), a condition that causes abnormal, precancerous cells to thicken the uterine lining (endometrium). AEH develops when there is an excess of estrogen and too little progesterone. The progestin in hormonal IUDs helps thin the uterine lining, reducing the risk of progression to endometrial cancer in people with AEH.
How Long It Works
Hormonal IUDs may begin working immediately or take up to seven days to become effective, lasting anywhere from three to eight years, depending on the brand.Nonhormonal (copper) IUDs start working immediately after insertion and effectively prevent pregnancy for up to 10 years.
Side Effects of Hormonal IUDs
Hormonal IUDs are generally well-tolerated, but some people experience side effects. Side effects are typically mild and temporary and are usually more noticeable in the first few months after insertion.Common side effects of hormonal IUDs include:
Short- and Long-Term Risks
Short-Term Risks
Complications with a hormonal IUD are rare. When they do occur, they typically happen during or shortly after insertion and can include:
Hormonal IUD & Cancer RisksResearch suggests that hormonal contraceptives, including IUDs, may slightly increase the risk of breast cancer, though this increase is generally small. Overall, people who use hormonal IUDs tend to have a reduced overall cancer risk because hormonal IUDs also lower the risk of endometrial, ovarian, and colon cancers.
Hormonal IUD & Cancer Risks
Research suggests that hormonal contraceptives, including IUDs, may slightly increase the risk of breast cancer, though this increase is generally small. Overall, people who use hormonal IUDs tend to have a reduced overall cancer risk because hormonal IUDs also lower the risk of endometrial, ovarian, and colon cancers.
Long-Term Risks
Possible long-term risks of hormonal IUD use include:
Mirena
Mirenaeffectively prevents pregnancy for up to eight years after insertion. It begins working immediately if inserted during the first seven days of your menstrual cycle. Otherwise, it takes about seven days to prevent pregnancy.
Kyleena
Liletta
Lilettaeffectively prevents pregnancy for up to eight years after insertion. If inserted during the first seven days of your menstrual cycle, it begins working immediately following insertion. Otherwise, it takes seven days to work. Liletta is a T-shaped device measuring 32 mm wide and 32 mm tall. It initially releases 20 mcg of levonorgestrel daily, decreasing to about 6.5 mcg/day after eight years.
Skyla
Skyla prevents pregnancy for up to three years. It is immediately effective after insertion if placed during the first seven days of your menstrual cycle; otherwise, it takes seven days to work. Skyla is a small, T-shaped device measuring 28 mm wide and 30 mm tall, making it ideal for those seeking a smaller IUD option. It initially releases 14 mcg of levonorgestrel daily, decreasing to about five mcg daily.
How to Prepare Before the Procedure
IUD insertioncan take place at any point in your menstrual cycle and immediately following childbirth or an abortion.Before the IUD insertion procedure, your healthcare provider may recommend:
Before the IUD insertion, your provider will ask about your medical history and perform a gynecological examination to check your vagina, cervix, and uterus. They may test you for STIs to lower the risk of bacterial infection.
During the Procedure
The IUD insertion procedure takes about five minutes and involves:
You might experience mild to moderate cramping or discomfort as your provider places the IUD in your uterus. Some people may experience dizziness during or immediately after IUD insertion, and there’s a slight risk of fainting. It’s a good idea to bring someone to the appointment so you won’t need to drive or walk home alone.
The thought of having an IUD inserted or removed can be a source of anxiety, and many people worry about potential pain during the procedure. Remember, it’s OK to voice your concerns to your healthcare provider and request additional support during these procedures. Here are some tips for coping and managing pain:Take an over-the-counter pain reliever, such as Advil or Motrin (ibuprofen), about 20 to 30 minutes before the procedure can reduce cramping and discomfort.Talk to your healthcare provider about how you’re feeling. Ask them to explain each step and check in with you throughout the process.Listen to music or focus on deep breathing to help you relax during the procedure.Many people feel relief once the procedure is over, especially if they are anxious beforehand. Resting or spending the rest of the day relaxing with a good book or watching movies can help you recover.
The thought of having an IUD inserted or removed can be a source of anxiety, and many people worry about potential pain during the procedure. Remember, it’s OK to voice your concerns to your healthcare provider and request additional support during these procedures. Here are some tips for coping and managing pain:
Many people feel relief once the procedure is over, especially if they are anxious beforehand. Resting or spending the rest of the day relaxing with a good book or watching movies can help you recover.
After the Procedure
It’s normal to feel cramping or backachesafter an IUD insertion. Resting and holding a heating pad over your lower abdomen can help ease discomfort. You may experience breakthrough bleeding or spotting as your body adjusts to the IUD, but this typically goes away after three to six months, and most people can expect lighter periods with an IUD in place.
After the IUD is inserted, a string about 1 to 2 inches long will extend from your cervix into the upper part of your vagina. This string allows a healthcare provider to remove the IUD when it’s time. If you want to check the string, you can carefully insert your fingers into your vagina and feel toward your cervix, but avoid pulling on the string, as this could dislodge or remove the IUD.
Removal
IUD removal is a simple process that takes only a few minutes if the string is visible. Your healthcare provider will gently pull on the IUD string to slide it out. If the IUD is difficult to remove, your provider may need to use tools, but this is rare. Most people experience mild cramping during removal, and some light spotting can occur, but this is normal and goes away quickly.
Hormonal IUD Alternatives
While hormonal IUDs are effective and convenient, they’re not the right choice for everyone. Fortunately, there are several othercontraceptive optionsavailable, including:
Summary
22 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Planned Parenthood.What are hormonal IUDs?MedlinePlus.Levonorgestrel intrauterine system.American College of Obstestricians and Gynecologists.Long-acting reversible contraception implants and intrauterine devices.Lanzola EL, Ketvertis K.Intrauterine device. In:StatPearls. StatPearls Publishing; 2024.Merck Manual: Professional Version.Intrauterine devices (IUDs).Westin SN, Fellman B, Sun CC, et al.Prospective phase II trial of levonorgestrel intrauterine device: nonsurgical approach for complex atypical hyperplasia and early-stage endometrial cancer.Am J Obstet Gynecol. 2021;224(2):191.e1-191.e15. doi:10.1016/j.ajog.2020.08.032MedlinePlus.Deciding about an IUD.Planned Parenthood.What are the side effects of IUDs?Nelson AL, Massoudi N.New developments in intrauterine device use: focus on the US.Open Access J Contracept. 2016;7:127–141. doi:10.2147/OAJC.S85755Planned Parenthood.How safe is the IUD?American College of Obstestricians and Gynecologists.Hormonal contraception and the risk of breast cancer.Elsayed M, Dardeer KT, Khehra N, et al.The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices (LNG-IUDs): a systematic review.World J Biol Psychiatry. 2023;24(6):457-475. doi:10.1080/15622975.2022.2145354Nahum GG, Kaunitz AM, Rosen K, et al.Ovarian cysts: presence and persistence with use of a 13.5mg levonorgestrel-releasing intrauterine system.Contraception. 2015;91(5):412-417. doi:10.1016/j.contraception.2015.01.021Bayer.Frequently asked questions (FAQ) about Mirena.Bayer.Kyleena: Highlights of prescribing information.AbbVie.Liletta: Highlights of prescribing informationBayer.Skyla: Highlights of prescribing information.Planned Parenthood.What’s an IUD insertion like?Planned Parenthood.What to do before your IUD insertion appointment.Nguyen L, Lamarche L, Lennox R, et al.Strategies to mitigate anxiety and pain in intrauterine device insertion: a systematic review.J Obstet Gynaecol Can. 2020;42(9):1138-1146.e2. doi:10.1016/j.jogc.2019.09.014Planned Parenthood.What’s IUD removal like?Centers for Disease Control and Prevention.Contraception and birth control methods.
22 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Planned Parenthood.What are hormonal IUDs?MedlinePlus.Levonorgestrel intrauterine system.American College of Obstestricians and Gynecologists.Long-acting reversible contraception implants and intrauterine devices.Lanzola EL, Ketvertis K.Intrauterine device. In:StatPearls. StatPearls Publishing; 2024.Merck Manual: Professional Version.Intrauterine devices (IUDs).Westin SN, Fellman B, Sun CC, et al.Prospective phase II trial of levonorgestrel intrauterine device: nonsurgical approach for complex atypical hyperplasia and early-stage endometrial cancer.Am J Obstet Gynecol. 2021;224(2):191.e1-191.e15. doi:10.1016/j.ajog.2020.08.032MedlinePlus.Deciding about an IUD.Planned Parenthood.What are the side effects of IUDs?Nelson AL, Massoudi N.New developments in intrauterine device use: focus on the US.Open Access J Contracept. 2016;7:127–141. doi:10.2147/OAJC.S85755Planned Parenthood.How safe is the IUD?American College of Obstestricians and Gynecologists.Hormonal contraception and the risk of breast cancer.Elsayed M, Dardeer KT, Khehra N, et al.The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices (LNG-IUDs): a systematic review.World J Biol Psychiatry. 2023;24(6):457-475. doi:10.1080/15622975.2022.2145354Nahum GG, Kaunitz AM, Rosen K, et al.Ovarian cysts: presence and persistence with use of a 13.5mg levonorgestrel-releasing intrauterine system.Contraception. 2015;91(5):412-417. doi:10.1016/j.contraception.2015.01.021Bayer.Frequently asked questions (FAQ) about Mirena.Bayer.Kyleena: Highlights of prescribing information.AbbVie.Liletta: Highlights of prescribing informationBayer.Skyla: Highlights of prescribing information.Planned Parenthood.What’s an IUD insertion like?Planned Parenthood.What to do before your IUD insertion appointment.Nguyen L, Lamarche L, Lennox R, et al.Strategies to mitigate anxiety and pain in intrauterine device insertion: a systematic review.J Obstet Gynaecol Can. 2020;42(9):1138-1146.e2. doi:10.1016/j.jogc.2019.09.014Planned Parenthood.What’s IUD removal like?Centers for Disease Control and Prevention.Contraception and birth control methods.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Planned Parenthood.What are hormonal IUDs?MedlinePlus.Levonorgestrel intrauterine system.American College of Obstestricians and Gynecologists.Long-acting reversible contraception implants and intrauterine devices.Lanzola EL, Ketvertis K.Intrauterine device. In:StatPearls. StatPearls Publishing; 2024.Merck Manual: Professional Version.Intrauterine devices (IUDs).Westin SN, Fellman B, Sun CC, et al.Prospective phase II trial of levonorgestrel intrauterine device: nonsurgical approach for complex atypical hyperplasia and early-stage endometrial cancer.Am J Obstet Gynecol. 2021;224(2):191.e1-191.e15. doi:10.1016/j.ajog.2020.08.032MedlinePlus.Deciding about an IUD.Planned Parenthood.What are the side effects of IUDs?Nelson AL, Massoudi N.New developments in intrauterine device use: focus on the US.Open Access J Contracept. 2016;7:127–141. doi:10.2147/OAJC.S85755Planned Parenthood.How safe is the IUD?American College of Obstestricians and Gynecologists.Hormonal contraception and the risk of breast cancer.Elsayed M, Dardeer KT, Khehra N, et al.The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices (LNG-IUDs): a systematic review.World J Biol Psychiatry. 2023;24(6):457-475. doi:10.1080/15622975.2022.2145354Nahum GG, Kaunitz AM, Rosen K, et al.Ovarian cysts: presence and persistence with use of a 13.5mg levonorgestrel-releasing intrauterine system.Contraception. 2015;91(5):412-417. doi:10.1016/j.contraception.2015.01.021Bayer.Frequently asked questions (FAQ) about Mirena.Bayer.Kyleena: Highlights of prescribing information.AbbVie.Liletta: Highlights of prescribing informationBayer.Skyla: Highlights of prescribing information.Planned Parenthood.What’s an IUD insertion like?Planned Parenthood.What to do before your IUD insertion appointment.Nguyen L, Lamarche L, Lennox R, et al.Strategies to mitigate anxiety and pain in intrauterine device insertion: a systematic review.J Obstet Gynaecol Can. 2020;42(9):1138-1146.e2. doi:10.1016/j.jogc.2019.09.014Planned Parenthood.What’s IUD removal like?Centers for Disease Control and Prevention.Contraception and birth control methods.
Planned Parenthood.What are hormonal IUDs?
MedlinePlus.Levonorgestrel intrauterine system.
American College of Obstestricians and Gynecologists.Long-acting reversible contraception implants and intrauterine devices.
Lanzola EL, Ketvertis K.Intrauterine device. In:StatPearls. StatPearls Publishing; 2024.
Merck Manual: Professional Version.Intrauterine devices (IUDs).
Westin SN, Fellman B, Sun CC, et al.Prospective phase II trial of levonorgestrel intrauterine device: nonsurgical approach for complex atypical hyperplasia and early-stage endometrial cancer.Am J Obstet Gynecol. 2021;224(2):191.e1-191.e15. doi:10.1016/j.ajog.2020.08.032
MedlinePlus.Deciding about an IUD.
Planned Parenthood.What are the side effects of IUDs?
Nelson AL, Massoudi N.New developments in intrauterine device use: focus on the US.Open Access J Contracept. 2016;7:127–141. doi:10.2147/OAJC.S85755
Planned Parenthood.How safe is the IUD?
American College of Obstestricians and Gynecologists.Hormonal contraception and the risk of breast cancer.
Elsayed M, Dardeer KT, Khehra N, et al.The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices (LNG-IUDs): a systematic review.World J Biol Psychiatry. 2023;24(6):457-475. doi:10.1080/15622975.2022.2145354
Nahum GG, Kaunitz AM, Rosen K, et al.Ovarian cysts: presence and persistence with use of a 13.5mg levonorgestrel-releasing intrauterine system.Contraception. 2015;91(5):412-417. doi:10.1016/j.contraception.2015.01.021
Bayer.Frequently asked questions (FAQ) about Mirena.
Bayer.Kyleena: Highlights of prescribing information.
AbbVie.Liletta: Highlights of prescribing information
Bayer.Skyla: Highlights of prescribing information.
Planned Parenthood.What’s an IUD insertion like?
Planned Parenthood.What to do before your IUD insertion appointment.
Nguyen L, Lamarche L, Lennox R, et al.Strategies to mitigate anxiety and pain in intrauterine device insertion: a systematic review.J Obstet Gynaecol Can. 2020;42(9):1138-1146.e2. doi:10.1016/j.jogc.2019.09.014
Planned Parenthood.What’s IUD removal like?
Centers for Disease Control and Prevention.Contraception and birth control methods.
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