The IUD or hormonal IUD is a device inserted into the uterus that protects the woman from possible pregnancy. It is particularly recommended for women with heavy periods who wish to reduce/stop their flow.
The intrauterine device (more commonly called IUD, or SIU for “intrauterine system” and for a long time called the IUD – we should no longer call it that because the IUD does not make you sterile at all) is a means of contraception that a healthcare professional inserts it into the woman’s uterus. There are two types: copper IUD and the Hormonal IUD.
What is a hormonal IUD?
The hormonal IUD is a small device made of soft plastic, “T” shaped, measuring 3.5 cm long and ending in a small thread to facilitate removal (this small thread is not felt and does not bother the partner during intercourse). The thread contains a progestin hormone – levonorgestrel – a synthetic progestin similar to that contained in certain contraceptive pills. Inserted by a doctor or midwife into the uterus, it protects the woman from possible pregnancy.
What hormonal IUDs are available in France?
There are 3 types of hormonal IUDs:
- Mirena®: 52 mg of Levonorgestrel (Duration of 8 years if contraceptive indication and 5 years if treatment of functional menorrhagia)
- Kyleena®: 19.5 mg Levonorgestrel (Duration of 5 years)
- Jaydess®: 13.5 mg Levonorgestrel (Duration of 3 years)
For which women is it indicated?
According to Caroline Sylvestre, gynecologist, the installation of a hormonal IUD is recommended for:
- Women with heavy periods who wish to reduce/stop their flow
- Women carrying a symptomatic adenomyosis (heavy flow and painful periods)
- To cause therapeutic amenorrhea (stopping of periods) as part of the treatment ofendometriosis.
- Women wishing long-acting contraception
By continuously delivering a small amount of the hormone progestin to the walls of the uterus. This hormone thickens the secretions of the cervix, thus blocking the passage of sperm and it slows down the formation of the inner lining of the uterus (endometrial atrophy). This hormone is contained in the vertical stem of the “T”.
How effective is a hormonal IUD?
“The hormonal IUD is one of the most effective contraceptives with a Pearl index (number of pregnancies per 100 women per year) estimated at 0.2 in common use“, reports Caroline Sylvestre. Beyond this period, it must be replaced, because the progestin hormone it contains has been completely released.
What impact on the rules?
The hormonal IUD induces a change in menstrual cycles.
► With Mirenathere is an absence of periods (16% of women after 1 year of use), a reduction in the flow of periods (57% of women after 1 year of use) but can also be responsible more sporadically for spotting ( intermittent bleeding) or continuous bleeding.
► With Kyleena and 1 year of use, there may be oligomenorrhea (few and more spaced periods) in 26% of cases, spotting (intermittent bleeding) in 25% of cases and absence of periods in 12% of cases. Over time, the frequency of amenorrhea and oligomenorrhea increases at the expense of prolonged and irregular bleeding.
► The Jaydess IUD “is used less and less since the arrival of Kyleena”, underlines our interlocutor. The latter makes it possible to combine a lower hormonal dosage of levonorgestrel than with Mirena but a contraceptive duration extended to 5 years instead of 3 years.
“Hormonal IUDs are preferable to copper IUDs if periods are heavy, long and painful“, replies our interlocutor. Before making your choice, ask your gynecologist about the contraindications, use, advantages, cost, side effects, their composition… Because in fact, these two intrauterine devices (copper or hormonal) have advantages and disadvantages.
Before opting for a hormonal IUD, you must consult a gynecologist or your attending physician who will determine whether you have any contraindications. Once you have obtained the prescription, you can buy your hormonal IUD at the pharmacy. The installation takes place during a second consultation with a doctor. Installation is quite quick and can be a little unpleasant. It is done by the doctor who will insert the device, folded, into the vagina into the uterus where it will unfold. The healthcare professional cuts the IUD thread fairly short. Worried and sensitive women can talk to their doctor who may, during the installation, offer them local anesthesia or pain medication. Approximately two months after insertion, an ultrasound is recommended to confirm that the IUD has been correctly inserted.
Removal is also quick and not painful; a slightly unpleasant pinching sensation may be felt. Withdrawal is done at any time during the cycle. The doctor gently pulls on the IUD string, visible at the entrance to the uterus, using small forceps.
What are its side effects?
The hormonal IUD can cause the same side effects as oral contraceptives containing progestin (such as the progestin-only pill). Among the most common possible side effects:
- Mood and libido disorder
- Headaches, migraines
- Abdominal pain
- Nausea
- Acne, hirsutism
- Ovarian Cyst
- Mastodynia
- Weight gain
- Spottings, metrorrhagia
- Expulsion
What are the contraindications to insertion of an IUD?
Only a doctor authorizes or not the insertion of a hormonal IUD in a patient. Contrary to popular belief, women who have never had children can very well use this contraception. Indeed, for a long time, some specialists thought that an IUD could only be inserted in a woman who had already given birth vaginally and therefore, with a more enlarged uterus. However, there are some contraindications to inserting an IUD:
► Certain histories such as uterine pathologies, abnormal vaginal bleeding, certain STIs (before they are treated or less than three months after) or sensitivity to one of the components of the IUD may prevent the insertion of this device;
► The IUD is contraindicated in cases of venous thrombosis, genital tuberculosis, pulmonary embolism, phlebitis, breast cancer, cervical or endometrial cancer (before treatment), hepatitis…
► The IUD is contraindicated between 48 hours and 4 weeks after childbirth and of course, during pregnancy, to women whose cervix is too wide due to multiple or complicated deliveries and finally, to women with had an infection after childbirth or after abortion less than 3 months ago.
Can you use tampons with a hormonal IUD?
Because levonorgestrel prevents the lining of the uterus from growing, period bleeding is usually less heavy. Some women don’t even have periods at all while they have an IUD. No matter how heavy your periods are, it is entirely possible to use tampons (except for the first days following installation) because the tampon is located at the level of the vagina, it will never be in contact with the uterus and therefore with the IUD. “We warn women wishing to use the cup although it is not incompatible. The strings can sometimes be long and pinched in the cup or the suction effect is poorly canceled resulting in removal of the IUD without the woman realizing it.“, she explains.
Does it have an impact on libido?
As with all hormonal contraception, the IUD has an influence on a woman’s menstrual cycle and can therefore have repercussions on libido. Progesterone could sometimes cause vaginal dryness that can make intercourse a little more painful, which would slow down the libido. However, the quantity of progesterone released is quite low and should not have much impact on a woman’s sexual desire. However, if this is problematic, talk to your doctor or gynecologist who will consider another contraceptive method with you.
How much does a hormonal IUD cost? Is this reimbursed?
The intrauterine device is prescribed by a doctor, gynecologist or midwife. It is then obtained in pharmacies against a medical prescription. Kyleena® and Jaydess® cost 94.73 euros (indicative public price) and Mirena® costs 97.35 euros. The hormonal IUD is reimbursed at 65% by Health Insurance.
Thanks to Caroline Sylvestre, gynecologist.