Hormonal IUD (Levonorgestrel)

How it works

Levonorgestrel acts locally inside the uterus. It thickens cervical mucus and makes it harder for sperm to pass. It thins the endometrium and prevents implantation. Higher-dose models may also suppress ovulation. Systemic absorption is low, so hormonal side effects are fewer than with the pill. Once it is removed, the effect ends quickly and fertility usually returns in the next cycle.

Brands and durations

• 52 mg levonorgestrel (Mirena type): contraception for up to 8 years. Also approved for heavy menstrual bleeding. Amenorrhea rate about 20% in year 1 and 30–40% in years 5–8.
• 19.5 mg (Kyleena type): 5 years. Smaller frame. Amenorrhea about 12% in year 1 and 23% in year 5.
• 13.5 mg (Skyla type): 3 years. Smallest frame. May be preferred for women who have never given birth.

The choice depends on the size of the uterus, your wishes about bleeding and how long you plan to use it. At SoftCare, the length of the uterus is measured by ultrasound and the suitable model is discussed with you.

Who it is suitable for

• Those who want long-term protection with little risk of forgetting
• Those with heavy menstrual bleeding or adenomyosis
• Those who cannot use estrogen (migraine with aura, history of thrombosis, breastfeeding)
• Those who cannot take the pill regularly
• Women who have or have not given birth (with a suitable model)

Contraindications: active pelvic infection, unexplained vaginal bleeding, uterine anomaly, pregnancy, history of breast cancer (progestin-sensitive); Wilson disease is not a contraindication (it applies to the copper IUD). The CDC US MEC 2024 criteria are used.

Insertion process

Before insertion, a pregnancy test, infection screening and an ultrasound are done. It can be inserted on any day of the cycle once pregnancy has been ruled out. The procedure is performed after placing a speculum, cleaning the cervix and measuring the uterus with a uterine sound. Insertion takes a few minutes. For women who have never given birth, local anesthesia (paracervical block) or sedation is discussed.

Cramping and brief dizziness may occur during the procedure. Resting for 1–2 hours afterwards is enough. Light bleeding and cramps in the first 24–48 hours are normal. A string check and a follow-up ultrasound after 4–6 weeks are planned. Backup contraception may be needed for the first 7 days, depending on timing.

Changes in bleeding

In the first 3–6 months, the most common complaint is irregular spotting and breakthrough bleeding. The number of bleeding days may increase. This is an adjustment period. After the 6th month, bleeding usually decreases. In many women, periods become lighter or stop completely. Amenorrhea does not mean pregnancy; it happens because the hormone thins the endometrium.

If your periods stop and pregnancy is suspected, a test is done. If heavy bleeding starts suddenly, or bleeding that used to be light becomes heavy, a check-up is needed. If there is anemia, a complete blood count is requested. If bleeding continues, the position of the IUD is checked by ultrasound; it is removed if needed.

Side effects

Common:

• Spotting and cramps in the first months
• Headache
• Breast tenderness
• Acne
• Mood changes (rare because of low systemic absorption)

Rare risks:

• Pelvic infection (higher in the first 20 days)
• Expulsion: about 2–5% in the first year
• Perforation: 1–2 per 1,000
• Ectopic pregnancy: the absolute risk is low, but if pregnancy occurs, the share of ectopic pregnancies is higher
• Ovarian cyst: most resolve on their own

Severe pain, fever, foul-smelling discharge, very heavy bleeding or suspected pregnancy need urgent assessment.

Difference from the gold IUD

At SoftCare, the gold IUD is our first choice. The hormonal IUD may be preferred in the following situations:

• Heavy menstrual bleeding or adenomyosis
• When a clear reduction in period pain is wanted
• When a hormonal method is preferred and the pill is not suitable

The gold IUD is hormone-free and may increase menstrual bleeding. The hormonal IUD reduces bleeding. Neither method protects against STIs; condoms should be added. The decision is based on your bleeding profile, hormone preference and how long you plan to use it.

Removal and afterwards

Removal is done in the clinic by pulling the string with a speculum in place. The cramping is brief. You can become pregnant right after removal. If you want to continue contraception, the new method is started on the same day. The IUD can be removed before its duration ends. After removal, periods usually return to normal within 1–2 months.

Pregnancy and breastfeeding

If pregnancy is suspected, the IUD is removed. If it is not removed in early pregnancy, the risk of miscarriage and infection increases. The hormonal IUD can be used while breastfeeding; it does not affect milk supply. At SoftCare, it is inserted no earlier than 8 weeks after birth; earlier insertion may increase the risk of perforation.

Follow-up

• Ultrasound and string check after 4–6 weeks
• Yearly gynecological examination
• Extra check-up for abnormal bleeding, pain or if the strings cannot be seen
• Replacement plan before the duration ends
• STI testing if there is a risk

At SoftCare, patients who have a hormonal IUD inserted receive written information on what bleeding to expect and when to seek urgent care.

Our approach at SoftCare

At SoftCare Clinic, assessment for the hormonal IUD starts with your gynecological history, an ultrasound and your bleeding profile. The gold IUD is our first recommendation; if there is heavy bleeding or a preference for a hormonal method, the hormonal IUD is discussed. The suitable model (52 mg, 19.5 mg or 13.5 mg) is chosen according to the size of the uterus. Insertion is done in the clinic. Changes in bleeding during the first 3–6 months are explained. If there are worrying symptoms, an ultrasound and, if needed, removal are arranged. If there is an STI risk, condoms and testing are recommended.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. American College of Obstetricians and Gynecologists (ACOG). Long-Acting Reversible Contraception: IUD and Implant.
• 2. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.
• 3. Bayer. Kyleena Prescribing Information and bleeding data.
• 4. Winner B, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998–2007.
• 5. Reed SD, et al. Association between intrauterine device type and risk of perforation and device expulsion. Am J Obstet Gynecol. 2022.
• 6. NICE Clinical Knowledge Summaries. Contraception – IUC. Risks and adverse effects.
• 7. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
• Note: Approved durations and bleeding rates for each brand may change according to the current package inserts. At SoftCare, the gold IUD is our first choice; the hormonal IUD is discussed for selected indications. This reference list is for information purposes.

A citation does not mean that SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026