• Modes of action
  • Side effects
  • Purchase / manufacturers
  • Insertion
  • Materials
  • Tolerability
  • Reimbursement of costs
  • Pregnancy test
  • Anemia treatment
  • Hard questions and remote diagnoses
  • Literature and sponsorships

Modes of action

Which hormone does the hormonal IUS contain?

The hormonal IUS contains the progestin levonorgestrel, also known as “yellow body hormone”.

What is the likelihood, when using the hormonal IUS, that a sperm will reach the egg and fertilize it? What’s the actual risk?

The probability of pregnancy is very low. Women are as well protected with the hormonal IUS as they are after sterilisation (tubal ligation). If 1,000 women use an IUS for one year, only 2 will become pregnant.

What is the probability that sperm will overcome the barriers and fertilise the egg?

Due to the local action of the hormonal IUS, the cervical mucus thickens over the entire cycle, making it impassable for sperm. Ectopic pregnancies with an IUS are very, very rare and occur about as frequently as in women who have had sterilisation. This is a sign that the cervix is practically impenetrable to sperm and that fertilisation does not occur, making the IUS one of the most effective contraceptive methods.

Does the hormonal IUS suppress ovulation?

Not in most cases. Women who use an IUS for contraception usually ovulate because the dosage of the hormone is so low that it doesn’t lead to a suppression of ovulation.

How long does the hormonal IUS stay effective? I’ve been using it for 5 years now. My gynaecologist thinks it’s possible to leave it in for another year with full protections.

The manufacturers specify 5 years, with a certain safety cushion. The 5-year duration is really a given for all women. Presumably, protection will likely extend beyond that for some women, but no reliable data supports this.

My hormonal IUS was inserted immediately after an abortion. When does it start preventing pregnancy in this case?

In this case, you are immediately protected. But after the next menstruation, you must check to ensure the IUS is still in place because it may be expelled in rare cases.

My uterus has just expelled the hormonal IUS. How long will the contraceptive protection last?

You can become pregnant as soon as the IUS is removed or (rarely) ejected. You no longer have any protection.

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Can the hormonal IUS interact with medication?

Although the degradation of progestins can be accelerated by the simultaneous administration of certain (enzyme-inducing) substances such as anti-convulsants and anti-infectives, interactions of the IUS with other drugs is not expected from a medical point of view, because the IUS mainly works locally in the uterus. Because of this localized effect, it doesn’t matter what other medications you are taking.

Will the hormonal IUS interact with St. John’s wort? Is it safe to use contraception at the same time?

There’s no supported data on this, but due to the mode of action, no interaction with St. John’s wort or other medications is expected, as the IUS effect is localized to the uterus. Therefore, liver function is not important in terms of IUS effects, and there is no change in the mode of action for St. John’s wort. In contrast, the efficacy of the pill depends on the concentration of hormones in the blood and thus on liver function, which is why the pill interacts with St. John’s wort.

I had a hormonal IUS inserted 8 years ago. It is still in my body because I don’t like going to the doctor. After 3 years, I switched to barrier methods of contraception. Can the IUS have negative consequences for me?

The hormonal IUS remains very effective for at least 5 years and after that, you are no longer reliably protected. Keep in mind that barrier methods are only moderately effective, which means a higher probability of becoming pregnant if you only use these methods. Therefore, it may be advisable to have a new IUS placed.

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Side effects

Does the hormonal IUS cause weight gain? Would this only happen during the adjustment phase? Why is there nothing about weight gain on the manufacturer’s website under disadvantages?

Studies have shown that the hormonal IUS does not lead to weight gain, which is to be expected because of the mode of action. First, the IUS does not contain any estrogen, which is the hormone responsible for weight gain in women taking the pill. Second, the dosage of the yellow body hormone is so low that it only has a localized effect. A whole-body effect would not not be expected due to the low dosage.

However, Bayer (the manufacturer of Mirena®, Jaydess®, and Kyleena®) notes that for legal reasons, they are obligated to list all reported side effects, even if they have no connection with the drug. This is why weight gain is listed as a possible side effect in the manufacturer’s information.

Keep in mind that most adults gain a bit of weight with age. If we compare women who have a copper IUD with women who have a hormonal IUS, the weight gain is the same in both groups.

Weight gain varies greatly from individual to individual and depends on many factors. Even if there is an an association between weight gain and the placement of a hormonal IUS in a few cases, that does not mean the IUS is responsible.

I used a hormonal IUS but had it removed because of side effects. In the future, I will warn all woman I know who want to have an IUS inserted.

It is unfortunate you had side effects. This does happen in rare cases. However, please remember that the vast majority of users are very satisfied with the hormonal IUS and it gives them highly effective protection against unwanted pregnancies.

Unfortunately, in some situations it is difficult to find a suitable contraceptive that is also effective, because people often react differently to different situations. While no method of contraception is equally well-tolerated by all women, the proportion of women who tolerate the IUS well is higher than with other contraceptives.

It is understandable that you may want to discourage other women from using the hormonal IUS because of your own bad experience. However, you should also recommend another equally effective method of contraception; otherwise, women will have a higher risk of unwanted pregnancy and thus abortion.

I have back pain. Is this caused by the hormonal IUS?

It’s difficult to know for sure. In principle, it’s conceivable that a foreign body like a hormonal IUS can stimulate the uterus to contract, just like during menstruation. This can sometimes lead to back pain, because the uterus is attached to the spine by ligaments and pulling those ligaments can cause back pain. However, such complaints are very rare, and the hormonal IUS usually leads to a decrease in menstrual pain.

If the pain already existed before IUS insertion, there is probably no connection. If the discomfort occurred only after insertion, and disappears soon after removal of the IUS, it is likely that the back pain was caused by the IUS. But before removing the IUS, all other possible causes of back pain should be excluded. Further, after removing the IUS, the return of menstruation may give rise to similar pain or other complaints, plus you would need to use other methods of safe contraception if necessary.

Does the hormonal IUS delay menopause? I would like to experience natural menopause.

The hormonal IUS has no influence on menopause.

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Purchase / manufacturers

Where can I get the hormonal IUS?

You can either get the hormonal IUS directly from your doctor, or your doctor can give you a prescription for it.

Does the hormonal IUS differ from country to country?

The hormonal IUS is the same all over the world, with minor differences between brands (see below).

What IUS brands are available, who makes them, and what are the differences?

The following companies make the hormonal IUS:

  • Mirena® – Bayer: ?? [please add some brief text on the differences between each brand]
  • Jaydess® (known as Skyla in North America) – Bayer: has a small silver ring to make removal easier; ??
  • Kyleena® – Bayer: ??
  • Levosert® – Gedeon Richter, (in Polish): ??

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Is a uterine perforation likely to occur during insertion of the hormonal IUS, and under what conditions?

A uterine perforation is very rare and depends mostly on the experience of the doctor who inserts the IUS. The risk can be higher if the cervix is very tightly closed or the uterus is tilted.

I take a long-cycle pill. Should I switch to a normal cycle pill for two months before inserting the hormonal IUS so that any buildup of menstrual tissue over the long-term cycle can bleed off?

You should discuss this with your doctor. Provided the uterine lining is minimal, you can place the IUS without a break.

A week ago, I had a hormonal IUS inserted. Since then I’ve had severe abdominal pain, like bad period cramps. My gynaecologist checkup showed that the IUS had changed position and rotated, and the thread was no longer outside my uterus. Should I have the IUS removed?

It is rare for as IUS to slip but it can unfortunately happen. Sometimes it does so for a reason, such as a slight alteration in the uterus, but often there is no obvious reason.

A wrong position sometimes leads to the complaints you described. However, an accurate assessment is only possible with an ultrasound. If your symptoms do not improve, you should have the IUS removed. Keep in mind you will no longer have contraceptive protection and will need to consider another method or discuss it with your gynaecologist.

Since I started using the hormonal IUS a month ago, I have had abdominal pain and period-like bleeding. Is that normal?

Pain and bleeding should not be long-lasting or severe. Your symptoms could be caused by the IUS slipping out of place. Your gynaecologist would need to do an ultrasound examination. Regardless, if your symptoms don’t improve, you may need to have the IUS removed.

What should I do if I can no longer feel the thread of the hormonal IUS?

If you can’t feel the thread, you should have an ultrasound check with your gynaecologist. Either the IUS has been ejected or the thread is inside the uterus. The latter situation is not a problem and you can still leave the IUS in place until the next planned change, unless it’s causing you discomfort.

The thread of my hormonal IUS was cut too short, so it cannot simply be pulled to remove it. My gynaecologist tried several times in vain and recommended that I have it done with a local anaesthetic. During the appointment (without an examination), I was told that a scraping needs to be done. Is this necessary?

From a medical point of view, there is no compelling reason for curettage (scraping) when removing the IUS. A short thread only means that removal might be more labour-intensive and a local anaesthetic would certainly be useful. If necessary, your cervix should also be prepared with a medication (Cytotec®/Cyprostol® or Mifegyne®) to relax the opening and make removal easier.

How long do I have to wait after insertion before having sex again? My gynaecologist said I can have sex immediately, but I’ve often heard that you have to wait at least a week because the open cervix can introduce germs. Which is correct?

You can have sex again right away. The cervix opens only very slightly when inserting the hormonal IUS and closes again quickly, thereby giving immediate protection against any infection. The IUS also immediately protects against unwanted pregnancies if it was placed during menstruation.

I don’t use the hormonal IUS for contraception, but just to reduce bleeding and severe menstrual problems. I’ve been using the same IUS for 8 years. Is there a risk that the IUS will be harder to remove the longer it’s inside my uterus?

Removal is easy and independent of how long the IUS has been in place. However, once the hormone reservoir is empty, you will start menstruating again and will no longer be protected from pregnancy, unless you’re already using an alternate method.

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I have a plastic allergy. Will I be able to tolerate the hormonal IUS? What kind of plastic is the IUS made of and what are the threads made of?

Please direct your question to the manufacturer.

Does the hormonal IUS contain metallic parts, or any copper?

Most hormonal IUS brands do not contain any metallic components, including copper. They are manufactured with plastic material. Howvever, the Jaydess brand has a silver ring, which makes it easier to see in an ultrasound.

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I do not tolerate the progestogen pill, so will I also not be able to tolerate the hormonal IUS?

The hormonal IUS also contains a progestogen, but the dose is much lower than with the progestogen pill or the implant. Therefore, it should not be assumed that the IUS will have the same effect as the progestogen pill.

Can I still use the hormonal IUS if I have high blood pressure?

Yes, the hormonal IUS has no influence on blood pressure.

Can a hormonal IUS cause problems during sports, sexual intercourse, or physiotherapy for abdominal problems?

From a medical point of view, there should never be a problem with an IUS during sports, sexual intercourse, or physiotherapy. Even if the uterus moves a bit, such as during a gynaecological examination or during sexual intercourse, an IUS is not a problem because it is so soft and flexible.

Can I be prescribed an electric bath (electrotherapy or galvanic bath) despite having a hormonal IUS?

Most hormonal IUS brands do not contain any metallic components, so effectiveness should not change due to the electrical current. However, the Jaydess brand has a silver ring, which makes it easier to see in an ultrasound.

Can I have fat pads / love pads “shot off” by ultrasound despite using a hormonal IUS?

Most hormonal IUS brands do not contain any metallic components, just plastic. Howvever, the Jaydess brand has a silver ring, which makes it easier to see in an ultrasound. If you have this type of IUS, talk to your doctor before any ultrasound is carried out

Can I continue to use vibrators with the hormonal IUS?

From a medical point of view, there is nothing against it. There are no studies or reports of any problems.

Can a vibrating massage belt disturb the position of the hormonal IUS?

From a medical point of view, there should be no disturbance.

I regularly go to the gym and train on a vibration plate. Can the hormonal IUS slip?

The IUS cannot slip due to vibrations.

Can I use a laser hair remover if I have a hormonal IUS inserted?

There is no disturbance of the IUS or any effect on it from the laser, because the laser beam does not penetrate the body.

Can constraint-induced movement therapy (CIMT) be used for gastro-intestinal problems if I use a hormonal IUS?

The hormone in the IUS is released slowly through a semi-permeable membrane. It is not possible for waves from a medium-frequency device to impair this diffusion or alter the contraceptive effect.

My uterus is slightly bicornate (split partly in two). Can I use the hormonal IUS?

It all depends on the size and structure of the bicornate uterus and how well it would tolerate an IUS. If the split in the uterus is not very pronounced, an IUS could be inserted and work effectively. However, it’s possible you may need a separate IUS for each side of your uterus, which would increase the financial cost. You may want to consider the copper IUD Gynefix®, which is less expensive than the hormonal IUS.

I’ve been diagnosed with a liver tumour. Should the hormonal IUS be removed?

It depends on the type of tumour. If it’s a hepatocellular adenoma, the IUS should be removed for safety’s sake.

My uterus is too small for the hormonal IUS. Are there smaller ones?

The company Bayer manufactures a new, slightly smaller hormonal IUS called Jaydess, which also releases a bit less hormone. According to studies, it is also very well tolerated.

Is it safe to undergo magnetic resonance imaging (MRI) with an IUS?

Most hormonal IUS brands do not contain any metallic components, just plastic. In this case, an MRI is completely unproblematic. However, the Jaydess brand has a silver ring. If you have this type of IUS, talk to your doctor before any MRI is carried out.

I have expelled the hormonal IUS. Should I have it inserted again?

Unfortunately, there is no data on why or when a hormonal IUS may be expelled. An ejection is very rare, even rarer than with copper IUDs. When it does happen, there is often no known cause. If a myoma (benign tumour) is present in the uterus, this could be an explanation. However, an IUS often remains firmly in place even with fibroids. There is no health issue associated with another insertion, only a financial one.

My uterus expelled the hormonal IUS a few days after insertion. What are the chances this will happen again? What factors influence this?

An expulsion after such a short time is rare. It would be useful to see whether the shape of the uterus has changed in any way, such as due to a myoma (benign tumour) or a bicornate uterus (partly split in two), during a detailed ultrasound examination. Myomas are very common and rarely cause discomfort. However, a myoma can sometimes change the shape of the uterus cavity and cause an expulsion of the IUS. It would also be important to know whether your gynaecologist has performed an ultrasound after placing the IUS to check the correct position.

It is difficult to determine how high the risk of ejection is. If the shape of your uterus has not changed, and if the position of the IUS was correct, it’s unlikely to happen again. If there is any indication that the IUS was not correctly positioned, your gynaecologist should be ensure it is placed correctly next time. If, for example, your fibroids change the shape of the uterus, this is more likely to happen again in the future.

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Reimbursement of costs

I’ve rejected my hormonal IUS. Will the manufacturer reimburse me for the costs?

An expulsion of a hormonal IUS is a very rare event. Understandably, it is annoying for the few women affected. Basically, the ejection is comparable to side effects or a rare lack of efficacy. Usually there is no substitute from the manufacturer. Because we are independent from IUS manufacturers, we have no influence on their policies. But you can of course contact the manufacturer with your concerns.

I had the hormonal IUS removed because of a side effect. Can I get a refund from you?

Severe side effects that make premature removal necessary are a very rare occurrence with the hormonal IUS. Understandably, it is annoying for the few women affected. Unfortunately, every effective drug can have undesirable side effects. Normally, there is no substitute or refund from the manufacturer.

This website was created independently from IUS manufacturers. Please contact your doctor or the manufacturer with your request.

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Pregnancy test

Can I do a pregnancy test when I have a hormonal IUS inserted?

You can do a pregnancy test at any time and it will be reliable, even with an IUS inserted. But this is one of the most reliable contraceptive methods and pregnancy is very rare.

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Anemia treatment

In case of severe anemia caused by very heavy bleeding and prolonged spotting, what’s more effective and less costly – using a hormonal IUS or getting a hysterectomy?

It’s difficult to determine whether a hormonal IUS is more effective than removing the uterus. However, an IUS is a very, very effective treatment for this situation, and is much cheaper and far less drastic than a hysterectomy.

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Hard questions and remote diagnoses

My case is very special. Would you be able to give me your opinion?

Specific questions are often difficult or impossible to answer from a distance. It is best to discuss your specific case with your gynaecologist, who can carry out examinations if necessary. You can also ask for the opinion of several doctors.

My gynaecologist is on holiday. Can you help me?

Specific questions are often difficult or impossible to answer from a distance. If this is an emergency or urgent case, please contact another gynaecologist.

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Literature and sponsorships

Can you please send me literature?

This website operates independently from hormonal IUS manufacturers. To obtain material, please contact the manufacturer or check their websites. We do have a postcard with basic information and will be happy to send it to you free of charge (info@gynmed.at). We can also send you a folder of information about our Museum of Contraception and Abortion (http://en.muvs.org/).

Can you sponsor an event or provide materials in order to promote the hormonal IUS or particular brands?

Unfortunately, we don’t have a budget for sponsorship. This website operates independently of the manufacturers. Please contact the manufacturer if you have any questions about sponsorship.

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