Written by Samantha Glass

Hormonal intrauterine devices (IUDs) have been in use for over thirty years. Levonorgestrel-IUDs prevent pregnancy primarily by inducing a sterile inflammatory response in the uterus that is toxic to sperm and ova, with additional hormonal effects on the endometrium and cervical mucus. There are various hormonal IUD options that are effective for up to three to eight years. All hormonal IUDs can help with heavy periods and cramps along with providing long-term contraception that doesn’t depend on action from its users. Recent evidence supports a maximum duration for the two 52-mcg IUDs (Mirena and Liletta) to eight years. Benefits of hormonal contraception include reduced menstrual bleeding and pain, and long-term contraception. Patients may choose these options because they do not require repeated dosing as with an oral or injectable contraceptive and are highly efficacious. With new data regarding efficacy, it is important to provide patients with up-to-date information regarding insertion, use, and removal.

As with all contraceptive options, it is important to center each individual patient and their priorities for contraception. Side effects, such as pain, irregular menstrual bleeding, and possible systemic symptoms, should not be minimized. Long-acting reversible contraceptive methods have been used coercively to control the reproductive choices of people of color. Clinicians should keep this history in mind when counseling patients.

Additionally, there are some medical conditions that are contraindicated in those using a hormonal IUD such as current pelvic inflammatory disease, endometritis, or recent septic abortion. Efficacy may also be reduced in patients taking CYP3A4 inhibitors such as antifungal medications like ketoconazole or anti-seizure medications including phenytoin. A full list of contraindications is available for clinicians via the US Medical Eligibility Criteria for Contraceptive Use.

Hormonal IUDs serve as an excellent choice of long-term reversible contraception for those individuals who cannot use estrogen. It is important to educate patients about all birth control options, lowering barriers to access while ensuring patients’ autonomy.

RHAP resources:

Your Birth Control Choices Fact Sheet

IUD Fact Sheet

Hormonal IUD User Guide

Sources:

Beatty MN, Blumenthal P. The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability. Ther Clin Risk Manag. 2009;5:561-574. https://doi.org/10.2147/TCRM.S5624

‌“CDC – Potential Drug Interactions: Hormonal Contraceptives and Antiretroviral Drugs – USMEC – Reproductive Health.” www.cdc.gov, 7 Aug. 2019, www.cdc.gov/reproductivehealth/contraception/mmwr/mec/appendixm.html. Accessed 28 Sept. 2022.

Dethier, Divya, et al. “Society of Family Planning Clinical Recommendation: Extended Use of Long-Acting Reversible Contraception.” Contraception, June 2022, 10.1016/j.contraception.2022.06.003. Accessed 5 July 2022.

Gomez, Anu Manchikanti, et al. “Women or LARC First? Reproductive Autonomy and the Promotion of Long-Acting Reversible Contraceptive Methods.” Perspectives on Sexual and Reproductive Health, vol. 46, no. 3, 23 May 2014, pp. 171–175, onlinelibrary.wiley.com/doi/abs/10.1363/46e1614, 10.1363/46e1614.

Pharma-free

The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.