What is the hormonal IUD?
- The hormonal IUD (intra-uterine device) is a small, T-shaped piece of plastic with a band containing one hormone (progestin) that a clinician inserts into your uterus.
- It is sometimes called an IUS (intra-uterine system), Mirena, or Jaydess.
How does the hormonal IUD prevent pregnancy?
- In order to get pregnant, sperm must enter your vagina*, swim up into your uterus and fertilize an egg that has been released from your ovaries during ovulation. Having an IUD in your uterus changes the chemistry of the uterus and makes it hard for sperm and eggs to survive and meet.
- The progestin thickens the mucus on your cervix (the opening to your uterus), which makes it harder for sperm to get into your uterus and fertilize an egg.
- It also thins the lining of your uterus (the endometrium). This makes it harder for a fertilized egg to implant in your uterus and become a pregnancy.
- For some people, the hormonal IUD may stop eggs from being released from your ovaries (ovulation).
How effective is the hormonal IUD?
- The hormonal IUD is 99.9% effective. This means that if 1000 people had a hormonal IUD in place for one year, only one person would get pregnant.
How do you use the hormonal IUD?
- A clinician inserts the IUD into your uterus using a thin (less than 5mm) applicator tube.
- The hormonal IUD looks like a plastic T with strings attached at the bottom. The plastic part stays in your uterus, and the strings hang outside your cervix (the opening of your uterus). These strings are short and will not hang outside your vagina. You can feel them if you put a finger into your vagina and touch your cervix, but the strings cannot not usually be felt by a penis*.
- It is normal for the strings to move around a bit or seem to change length. If you are curious, you can check your strings by feeling for them with your fingers.
- You can have a hormonal IUD removed by a clinician whenever you are finished with it, or leave it in place for up to 3 or 5 years depending on the model.
How to start using the hormonal IUD
- If you and your clinician decide that the hormonal IUD is the right method for you, they will write you a prescription. You can buy your hormonal IUD at a pharmacy (approximately $300-$550) or at a sexual health clinic that sells IUDs (approx. $270 – $380).
- Planned Parenthood Toronto’s Health Services sells the hormonal IUD for $306 (3-year) or $380 (5-year).
- Before you get a prescription, your clinician will need to do a complete pelvic exam and test you for infections, including some sexually transmitted infections (STIs).
- Your clinician may want to put in the IUD while you are on your period, but this is not always necessary.
- After insertion you may feel some discomfort and cramping. This usually goes away within a few days. You may want to talk to your clinician about using pain medication.
- You will be protected from pregnancy right away, but you may want to wait 48 hours before having vaginal sex. Your clinician may also recommend you use a back-up method of birth control like condoms or spermicides for the first 6 weeks.
What are the side effects of the hormonal IUD?
- You may have spotting (a small amount of blood lighter than a period) or light bleeding pretty often for the first 3 months.
- Your periods may be lighter, shorter, or more irregular
- After one year, 16-35% of people will stop having periods at all while the IUD is in place.
- Other rare side effects include acne, headache, and sore breasts*. Only 5% of people experience these side effects.
- Talk to your doctor if you have a history of depression or if you are concerned about potential weight gain.
Advantages of the hormonal IUD
- Your chances of getting pregnant are extremely low.
- It can be used for up to 3 or 5 years depending on the model.
- You don’t have to do anything just before or after you have sex.
- It is a relatively “hands off” method. You only need to have a clinician check for your strings when you get a routine pelvic exam to make sure the IUD is in place.
- It may make your period lighter and less crampy. After one year, 16-35% of people will stop having periods while the IUD is in place.
- You can use this method if you cannot use birth control with estrogen in it.
- It doesn’t affect your ability to get pregnant after you stop using it.
- You don’t have to rely on your partner(s) to use it.
- If you want to keep your birth control use private, there is no packaging to be found.
- Over the course of 5 years, the monthly cost of the IUD works out to be cheaper than other hormonal options like the pill or ring.
Disadvantages of the hormonal IUD
- A clinician must insert and remove the IUD.
- Insertion may be uncomfortable or painful.
- There is a very small chance that the IUD could break through the wall of your uterus while it is being put in. (Fewer than 1 in 1000 insertions). Your uterus should heal if this happens.
- There is small chance your body could expel (push out) your IUD in the first year (2-10% of users). If this happens you are not protected from pregnancy. IUD expulsion is the most common in the first 6 weeks after insertion. Your clinician may recommend you use a back-up method of birth control like condoms or spermicides for the first 6 weeks.
- If your uterus expels the IUD and you would like another one inserted, you will have to pay for another IUD.
- If you have an STI or other infection when you have your IUD inserted, or if you get one within the first 3 weeks of having an IUD, you are at a slightly increased risk of developing pelvic inflammatory disease (PID). PID can be painful and can lead to infertility. The risk of PID after 3 weeks is not significantly higher when compared to people without IUDs.
- Some clinicians may be hesitant to prescribe an IUD to people who have a higher perceived risk of STIs.
- You may experience side effects.
- Some people may not be comfortable using a method that can take their period away.
- It doesn’t protect you from STIs.
Download Planned Parenthood Toronto’s info pamphlet on this subject: Hormonal IUDs
*We know that these aren’t the words everyone uses for their bodies (eg. trans folks), and support you using the language that feels best for you