Everything You Need to Know About Hormonal IUDs (2025)

Hormonal intrauterine devices (IUDs) are a long-acting form of birth control that are over 99% effective. Hormonal IUDs are small devices that sit in the uterus, releasing tiny amounts of progestin, a synthetic form of the natural hormone progesterone. Progestin helps prevent pregnancy by thickening cervical mucus, thinning the uterine lining, and inhibiting sperm movement. In some cases, hormonal IUDs can also help reduce heavy menstrual bleeding and cramping.

What Is a Hormonal IUD?

A hormonal IUD is a small, T-shaped contraceptive device healthcare providers insert into the uterus to prevent pregnancy. A hormonal IUD releases small amounts of levonorgestrel (progestin) each day, a synthetic version of the hormone progesterone the body naturally produces. Progestin released from a hormonal IUD prevents pregnancy in several ways, such as:

• Affects sperm movement, making it more difficult for sperm to reach and fertilize an egg
• Thickens cervical mucus, preventing the sperm from entering the uterus
• Thins the uterine lining, reducing the likelihood of implantation if fertilization occurs

Hormonal IUDs are a long-acting, reversible contraception (LARC), offering a convenient, reliable form of birth control that can last three to eight years, depending on the brand. One of the advantages of a hormonal IUD is its reversibility—if you decide to become pregnant, you can have an IUD removed at any time to restore your fertility.

How Is the Hormonal IUD Different from Nonhormonal IUDs?

Ability to Prevent Pregnancy

Hormonal IUDs release progestin, which thickens cervical mucus, making it difficult for sperm to reach an egg, and thins the uterine lining to make implantation less likely to occur.

Nonhormonal IUDs contain copper, which creates a hostile environment for sperm. With a copper IUD, sperm cannot move well enough or survive long enough to reach and fertilize an egg.

Effect on Menstrual Bleeding

Hormonal IUDs help reduce heavy menstrual bleeding and ease painful menstrual cramps. Many users notice decreased bleeding within the first few months of use, and up to 20% of people with a hormonal IUD stop having periods entirely while using a hormonal IUD.

Treatment for Specific Conditions

Specific hormonal IUDs (those containing 52 milligrams (mg) of levonorgestrel) are also an effective treatment for atypical endometrial hyperplasia (AEH), a condition that causes abnormal, precancerous cells to thicken the uterine lining (endometrium). AEH develops when there is an excess of estrogen and too little progesterone. The progestin in hormonal IUDs helps thin the uterine lining, reducing the risk of progression to endometrial cancer in people with AEH.

How Long It Works

Hormonal IUDs may begin working immediately or take up to seven days to become effective, lasting anywhere from three to eight years, depending on the brand. Nonhormonal (copper) IUDs start working immediately after insertion and effectively prevent pregnancy for up to 10 years.

Side Effects of Hormonal IUDs

Hormonal IUDs are generally well-tolerated, but some people experience side effects. Side effects are typically mild and temporary and are usually more noticeable in the first few months after insertion. Common side effects of hormonal IUDs include:

• Acne
• Bacterial vaginosis
• Breast tenderness
• Cramping or discomfort during and shortly after insertion
• Headaches
• Irregular bleeding or spotting, especially in the first 3-6 months
• Lighter periods or, in some cases, no periods at all over time
  
• Mood changes, including irritability or low mood
  
• Nausea
• Ovarian cysts
• Pelvic pain

Short- and Long-Term Risks

Short-Term Risks

Complications with a hormonal IUD are rare. When they do occur, they typically happen during or shortly after insertion and can include:

• Pain or cramping during insertion: Some people experience temporary pain or cramping during the insertion procedure, which usually subsides within a few days.
• Spotting or irregular bleeding: It's common to experience irregular bleeding or spotting between periods in the first three to six months after insertion as your body adjusts to the IUD.
• Expulsion: An IUD can sometimes slip partially or entirely out of the uterus. This is more likely to happen in the first year after insertion and is most common in teenagers, those with heavy menstrual bleeding, or when IUD insertion takes place immediately after childbirth.
• Uterine perforation: Very rarely, the IUD may puncture the uterine wall during insertion.
• Pelvic inflammatory disease (PID): PID is a bacterial infection affecting the female reproductive organs (e.g., uterus, ovaries). PID is rare but can occur if you have an untreated sexually transmitted infection (STI) at the time of insertion.

Long-Term Risks

Possible long-term risks of hormonal IUD use include:

• Mood changes: Research suggests hormonal IUDs may increase the risk of depression in some people.
• Ovarian cysts: Hormonal IUDs may lead to the formation of ovarian cysts, which are usually small and resolve without requiring treatment.
• Pregnancy: Although pregnancy is very rare with an IUD, it can occur. The risk of an ectopic pregnancy—when an embryo implants outside of the uterus—is higher with an IUD.
  

Brand Names

Mirena

Mirena effectively prevents pregnancy for up to eight years after insertion. It begins working immediately if inserted during the first seven days of your menstrual cycle. Otherwise, it takes about seven days to prevent pregnancy.

Mirena is T-shaped, measuring 32 millimeters (mm) long by 32 mm wide. The device contains 52 mg of the hormone levonorgestrel and gradually releases it into the body. Within the first 24 days, it releases about 21 mcg per day. Over time, the release rate decreases to about 11 mcg per day after five years and seven mcg per day after eight years.

Kyleena

Kyleena prevents pregnancy for up to five years after insertion. It is effective immediately if insertion occurs during the first seven days of your menstrual cycle; otherwise, it takes seven days to work.Kyleena is a small T-shaped IUD measuring 28 mm long by 30 mm wide. It initially releases 17.5 micrograms (mcg) of levonorgestrel per day, decreasing to 7.4 mcg/day over time.

Liletta

Liletta effectively prevents pregnancy for up to eight years after insertion. If inserted during the first seven days of your menstrual cycle, it begins working immediately following insertion. Otherwise, it takes seven days to work. Liletta is a T-shaped device measuring 32 mm wide and 32 mm tall. It initially releases 20 mcg of levonorgestrel daily, decreasing to about 6.5 mcg/day after eight years.

Skyla

Skyla prevents pregnancy for up to three years. It is immediately effective after insertion if placed during the first seven days of your menstrual cycle; otherwise, it takes seven days to work. Skyla is a small, T-shaped device measuring 28 mm wide and 30 mm tall, making it ideal for those seeking a smaller IUD option. It initially releases 14 mcg of levonorgestrel daily, decreasing to about five mcg daily.

What to Expect for the Insertion and Removal Process

How to Prepare Before the Procedure

IUD insertion can take place at any point in your menstrual cycle and immediately following childbirth or an abortion. Before the IUD insertion procedure, your healthcare provider may recommend:

• Taking 800 mg of Advil or Motrin (ibuprofen) about 30 minutes before your appointment to ease discomfort or cramping during and after the insertion
• Bringing in test results or any information about existing health conditions, current medications, or history of pelvic or sexually transmitted infections
• Having a light meal and staying hydrated before the appointment to prevent dizziness or fainting during the procedure

Before the IUD insertion, your provider will ask about your medical history and perform a gynecological examination to check your vagina, cervix, and uterus. They may test you for STIs to lower the risk of bacterial infection.

During the Procedure

The IUD insertion procedure takes about five minutes and involves:

• Medicine to open or numb your cervix to reduce pain or discomfort (optional)
• Placing a speculum in your vagina and using a small tube to move the IUD through your cervix and place the IUD in your uterus

You might experience mild to moderate cramping or discomfort as your provider places the IUD in your uterus. Some people may experience dizziness during or immediately after IUD insertion, and there's a slight risk of fainting. It's a good idea to bring someone to the appointment so you won't need to drive or walk home alone.

After the Procedure

It's normal to feel cramping or backaches after an IUD insertion. Resting and holding a heating pad over your lower abdomen can help ease discomfort. You may experience breakthrough bleeding or spotting as your body adjusts to the IUD, but this typically goes away after three to six months, and most people can expect lighter periods with an IUD in place.

After the IUD is inserted, a string about 1 to 2 inches long will extend from your cervix into the upper part of your vagina. This string allows a healthcare provider to remove the IUD when it's time. If you want to check the string, you can carefully insert your fingers into your vagina and feel toward your cervix, but avoid pulling on the string, as this could dislodge or remove the IUD.

Removal

IUD removal is a simple process that takes only a few minutes if the string is visible. Your healthcare provider will gently pull on the IUD string to slide it out. If the IUD is difficult to remove, your provider may need to use tools, but this is rare. Most people experience mild cramping during removal, and some light spotting can occur, but this is normal and goes away quickly.

Hormonal IUD Alternatives

While hormonal IUDs are effective and convenient, they're not the right choice for everyone. Fortunately, there are several other contraceptive options available, including:

• Copper IUD (ParaGard, Miudella): A nonhormonal IUD that uses copper to prevent pregnancy for up to 3 years (Miudella) or 10 years (ParaGard).
• Birth control pills: Daily oral contraceptives contain a combination of estrogen and progestin or just progestin. They require consistent use but offer additional benefits like cycle regulation.
• Implant: A small rod inserted under the skin of the arm that releases progestin to prevent pregnancy for up to three years.
• Injection: An injection of progestin that provides contraception for about three months per dose.
• Patch: A patch that sticks to the skin on the buttocks, lower abdomen, or upper body (not the breasts) and delivers hormones through the bloodstream. You wear it for three weeks, removing it the week you menstruate.
• Vaginal ring: A flexible ring placed in the vagina that releases estrogen and progestin. You wear the ring for three weeks a month, removing it during menstruation.
• Barrier methods: Options like condoms, diaphragms, or cervical caps prevent sperm from reaching the egg without the use of hormones.
• Fertility awareness methods: Natural family planning techniques involve tracking the menstrual cycle to avoid intercourse during fertile days.
• Tubal surgery or vasectomy: Permanent options such as tubal ligation (getting your "tubes tied") for women or people assigned female at birth or vasectomy for men and people assigned male at birth for those who do not wish to have children in the future.

Summary

Hormonal IUDs are a highly effective, long-lasting birth control option that also offers benefits like reducing heavy periods and easing menstrual pain. They work by releasing progestin to prevent pregnancy and can last between three to eight years, depending on the brand. Insertion and removal are straightforward procedures, though some discomfort can occur during and shortly after the procedure. Ask a healthcare provider about the risks and benefits if you are considering a hormonal IUD.