Levonorgestrel IUD: Benefits, Side Effects, and How It Works

Summary of Key Points

The Levonorgestrel intrauterine device (IUD) is a long-acting, reversible form of birth control that also helps manage various gynecological conditions. It releases levonorgestrel, a hormone that prevents pregnancy and alleviates symptoms such as heavy menstrual bleeding and endometrial hyperplasia. A healthcare provider inserts the hormonal IUD into the uterus, where it can remain effective for 3 to 7 years, depending on the specific type. Always consult your doctor before starting or discontinuing any treatment.

Names of Medication

Mirena (levonorgestrel)

Liletta (levonorgestrel)

Kyleena (levonorgestrel)

Skyla (levonorgestrel)

The generic name, levonorgestrel, is the active ingredient in these medications, listed in parentheses after the brand name.

Pharmacologic Category

Progestin-only contraceptives

Hormonal intrauterine devices (IUDs)

Dosing

The Levonorgestrel IUD is used to treat various conditions, with the dosing and duration of treatment depending on the specific condition being addressed. Always consult your healthcare provider before making any changes to your dose or treatment plan. You can also schedule a telemedicine appointment with one of our providers for personalized advice.

Contraception

Mirena: Inserted once, effective for up to 7 years.

Kyleena: Inserted once, effective for up to 5 years.

Liletta: Inserted once, effective for up to 6 years.

Skyla: Inserted once, effective for up to 3 years.

Heavy Menstrual Bleeding

Mirena: Inserted once, effective for up to 5 years to reduce heavy menstrual bleeding.

Endometrial Hyperplasia (Prevention)

Mirena: Inserted once, effective for up to 5 years to prevent thickening of the uterine lining (endometrial hyperplasia).

Dysmenorrhea (Painful Periods)

Mirena: Inserted once, effective for up to 5 years to alleviate menstrual pain.

Endometriosis

Mirena: Inserted once, effective for up to 5 years to manage symptoms of endometriosis.

Uterine Fibroids

Mirena: Inserted once, effective for up to 5 years to help control symptoms of uterine fibroids, such as heavy bleeding.

Pelvic Inflammatory Disease (Prevention)

Mirena: Inserted once, effective for up to 5 years to reduce the risk of pelvic inflammatory disease (PID).

Amenorrhea (Absence of Periods)

Mirena: Inserted once, effective for up to 5 years to induce amenorrhea in women who prefer not to have periods.

Irregular Menstruation

Mirena: Inserted once, effective for up to 5 years to help regulate irregular menstrual cycles.

Premenstrual Syndrome (PMS)

Mirena: Inserted once, effective for up to 5 years to manage PMS symptoms.

Dosage Forms and Strengths

Mirena: 52 mg levonorgestrel, releases 20 mcg/day initially.

Kyleena: 19.5 mg levonorgestrel, releases 17.5 mcg/day initially.

Liletta: 52 mg levonorgestrel, releases 18.6 mcg/day initially.

Skyla: 13.5 mg levonorgestrel, releases 14 mcg/day initially.

Administration Instructions

The Levonorgestrel IUD must be inserted by a healthcare provider, typically in a medical office or clinic. Before insertion, your provider may perform a pelvic exam to ensure the IUD is appropriate for you. The device is placed inside the uterus, where it releases a small amount of hormone daily. Some discomfort during insertion is common but usually resolves quickly. After insertion, it’s important to regularly check the IUD strings to ensure the device remains in place. If you experience unusual symptoms, such as severe pain or heavy bleeding, contact your healthcare provider immediately. You can also schedule a telemedicine visit with one of our providers for further guidance.

Adverse Reactions and Side Effects

Like all medications, the Levonorgestrel IUD can cause side effects. Most are mild, but some may require medical attention. If you experience any of the following, contact your healthcare provider or schedule a telemedicine visit with us:

Common (1-10%):

Spotting or irregular bleeding: Light bleeding between periods is common, especially in the first few months after insertion.

Cramping: Mild to moderate cramping may occur after insertion.

Less Common (0.1-1%):

Ovarian cysts: Small, fluid-filled sacs may form on the ovaries but usually resolve on their own.

Headache: Some users report mild headaches after insertion.

Rare (<0.1%):

Pelvic infection: There is a small risk of infection during the first few weeks after insertion.

Uterine perforation: In rare cases, the IUD may puncture the uterine wall during insertion.

Contraindications

A contraindication is a condition where a treatment or medication should not be used because it may cause harm. For the Levonorgestrel IUD, several conditions make it unsuitable. Discuss these contraindications with your healthcare provider before starting treatment.

Pregnancy: The Levonorgestrel IUD should not be used during pregnancy as it can increase the risk of miscarriage, infection, or preterm labor.

Active pelvic infection: If you have an active pelvic infection, such as pelvic inflammatory disease (PID), using the IUD can worsen the infection and lead to serious complications.

Unexplained vaginal bleeding: If you have abnormal vaginal bleeding that has not been diagnosed, it’s important to determine the cause before using the IUD, as it may mask or worsen underlying conditions.

Uterine abnormalities: If you have structural abnormalities in the uterus, such as fibroids that distort the uterine cavity, the IUD may not fit properly and could cause injury or fail to work effectively.

Breast cancer: Levonorgestrel is a hormone, and if you have or have had breast cancer, using a hormonal IUD could potentially stimulate cancer growth.

Severe liver disease: Since the hormone in the IUD is processed by the liver, it is not recommended for individuals with severe liver disease, as it could worsen liver function.

Drug to Drug Interactions with Levonorgestrel IUD

Certain medications can interact with the Levonorgestrel IUD, potentially reducing its effectiveness or increasing the risk of side effects. It is essential to inform your healthcare provider about all the medications you are taking, including over-the-counter drugs and supplements.

Rifampin (Rifadin): This antibiotic can decrease the effectiveness of hormonal contraceptives, including the Levonorgestrel IUD.

Carbamazepine (Tegretol): Used to treat seizures, this medication can reduce the IUD’s effectiveness by increasing the breakdown of levonorgestrel in the body.

Phenytoin (Dilantin): Another anti-seizure medication that can lower the IUD’s effectiveness by speeding up the metabolism of levonorgestrel.

St. John’s Wort: This herbal supplement is known to decrease the effectiveness of hormonal contraceptives, including the Levonorgestrel IUD.

Levonorgestrel IUD and Pregnancy

It is not safe to use the Levonorgestrel IUD during pregnancy. If pregnancy occurs while the IUD is in place, there is an increased risk of miscarriage, infection, and preterm labor. If you suspect you are pregnant while using the IUD, contact your healthcare provider immediately. They may recommend removing the IUD to reduce the risk of complications.

Levonorgestrel IUD While Breastfeeding

The Levonorgestrel IUD is generally considered safe to use while breastfeeding. The small amount of hormone released does not significantly affect breast milk production or quality. However, it is always a good idea to discuss any concerns with your healthcare provider, especially if you are breastfeeding a newborn.

Estimated Cost of Levonorgestrel IUD

The cost of a Levonorgestrel IUD can vary depending on your location and pharmacy. Without insurance, the estimated cost using a GoodRx coupon ranges from $500 to $1,000 for the device. Unlike daily medications, the IUD provides long-term contraception for 3 to 5 years, eliminating the need for monthly refills.

Possible Alternatives to Levonorgestrel IUD

If the Levonorgestrel IUD is not suitable for you, or if you are exploring other options, there are alternative treatments and lifestyle changes for various conditions. Always consult your healthcare provider before making any changes to your treatment plan. You can schedule a telemedicine visit with one of our providers to discuss these options in more detail.

1. Endometrial hyperplasia: Alternatives include oral progestins, combined oral contraceptives, or, in severe cases, a hysterectomy. Weight loss and managing conditions like diabetes may also help reduce the risk.
2. Heavy menstrual bleeding: Non-hormonal options include NSAIDs like ibuprofen. Hormonal alternatives include oral contraceptives or tranexamic acid (Lysteda).
3. Dysmenorrhea (painful periods): NSAIDs, heat therapy, or hormonal birth control pills can help manage symptoms. Regular exercise and stress management techniques may also reduce pain.
4. Endometriosis: Hormonal treatments like oral contraceptives or GnRH agonists can help manage symptoms. In some cases, surgery may be necessary to remove endometrial tissue.
5. Uterine fibroids: Alternatives include medications like GnRH agonists, oral contraceptives, or surgery (myomectomy or hysterectomy). Uterine artery embolization is another option for shrinking fibroids.
6. Contraception: Other options include oral contraceptives, contraceptive implants (Nexplanon), or barrier methods like condoms or diaphragms.
7. Pelvic inflammatory disease (PID): Antibiotics are the primary treatment for PID. It is important to treat both partners to prevent reinfection. Regular STI screenings and safe sex practices can help prevent PID.
8. Amenorrhea (absence of menstruation): Treatment depends on the underlying cause. Hormonal therapies, lifestyle changes (such as weight management), or addressing stress can help restore normal menstruation.
9. Irregular menstruation: Hormonal birth control or lifestyle changes, such as maintaining a healthy weight and managing stress, can help regulate periods.
10. Premenstrual syndrome (PMS): Lifestyle changes like regular exercise, a healthy diet, and stress management can help. Some women benefit from hormonal birth control or antidepressants.

Recent Updates on Levonorgestrel IUD Research

Recent studies have explored the use of the Levonorgestrel IUD for conditions beyond contraception. Research suggests it may be effective in managing endometriosis symptoms, reducing the size of uterine fibroids, and treating endometrial hyperplasia. Ongoing studies are also investigating the long-term safety and effectiveness of the IUD in different populations, including adolescents and women approaching menopause. These findings are promising, but it is important to discuss the latest research with your healthcare provider to determine if the Levonorgestrel IUD is the right option for you.

James Kingsley

Learn More