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The IUS for heavy periods
Published by Bupa's health information team, July 2008.
This factsheet is for women who are considering having the intra-uterine system (IUS) for heavy periods, or who would like information about it.
The IUS is a contraceptive device that's placed in the womb (uterus). It can also help women who suffer from very heavy periods (menorrhagia).
About the IUS
The IUS is an effective contraceptive. Over five years, fewer than one in 100 women who use the IUS will get pregnant.
The IUS is a small T-shaped plastic frame that's fitted inside your womb. The stem of the "T" has a small reservoir that contains a hormone called levonorgestrel. Levonorgestrel is similar to the natural progesterone hormone that's produced by your ovaries each month.
The type of IUS available in the UK is called Mirena. This can be placed in your womb for up to five years.
Why use an IUS for heavy periods?
Very heavy periods can be quite disruptive to your lifestyle and increase your risk of developing anaemia. Your doctor may recommend the IUS to help manage your heavy periods.
Is it suitable for all women?
Your family and medical history will help determine whether or not you're suitable for the IUS.
For example, the IUS may not be suitable for you if you have a personal history of fibroids, liver disease, breast or endometrial cancer, or bleeding from your vagina with no known cause (for example between periods or after sex).
What are the alternatives?
Alternative treatments for heavy periods include:
medicines (these may or may not contain hormones, such as the combined contraceptive pill)
endometrial ablation (also called endometrial resection)
If you would like information on whether these treatments would be suitable for you, contact your GP for advice.
How does the IUS work?
There is no single explanation of how an IUS can reduce heavy periods. It works in several different ways but probably the most important way is how it affects the lining of your womb (endometrium).
During each menstrual cycle, the lining of your womb thickens and gets ready for an embryo to implant if one of your eggs is fertilised. If you don't become pregnant, the womb lining breaks down and you have a period. A period is your body's natural way to remove the lining of your womb.
The IUS releases levonorgestrel very slowly into the womb. This hormone stops the lining of your womb thickening each month, making your periods shorter and lighter.
The IUS works as a contraceptive by making it difficult for an embryo to implant in your womb. It can also thicken the mucus that your cervix produces and this can help prevent sperm from entering your womb.
In some cases, the IUS can also stop your ovaries producing eggs, however this is temporary and your ovaries will return to normal function once your IUS is removed.
How is an IUS fitted?
An IUS is fitted by your GP, gynaecologist, or by a specially trained nurse. An instrument called a speculum is placed in your vagina to help view the neck of your womb (cervix). A thin tube containing the IUS is then passed up through your vagina into your womb. The tube is removed once the IUS is in place. The IUS opens up into a T-shape when it's in your womb.
Two strings attached to the IUS will hang down through the neck of your womb into the top of your vagina.
The IUS is usually fitted within seven days after the start of your last period. This is when the womb lining is at its thinnest and so the IUS can be immediately effective as a contraceptive. It's also when your cervix is slightly more open and therefore it's easier to pass the IUS into your womb. If your IUS is fitted after the seventh day you will need to use other forms of contraception (condoms for example) for seven days.
You may feel a little faint when you're having an IUS fitted and you may feel some pain and discomfort. You may also get light bleeding for a few days after having an IUS fitted.
Taking over-the-counter painkillers such as paracetamol or ibuprofen an hour before the fitting can help minimise any discomfort. Always follow the instructions in the patient information leaflet that comes with medicine and ask your pharmacist for advice.
What to expect after having your IUS fitted
Your periods may last longer than usual for the first few months after having IUS fitted. Your periods may also become more irregular and you may have some bleeding between periods. This can be disappointing when you had expected the IUS to make your periods lighter but it should settle down within a few months of having your IUS fitted.
After a few months, your periods should become lighter. It's possible you may not have a period at all which is perfectly normal.
During a period, you can still use tampons. Tampons will not change the position of the IUS in your womb.
Checking your IUS
About six weeks after having your IUS fitted, your GP, gynaecologist or nurse will check that it's still in place, and that you aren't having any problems. The IUS can then stay in place for five years. You will need to have the IUS removed and replaced after five years.
You can keep a check on the IUS yourself by simply feeling the two threads in your vagina. But don't pull on the threads. It's a good idea to check at the end of each period because the IUS can sometimes move into the neck of your womb during your period.
You should contact your GP if your partner feels the IUS during sexual intercourse or if you:
feel part of the T-frame in your vagina
feel any discomfort
find sexual intercourse painful
If any of this happens, it's likely that the IUS has moved out of place and you may need to have it re-fitted.
Removing your IUS
The IUS is simple to remove and can be taken out easily if you wish. You should not attempt to remove the IUS by yourself. Your GP or nurse will examine you and then remove the IUS by gently pulling on the threads that hang down into your vagina.
You may feel slight discomfort for a second or two as your IUS is removed.
You can usually have another IUS fitted immediately after having your old one removed if you wish.
The contraceptive effect of your IUS disappears as soon as it's removed and your fertility will return to normal. You may need additional contraception in the days leading up to removal of your IUS and so it's best to discuss this with your GP. He or she can also tell you about alternative forms of contraception if you do not wish to get pregnant after your IUS is removed.
These are the unwanted but mostly temporary effects of a successful procedure. After having an IUS fitted you may develop tender breasts, acne, headaches and have mood changes.
There is a small chance that your IUS can be expelled after it's inserted; this happens in about one in 20 women.
It's possible you may develop cysts on your ovaries. These are usually harmless and cause no symptoms and they usually get better without treatment.
Very rarely, the IUS can increase your risk of developing pelvic inflammatory disease. However, your risk is only increased when you have your IUS fitted, and up to 20 days afterwards. After this, you won't be at an increased risk of developing pelvic inflammatory disease compared to women without an IUS.
If you're worried about any side-effects, contact your GP or nurse for advice.
If you become pregnant
It's very unlikely that you will become pregnant after you have had the IUS fitted. However, if you do become pregnant, your GP will advise you to have your IUS removed.
- Heavy menstrual bleeding. National Institute for Health and Clinical Excellence (NICE), January 2007. www.nice.org.uk
- Long-acting reversible contraception. National Institute for Health and Clinical Excellence (NICE), October 2005. www.nice.org.uk
- Thonneau PF, Almont TE. Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008; 198(3): 248-253. http://journals.elsevierhealth.com/periodicals/ymob
- British National Formulary (BNF). BMJ Publishing Group. 2007. 54:429-431
- Lethaby AE, Cooke I, Rees M. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochane database of systematic reviews 2005; Issue 4. http://mrw.interscience.wiley.com
- Faculty of family planning and reproductive health care (FFPRHC). FFPRHC Guidance. The levonorgestrel-releasing intrauterine system (LNG-IUS) in contraception and reproductive health. J Fam Plann Reprod Health Care 2004; 30:99-109. www.ingentaconnect.com
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Andrew Hextall, MD FRCOG, Consultant Obstetrician and Gynaecologist, Spire Harpenden, Harpenden, and by Bupa doctors. It has also been reviewed by Women's Health Concern. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
Publication date: July 2008.