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The IUSThis factsheet is for women who have heavy periods and are considering using the levonorgestrel intra-uterine system (Mirena coil). The levonorgestrel intra-uterine system (IUS) is a device that is a placed in the uterus (womb). It contains a hormone called levonorgestrel, which is released very slowly into the womb. An IUS can help women who suffer from very heavy periods (menorrhagia). The IUS can also be used as a contraceptive. What is an IUS?An IUS is a small T-shaped plastic frame that is 32mm (about an inch) long. The stem of the T has a small reservoir that contains the hormone called levonorgestrel. Why use an IUS?Heavy periodsVery heavy or very long periods can be quite disruptive to lifestyle and some women can feel depressed and tired due to excessive blood loss. An IUS can reduce the length and severity of your periods and in some cases can prevent ovulation. ContraceptionAn IUS is also an effective contraceptive. At least 99 women out of 100 using it per year won't get pregnant. Is it suitable for all women?Some women with heavy periods cannot use an IUS. If you have an abnormally shaped womb, or large fibroids, you are less likely to find an IUS effective and it may not be possible to fit it. There are a number of other conditions that may rule out an IUS for you. These include:
Your doctor will give you more advice. What are the alternatives?Alternative treatments for heavy periods include:
For more information about alternative contraception, please see the separate BUPA factsheets, Hormonal contraception and Non-hormonal contraception. How does it work?There is no single explanation of how an IUS can reduce heavy periods. It works by several different mechanisms but probably the most important is its influence on the womb. Every month, your ovaries (small organs where the egg cells are produced and stored) produce a hormone called progesterone. This causes the lining of the womb (the endometrium) to thicken, ready for the implantation of an embryo if pregnancy occurs. If you do not become pregnant, this lining is expelled from your body when you have your period. Over time, the IUS prevents the lining of the womb thickening each month. This makes it less likely to accept a fertilised egg. It also means that your period will be lighter as there is less of the womb lining to come away during your period. In some cases, the IUS can prevent ovulation. How is an IUS fitted?An IUS is fitted by a doctor or nurse. An instrument called a speculum will be placed in your vagina to enable your doctor or nurse to see the neck of your womb (cervix). A thin tube containing the IUS will then be passed through your cervix into your womb. The arms of the 'T' shaped IUS will open up when it is in place. Your doctor or nurse will then remove the tube, leaving the IUS inside your womb. Two strings attached to the IUS will hang down through the opening at the entrance of your womb (cervix) into the top of your vagina. Some women feel a little faint while this is being done and you may feel some discomfort. If you take a painkiller that you would normally take for a headache an hour before the fitting this should reduce any discomfort - but check with your doctor first. The IUS is usually fitted within seven days of the start of your last period. It is then immediately effective as a contraceptive. If it is fitted after the seventh day you will need to use other forms of contraception (condoms for example) for seven days.
Checking the IUSAbout six weeks after you have the IUS fitted, your doctor or nurse will need to check that it is still in place, and that you are not having any problems. After this, you should have checks every 12 months. At the end of five years, you will need to have the IUS removed and replaced. You can also check to make sure the IUS is still in place, simply by feeling for the two threads in your vagina. It's a good idea to check at the end of each period because the IUS can sometimes leave the womb with the monthly flow of blood. If you ever feel part of the T-frame in your vagina, you should see your doctor immediately because the IUS has become displaced. You should also see a doctor if you find sexual intercourse painful, or if your partner can feel the frame during intercourse. How will it affect my periods?To begin with, your periods may become longer. They 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 3 to 6 months after you had the IUS fitted. After this time your periods should be lighter and in some cases (and some cycles), you may not get a period at all. Can I use tampons with an IUS?You can still use tampons, they will not change the position of the IUS in your womb. PregnancyIt is very rare for a woman who has the IUS fitted to become pregnant. If this should happen, your doctor will advise removing the IUS, and also discuss whether you want to continue with the pregnancy. Removing the IUSIf you wanted to have the IUS removed, perhaps because you plan to have a baby, your doctor can remove it in a simple procedure. Your fertility will be restored immediately after the removal of the IUS. Deciding to use an IUSIf you have heavy periods and wish to avoid surgery, it is worth discussing the IUS with your doctor. The IUS is a commonly used treatment and for most people, the benefits are far greater than the disadvantages. However, you will want to take all the benefits and possible side-effects into consideration when making an informed decision about what is right for you. Side-effects are the unwanted but mostly temporary effects of a successful procedure. For an IUS, side-effects may include:
There is also a risk that an IUS can cause pelvic inflammatory disease, but this is rare. Side-effects usually improve after a few months. How do the side-effects compare to other treatments?The hormone released by the IUS mainly stays in the womb and very little gets into the blood stream. This means the dosage of hormone from the IUS in your circulation is lower than that with the standard progesterone only pill and very much lower than a standard combined oral contraceptive. Side-effects should therefore be milder. Further information
Sources
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and Mr Fraser Mcloed, FRCOG, consultant in gynaecology and obstetrics, BUPA Hospital Bristol and BUPA Women's Health Centre Bristol. Published by BUPA's health information team, healthinfo@bupa.com July 2006.
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