Bleeding on the IUD

Top things to know:

• IUDs provide long-term (3 to 10 years) reversible contraception
• There are two types of IUDs: copper IUDs and hormone-releasing IUDs
• Copper IUDs may make bleeding heavier and more painful (but this decreases over time for most people); they don’t suppress ovulation
• Hormone-releasing IUDs may make bleeding lighter; they sometimes suppress ovulation

The IUD is becoming a more popular contraceptive choice. In the United States, 5.3% women choose to use an IUD (1).

IUDs can have different effects on your period quality and quantity. Regardless of the changes in bleeding patterns, 9 out of 10 users report being satisfied with their IUD contraceptive by 6 months (2). But if you are considering getting an IUD and wondering what your period will be like after it’s inserted, here is what you should know.

What is an IUD?

An intrauterine device (IUD) is a type of female contraceptive that is inserted through the vagina into the uterus. The most common types of IUDs are T-shaped and plastic, and contain either a synthetic progesterone or copper. IUDs provide long-term contraceptive protection for 3 to 10 years (or more), depending on the type. IUDs do not protect you from sexually transmitted infections, so it’s important to combine them with a barrier method (like condoms) when having sex with a partner of unknown STI-status.

IUDs can affect your period in several different ways, depending on the type. Here’s how they differ:

1. Hormone-releasing IUD

The hormone-releasing IUD contains a synthetic version of progesterone called progestin, which is continuously released at a low daily dose. Progestin works to prevent pregnancy in several ways: it thickens cervical fluid to prevent sperm from travelling into the uterus, thins the uterine lining, and also sometimes suppresses ovulation (3). Ovulation suppression depends on the dose of progestin released from the IUD. For example, IUDs with a lower progestin dose are less likely to suppress ovulation in comparison IUDs with a higher progestin dose (4,5). The rate of ovulation suppression also seems to decrease the longer the IUD is worn (4). The presence of the IUD within the uterus causes an irritation, creating an inflammatory reaction in the uterus that makes it inhospitable to both egg and sperm (5). A single Hormonal IUD can last for 3 to 5 years, depending on the type.

How will my period change on the hormonal IUD?

Since the hormonal IUD thins the uterine lining and may inhibit ovulation (the release of an egg from the ovary) your period is likely to be different. Two out of three hormonal IUD users experience lighter bleeding within six months (6). Some people report spotting or unscheduled bleeding between periods (7,8). Many people using hormonal IUDs also report a decrease in cramping. You might stop getting your period at all (7,8). All of these changes are considered normal.

The hormonal IUD may be helpful for people who experience unmanageable pain with menstruation (dysmenorrhea), heavy menstrual bleeding, or endometriosis (8,9).

2. Copper intrauterine device (IUDs)

The copper IUD is a device that is inserted into the uterus by a medical professional. Like the hormonal-IUD, the copper IUD also causes physical irritation, creating an inflammatory reaction in the uterus (3). The copper IUD does not contain hormones, but instead prevents pregnancy by enhancing the inflammatory reaction which blocks sperm mobility and egg implantation. Because copper IUDs do not exert any changes to your hormone profile, users still ovulate and have a menstrual period. A single copper IUD can protect against pregnancy for up to 10 years, depending on brand.

Copper IUDs can also be used as an emergency contraceptive device when they are inserted up to 5 days after intercourse (7,10).

How will my period change on the copper IUD?

The copper IUD does not prevent ovulation, so you will still experience a menstrual period. But it is common for people to experience heavier or longer periods, as well as unscheduled spotting or bleeding, during the first few months of use (7,11). Upon starting the copper IUD, 6 in 10 people reported increased cramping and 7 in 10 reported increased bleeding during the first three months of use (6). These symptoms have been shown to decrease over time in most people (7,11). For people who do experience increased menstrual bleeding, there is an increased risk of developing an anemia due to excessive blood loss. Among copper IUD users with increased irregular bleeding, there may be an increase in prevalence of bacterial vaginosis (a bacterial overgrowth in the vagina), but more research is needed (12).

With both the copper IUD and hormonal IUD, there is an increased chance of spotting or bleeding for a few months after insertion (13). Choosing an IUD can be a difficult decision, so be sure to speak to your healthcare provider to see if an IUD is the right birth control choice for you.

Download Clue today to track your birth control and to learn more about how your period changes.

References

1. United Nations. World Contraceptive Use 2011. Accessed Oct 19 2017. http://www.un.org/esa/population/publications/contraceptive2011/contraceptive2011.htm

2. Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of Short-term Bleeding and Cramping Patterns with Long-Acting Reversible Contraceptive Method Satisfaction. Am J Obstet Gynecol. 2015;212(1):50.e1–50.e8.

3. Ortiz ME, Croxatto HB: Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 75:S16, 2007

4. Product monograph Pr Kyleena® levonorgestrel-releasing intrauterine system (19.5 mg). Bayer. Mississauga: [revision date: 2017 Sep 28; cited: 2017 Dec 6]. Pp 30,31. Available from: http://omr.bayer.ca/omr/online/kyleena-pm-en.pdf

5. Mirena monograph. Bayer. Whippany; [revision date: 2017 Jun; cited: 2017 Dec 6]. Pp 20. Available from: https://labeling.bayerhealthcare.com/html/products/pi/Mirena_PI.pdf

6. Diedrich JT, Desai S, Zhao Q, Secura G, Madden T, Peipert JF. Association of Short-term Bleeding and Cramping Patterns with Long-Acting Reversible Contraceptive Method Satisfaction. Am J Obstet Gynecol. 2015 Jan; 212(1): 50.e1–50.e8.

7. Centres for disease control and prevention. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. Morbidity and Mortality Weekly Report. 2016;65(4):7–14.

8. Kailasam C, Cahill D. Review of the safety, efficacy and patient acceptability of the levonorgestrel-releasing intrauterine system. Patient Prefer Adherence. 2008;2:293–302.

9. Brown J, Farquhar C. Endometriosis: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD009590.

10. Wu S, Godfrey EM, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial.BJOG. 2010;117(10):1205.

11. Hubacher D, Chen PL, Park S. Side effects from the copper IUD: do they decrease over time? Contraception. 2009 May;79(5):356–362.

12. Madden T, Grentzer JM, Secura GM, Allsworth JE, Peipert JF. Risk of Bacterial Vaginosis in Users of the Intrauterine Device: A Longitudinal Study. Sexually Transmitted Diseases. 2012;39(3):217–222.

13. Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs and World Health Organization. Family planning: a global handbook for providers. 2011 Update. WHO; 2011. Pp 131–164.