Levonorgestrel intrauterine system with hormone replacement therapy
The Levonorgestrel intrauterine system (IUS)
There are a number of IUS with differing licensed indications but only the 52.5mcg levenorgestril IUS may be used for menopause hormone replacement.
When a lower dose IUS is used twice yearly vaginal ultrasound scans (USS) are recommended to assess the endometrial (womb lining). If you experience irregular or unexpected bleeding contact your GP for further advice.
All IUS deliver a lower systemic dose of progestogen compared to any other progestogen product and be recommend if there is a history of severe progesterone intolerance.
The individual risks and benefits of using the IUS with HRT should be discussed with your health care professional.
Inserting or replacing an IUS
All IUS are licenced for contraception. If you are perimenopausal and need contraception your local GP or family planning service should be able to insert or change your coil. If you are postmenopausal and need an IUS inserted or changed, please ask your GP which local service you should be referred to.
An IUS cannot be inserted if there is a risk of pregnancy. Prior to insertion you will assessed for pregnancy risk.
Abdominal pain or cramps are commonly experienced with insertion of an IUS. It is recommended to take simple over the counter pain killers one hour before the procedure. A local anaesthetic gel or injection may be used during the procedure.
If you have any concern about having and IUS inserted whilst awake, please discuss this with your GP or specialist. It may be possible to have an IUS inserted with sedation or under general anaesthetic.
If your IUS is for contraception, avoid vaginal sexual intercourse or use barrier contraception for seven days. You may continue normal activity after the procedure as long as you feel comfortable and not in pain. Simple pain killers may be continued for at least 48-72 hours.
Common side effects
Following insertion of an IUS, common progestogen side-effects may occur including bloating, fluid retention and PMS-type symptoms. These symptoms generally settle within the first few months.
Risks of insertion of and IUS
- Some bleeding is commonly experienced after insertion of an IUS which may persist as spotting or irregular bleeding up to 6 months.
- 1 in 1000 (0.1%) IUS insertions may result in perforation of the womb at the time of insertion. See your GP or attend A&E if you have persistent abdominal pain. An ultrasound scan will be requested to check the position of the coil.
- A uterine infection after IUS insertion occurs in less than 1 in 100 (1%) IUS insertions. See your GP or attend A&E if you develop a temperature, abdominal pain or offensive discharge. Uterine infections are usually treated with antibiotics.
- Following insertion, 1 in 20 (5%) individuals may experience the IUS being expelled usually within the first six weeks. If the threads cannot be felt or seen at the entrance of the cervix, the GP may request an ultrasound scan can verify the position of the IUS or referred to a local gynaecology service.
Discontinuation of an IUS
- If your estrogen has been discontinued then the IUS should be removed.
- If you still require contraception, discuss your contraceptive needs with your GP or family planning clinic first.
- If you plan to continue with HRT or on estrogen implants, a suitable alternative progestogen must be prescribed before the IUS is removed.