The hormonal IUD, also known as an intrauterine system (IUS), is a plastic body about three centimeters in size, usually T-shaped, that is inserted into the uterus like the conventional IUD. While contraception in the latter is provided, among other things, by the copper ions released, the IUS releases a small amount of the synthetically produced hormone levonorgestrel into the body. The hormonal IUD is one of the safest methods of contraception. The risk of unwanted pregnancy despite hormonal IUD is about the same as sterilization.
Hormonal IUD: Effect
Contraception is provided from the first day of use and for a period of up to five years. Unlike the pill, the hormonal IUD releases the hormone locally, which means that only very small amounts enter the circulation. The hormonal IUD provides contraception in several ways:
- The luteal hormone levonorgestrel makes the mucus in the cervix thick. The permeability for sperm is thus made more difficult.
- The nevertheless coming through sperm are inhibited by the hormone in their activity.
- It comes to the influence up to the suppression of ovulation and egg maturation.
- The endometrium changes, making it difficult for a fertilized egg to implant.
Insert hormone IUD
Insertion of the hormonal IUD proceeds similarly to the copper IUD. First, a gynecological examination is performed, during which possible diseases are ruled out and risks are discussed. The size of the uterus is also measured to help determine the optimal position of the IUD. A special applicator is used to insert the hormonal IUD into the uterus after the genital area has been sterilized. The threads attached to the hormone coil are used for self-monitoring and are later used for removal. The doctor cuts the threads to a convenient length. Since insertion of the hormonal IUD can cause a slight pulling sensation or even more severe pain, patients should discuss with their doctor in advance whether anesthesia is advisable or desired.
Hormonal IUD: side effects not insignificant
The hormone IUD, which has been approved in Germany since 1996, can cause a number of side effects. Therefore, doctors must provide detailed information about the hormone IUD. Since 2007, physicians have also been required to provide interested patients with information on the use of the hormone-releasing intrauterine device and its side effects. If a woman decides to have a hormone-releasing intrauterine device (IUS), she must provide written informed consent and confirmation of information about possible risks before insertion. Side effects include (frequency especially pronounced during the first six months of the adjustment period):
- Cycle disturbances: Irregular menstruation or no menstruation at all (or intermittent bleeding).
- Pain: headaches, migraines, abdominal pain, tightness or pain in the chest, back pain.
- Skin rash, itching, eczema, acne (in isolated cases, negative effects on hair, increased body hair may also occur).
- Nervousness, mood swings and depressive moods (up to suicidal thoughts), loss of libido.
- Weight gain, water retention in the tissues
- Ovarian cysts (usually benign).
- Possible increased risk of breast cancer and thrombosis (roughly equivalent to combined oral contraceptives).
- Inflammation: Pelvic area, uterus, cervical mucus, vaginal mucosa and outer labia.
Hormonal IUD even in young women and breastfeeding?
The hormonal IUD is a fairly common contraceptive method in Germany and is particularly popular with women who are
- Have already given birth one or more times
- Want to use contraception in the long term
- Not tolerate the estrogen in certain contraceptives
- Have a very heavy menstrual period
In countries such as the United States or Sweden, hormonal IUDs are also a common contraceptive method for young, childless women. In Germany, however, many gynecologists advise against a hormonal IUD in the aforementioned group of people. The reason for this is not the risk of infection, which has since been disproved, but the pain that can occur both during insertion and withdrawal of the IUD, as well as the other side effects mentioned.In the meantime, there are extra small hormonal IUDs, so that these can also be an option for young women without children. A detailed consultation and explanation by the gynecologist is recommended in any case. A hormonal IUD can also be used during breastfeeding, as it has no effect on milk production or the child. However, insertion should not take place until six to eight weeks after birth, when the uterus has completely regressed.
Hormonal IUD: cost and price
The cost of the hormonal IUD is covered only for women up to the age of 20 and for women eligible for social assistance. Those who want to have the hormone IUD inserted should be sure that contraception is desired for a longer period of time. However, the initially relatively high costs of the hormone IUD of up to 400 euros pay off in comparison to the pill after the intended period of five years. The semi-annual ultrasound examinations to check the correct position of the hormone IUD – except for the first one after four to six weeks – are not paid for by the health insurance. Since the hormonal IUD is also used to treat menstrual cramps and to treat very heavy menstrual bleeding, the cost of the IUD is covered by health insurance in this case – provided that the hormonal IUD is prescribed exclusively for this reason.
Remove hormonal IUD
After five years, the effectiveness of the hormones wears off and contraception becomes less reliable. Women who now wish to have a child may become pregnant again as early as the next cycle after removing the hormonal IUD. If you want to continue using hormonal contraception, you can have a new IUD inserted immediately after removing the old one. The change should be made during menstruation; for women who are no longer menstruating, the hormone IUD can be changed at any time. More than half of all women who have the IUD inserted for the second time no longer have a menstrual period at all. When the hormonal IUD is changed directly, the side effects of the adjustment phase do not occur.
