IUD’s, Mirena, Kyleena, Skyla and Paragard

IUD’s are T-shaped plastic devices placed in the uterus and provide long-term birth control. Some have hormones at varying doses and one (Paragard) is copper and has no hormone. They can be used in women of all ages. They can be removed at any time, followed by a quick return to normal fertility. They can also be used while breastfeeding, and they don’t carry the risk of side effects related to birth control methods containing estrogen, so can be used in women with medical problems such as high blood pressure, migraine headaches, and smokers.

Mirena IUD – has the highest hormone level of all the IUD’s. This is a progesterone hormone that is slowly released in the uterus to prevent pregnancy for up to 5 years. It works by thickening the mucus in the cervix to stop sperm from reaching or fertilizing an egg. It also thins the lining of the uterus and partially suppresses ovulation.

For the first 3 to 6 months, you may also have frequent spotting or light bleeding but once your body adjusts, your bleeding decreases, and your periods may stop altogether.  By one year at least 1 out of 5 (and up to 60%) of users have no period at all. Once it’s placed, just do a monthly thread check to make sure it’s in the correct position. Dr. Fleming will explain how. If you don’t feel the threads or feel more than just the threads, call our office as Mirena may not be in the right position and may not prevent pregnancy. Use non-hormonal back-up birth control (such as condoms and spermicide) until Dr. Fleming can check that Mirena is still in the right place.

Your periods will return once Mirena is removed.

Benefits of Mirena include:

• Can remain in place for up to five years.
• Reduces severe menstrual pain and pain-related endometriosis.
• Reduces the risk of pelvic infection.
• Reduces the risk of endometrial/uterine cancer.
• Reduces heavy menstrual bleeding.
• Reduces anemia in women with heavy menstruation.

Risks and safety information:

• Less than 1 percent of women who use Mirena will get pregnant in a year of typical use.
• If you do conceive while using Mirena, you’re at higher risk of an ectopic pregnancy (fertilized egg implants outside the uterus, usually in a fallopian tube), however, because Mirena prevents most pregnancies, women who use it are at lower risk of having an ectopic pregnancy than are other sexually active women not using contraception.
• Mirena does not protect against STIs so please use condoms if you have any risks and/or a new partner.
• Rarely, insertion of Mirena causes perforation of the uterus. The risk of perforation might be higher when inserted after a recent pregnancy.

Side effects with Mirena are uncommon but may include:

• Headaches
• Acne
• Breast tenderness
• Irregular bleeding, which can improve after six months of use.
• Mood changes
• Cramping or pelvic pain
• Mirena expulsion from your uterus, particularly if you have never been pregnant, have heavy or prolonged periods, have previously expelled an IUD, are younger than age 20, had inserted immediately after childbirth.

Kyleena and Skyla IUD’s: are made by the same company as Mirena, but have less hormone and are slightly smaller. Skyla has the least amount of hormone and works for up to 3 years. Kyleena is between Skyla and Mirena and works for up to 5 years. These IUD’s may be an option for patients with smaller uteruses and those who would like some benefit of reduced period cramps and less bleeding, but want to limit hormones. They will, however, not have as much of a benefit as Mirena.

Paragard (copper) IUD: is a T-shaped plastic IUD that has a copper wire coiled around the device, produces an inflammatory reaction that is toxic to sperm and eggs, preventing pregnancy for up to 10 years after insertion. The most common side effects of PARAGARD are heavier and longer periods and spotting between periods; for most women, these typically subside after 2 to 3 months.

IUDs should not be used if you have:

• Acute pelvic inflammatory disease (PID) or current behavior suggesting a high risk of PID
• A postpregnancy or post-abortion uterine infection in the past 3 months
• Cancer of the uterus or cervix
• An infection of the cervix
• An allergy to any component
• Wilson’s disease (Paraguard only)
• An allergy to copper (Paraguard only)

 

When can your IUD be inserted:

• Anytime during your menstrual cycle as long as we can be sure you’re not pregnant. You may need to take a pregnancy test to confirm you’re not pregnant.
• Immediately after a pregnancy termination.
• Immediately after delivering a baby vaginally or by cesarean section, but does increase the risk of expelling your IUD.

Preparing for insertion:

• Take a nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin IB, others), one hour before the procedure to help reduce cramping. You have the option of a stronger nonsteroidal, Toradol, which is an intramuscular injection given in the office 30 minutes before insertion and has been shown in studies to reduce the pain after insertion.
• Make sure you have had something to eat within 2 hours of your procedure.

Insertion procedure:

• Dr. Fleming will insert a speculum into your vagina and clean your vagina and cervix with an antiseptic solution. Special instruments might be used to gently align your cervical canal and uterine cavity and to measure the depth of your uterine cavity.
• The IUD is folded in an applicator tube, which is inserted into your cervical canal and then gently placed in your uterus. The IUD is then released and the applicator tube is removed. The IUD strings will then be cut and length of the strings recorded.
• During IUD insertion, you may experience cramping, dizziness, fainting or a slower than normal heart rate.

After insertion:

• No intercourse and nothing in the vagina, including tampons, for 48 hours after insertion.
• If you have IUD inserted more than seven days after the start of your period, be sure to use backup contraception for one week.
• Once a month, check to feel that IUD strings are protruding from your cervix. Be careful not to pull on the strings.
• About a month after the IUD is inserted, Dr. Fleming may re-examine you to make sure IUD hasn’t moved and to check for signs and symptoms of infection.

Call Dr. Fleming if you have any of the following:

• Think you may be pregnant
• Unusually heavy, persistent vaginal bleeding
• Abdominal pain or pain during sex
• Unexplained fever
• Unusual or foul-smelling vaginal discharge
• Develop very severe headaches or migraines
• Have yellowing of the skin or eyes
• Can no longer feel the IUD strings, or they suddenly seem longer

IUD removal: Dr. Fleming will use forceps to grasp the device’s strings and gently pull. The device’s arms will fold upward as it’s withdrawn from the uterus. This is usually very quick and well tolerated. Light bleeding and mild cramping are common during removal. Rarely, removal can be more complicated.

Please see Dr. Fleming near Boston, MA for a consultation to determine which IUD will be best for you based on your concerns and preferences, as well as your medical history. She will check your blood pressure, your weight and review your medical history and medications you’re taking and together will choose a method that is best for you.