Hormonal IUDs are generally known as an effective birth control method. While it may not be the first thing you think of for menopause symptoms, it can help manage them. Read on to find out how it can alleviate troubling symptoms like excessive bleeding and irregular periods.
Find what you need quickly
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How does a hormonal IUD work?
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How is a hormonal IUD helpful in menopause?
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What are the benefits of using a hormonal IUD during menopause?
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How is it inserted?
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How long does it take for a hormonal IUD to stop periods?
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Does a hormonal IUD always stop periods?
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Does a hormonal IUD hurt?
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What are the side effects of a hormonal IUD?
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What does a hormonal IUD look like?
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How long does it take for the strings to soften?
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How long does a hormonal IUD last?
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Alice’s story
How does a hormonal IUD work?
A hormonal IUD releases progesterone hormone into your uterus. The Liletta IUD and Mirena IUD are both hormonal IUDs. They contain the same dose of progesterone and work in the same way.
A hormonal IUD can:
- Regulate cycles
- Reduce blood flow if you have heavy periods
- Prevent undesired pregnancy
It works by thickening the mucus in your cervix which prevents sperm from fertilizing an egg. It also thins your uterine lining, reducing bleeding. This is why a hormonal IUD can really help for heavy periods.
A hormonal IUD does not protect you from sexually transmitted infections so use a condom unless and until you are confident you and your partner are monogamous.
Find out more about contraception and menopause.
How is a hormonal IUD helpful in menopause?
A hormonal IUD has a number of uses during menopause. As well as being a good treatment for heavy periods and a reliable contraceptive, a hormonal IUD can be used as part of your HT.
HT works by supplying your body with estrogen. This supplies estrogen to your body when it no longer makes enough.
If you still have a uterus you also need to take progesterone. This is because estrogen can lead to abnormal thickening and even cancer of the uterine lining if taken alone. Taking progesterone with estrogen removes this risk.
That’s where a hormonal IUD comes in handy. It works by slowly releasing progesterone into the uterine lining so it stays thin. It can therefore be used instead of oral or transdermal progesterone to protect the uterine lining.
While Mirena IUD is not FDA-approved for endometrial protection in the US, there is clinical research to support this use.
What are the benefits of using a hormonal IUD during menopause?
Using a hormonal IUD such as Mirena or Liletta as part of HT has a few advantages.
- It is low-maintenance. Once inserted, its protection lasts for five years
- Since the progesterone is delivered directly to the uterine lining, this means that the rest of your body is exposed to lower levels of progesterone. Less progesterone ends up in your bloodstream when using a hormonal IUD compared to using, for example, a progesterone pill or patch
- You have the added benefit of the hormonal IUD acting as a reliable contraceptive, and making your periods lighter
How is it inserted?
You can get a hormonal IUD inserted by your healthcare provider. The IUD is not suitable for everyone, and it’s important to ask your healthcare provider if it is a suitable option for you.
The procedure can be done by your healthcare provider. They may discuss the advantages and disadvantages of using local anesthesia. They will ask you to lie on the gynecological exam table and then insert the IUD through your cervix and into your uterus. Most people experience some moderate pain and cramping during the procedure, and it generally takes less than five minutes for the actual insertion.
The appointment takes about 30 minutes in total. You will be asked to schedule a follow-up appointment – sometimes with an ultrasound – to check the IUD is in the correct position.
How long does it take for a hormonal IUD to stop periods?
A hormonal IUD can be ideal for those experiencing heavy or painful periods, as it usually results in lighter and shorter periods – even stopping periods in some cases.
Although the contraceptive effects are established after seven days, it does take a while for the hormonal IUD to influence your periods. When your hormonal IUD is inserted, you may find that your periods are longer or heavier than usual for the first three months. If symptoms persist past this time, you should go back to your healthcare provider to be reviewed. After six months, you should notice lighter bleeds or none at all.
Does a hormonal IUD always stop periods?
A hormonal IUD can affect periods in a number of ways.
By the end of the first year on the Mirena IUD:
- 20% of people will have no periods
- Just over 30% will have infrequent periods
These effects increase as time passes. By the end of five years with a hormonal IUD, just over 40% of users will have no periods at all. Overall, around 80% of users found that their bleeding was at least ‘much lighter’ after a year of use.
If your periods spot when using a hormonal IUD, after your IUD is changed you may notice some light bleeding in the first three months. This is to be expected, and tends to settle after this time.
If you’re struggling with heavy bleeding despite having a hormonal IUD, speak to your healthcare provider. They may want to refer you for further tests in order to rule out any other potential causes.
Does a hormonal IUD hurt?
When a hormonal IUD is inserted into your uterus via your vagina, it can be uncomfortable. The exact sensation varies from person to person. For some, there will be a little discomfort, as if you were having a pap smear. For others, it can feel quite painful. Your healthcare provider will be able to guide you.
You may suffer cramps similar to period pains for a day or two. Take painkillers, such as ibuprofen or tylenol, if you need to. If you have any severe pain, speak to your healthcare provider immediately so they can check to make sure the IUD is in the correct position.
What are the side effects of a hormonal IUD?
There can be some side effects when using a hormonal IUD, including breast tenderness and mood swings. Find out more on the Cleveland Clinic website.
What does a hormonal IUD look like?
A hormonal IUD is a T-shaped plastic device that is inserted into your uterus. It has two threads that hang down into the very top of your vagina. You can feel these to check the IUD is in place
How long does it take for the strings to soften?
At the beginning, you may be very aware of the ends of the threads. Over time, the threads will soften and you won’t be able to feel them.
Often the threads can be an issue in relation to sex and may cause discomfort or pain. This problem can usually be solved by your healthcare provider who can trim the threads so they are shorter.
Find out more about painful sex in menopause.
How long does a hormonal IUD last?
A hormonal IUD is a great option for a long-lasting treatment. Exactly how long it lasts depends on what you’re using it for.
If you are using Mirena or Liletta for contraception only, it can be used for eight years. If you are aged 45 or over when it is inserted, it can last until you reach age 55. You may notice that this is longer than previously recommended. Guidance was updated in 2024 to reflect the results of a new trial looking at Mirena use beyond the previously recommended five-year window.
However, if you are using it to treat heavy periods or as part of your HT, it is still recommended that it be replaced after five years.
If you have any issues with your hormonal IUD, you can get it removed at any time.
Alice’s story
I always felt lucky when it came to periods. I didn’t have cramps, they weren’t particularly heavy and didn’t last very long. Usually, I bled for four days every 32 days and was always regular. All this changed when I hit 40 and my usual period turned into a raging river. Thankfully, help has come in the form of a Mirena IUD, which has given me back energy and confidence.
The big gush
I can clearly remember when my periods began to change. My cycle went out of sync, arriving early and suddenly. I felt hot, wet blood gush down my legs while I was on stage hosting a conference. I was wearing a skirt suit in front of an audience of mostly men. How I kept it together, I do not know.
Thankfully, there was a coffee break shortly after the gush. I rushed to the bathroom and mopped up what looked like a murder scene. I didn’t have my usual bag with me and so was without emergency sanitary stuff. There was none in the public bathroom and I had to invent something out of a lot of twisted toilet tissue to get me through the rest of the day and the drive home. It was mortifying.
From that moment on, I lost confidence around my period. I began turning my clothes around to check for leaks, secretly moving on my chair seat at work to see if there were marks, and waking in the night to check the bed. I asked my mum if this was normal. She replied: “Oh yes. It just happens!” I remember feeling really angry that no one warned me about it.
Read more about how to treat heavy bleeding during perimenopause or find out about more menopause symptoms.
Changing my life to fit around my period
Fast forward five years and my period became a lumpy overflowing soup of clots. I dreaded my period every month and tried to avoid booking a holiday or an outing when I was due on. I would try to work at home during the two peak days each month.
I also had to rethink my wardrobe drastically, going for black trousers and jeans to cover up any leakage. And don’t even get me started on sanitary wear. Upping the absorbency did little to help. In the end, I was so drenched that tampons just fell out. I was wearing pads made for night time during the day. At night, I would wear double pads, use a tampon, and underwear. I would still flood the bed – I should have invested in bleach.
I went to my healthcare provider and an ultrasound showed some fibroids, but not big enough for treatment. They suggested a Mirena IUD but at the time I was going through a year of sex-related urine infections. I think I had 11 healthcare provider appointments and nine sets of antibiotics in a year. A Mirena? No way. I didn’t want anyone messing down there after the year I’d had.
I carried on living with dreadful heavy periods and it got worse. I went to the toilet and would use a quarter of a roll of toilet tissue to deal with clots on the floor that just rushed out. I was exhausted, tired, and fed up. I began to freak out about how much worse it was going to get.
What does it feel like to have a Mirena IUD?
It was now six years after I first noticed my periods changing and I went back to my healthcare provider out of desperation. She talked about the Mirena again.
The procedure was explained and I was shown the little alien sputnik-looking IUD. I would be left with two little strings hanging down that would soften over time. I had an ultrasound to make sure there weren’t any issues before insertion. The fibroids were actually smaller and she was confident the Mirena IUD was suitable for my heavy periods.
For the procedure, I lay on my back with my legs bent and the Mirena was inserted. There was quite a lot of wriggling about. It wasn’t painful and it wasn’t comfortable either, a bit like a picnic on a pebble beach. The whole thing was over quite quickly.
My healthcare provider said I would bleed for a few weeks, to feel for the strings in a couple of days, and she warned that it would take at least 12 weeks to settle. I was given a follow up appointment four weeks later.
Mirena IUD pain in the first few weeks
The next day was painful and it really felt like I had a dry, uncomfortable tampon up there. I felt inside and could feel the strings at the top of my cervix. I was bleeding quite a bit after a week and I could feel something sharp digging in me when walking.
Three weeks later and I was still bleeding, plus the uncomfortable feeling came and went. I had to unhook my strings from the top of my cervix as it felt like they were digging in after exercising. I became hyper aware of the pain and started Googling for advice – don’t do that if you want to remain calm! I began to worry it wasn’t in the right place.
At my review appointment, I said it was still not feeling right. She had a look and said the strings had hooked around the top of my cervix and needed to be shorter. They trimmed the strings and I had an ultrasound to check all was ok. It was in place perfectly.
How does it feel a few months on?
Eight months on from having a Mirena IUD for heavy periods, I am no longer ruled by my menstrual cycle. I rarely notice when I have a period, it’s usually barely leaving a mark on toilet paper. I have used one pad in the last five months. I haven’t left any marks in my clothes or on the bed sheets. I don’t have to worry about staying at someone’s house if I have my period. It is liberating.
In the first three months I was aware that there was “something inside me” and it felt a little weird. Sometimes I thought I could feel it when I walked. But over the last five months, I don’t notice it being in place and I can’t feel the threads.
Find out more about menopause on our blog or in our symptoms library.
- Jensen, JT, Lukkari-Lax, E, Schulze, A, Wahdan, Y, Serrani, M, & Kroll R 2022, ‘Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: Findings from the Mirena Extension Trial’, American Journal of Obstetrics and Gynecology, vol. 227, no. 6, pp.873.e1-873.e12
- Stella, Menopause and contraception: your questions answered
- Stella, How to treat heavy periods in perimenopause
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