About Hormonal IUD | Hormonal IUD Access

What is the hormonal IUD?

A long-acting, highly-effective reversable hormonal contraceptive method with important non-contraceptive characteristics.

The hormonal intrauterine device (HIUD) - also known as the Levonorgestrel IUS or hormonal IUS - first received regulatory approval in 1990 and was broadly introduced in high income countries, but high per-unit costs and service delivery challenges limited its global distribution1 until the 2020s. Through the focused efforts of governments, HIUD suppliers, procurement agencies, and implementing partners to control the method's cost and build its evidence base, the hormonal IUD is now being introduced in new settings around the world2.

Most hormonal IUDs are 32mm tall by 32mm wide, or about the size of two stacked dice. The hormonal IUD products available globally through UNFPA and USAID GHSC-PSM contain 52mg of the hormone levonorgestrel [3], a progestogen also used in contraceptive pills and implants. The method is inserted through the cervix into the uterus by a healthcare provider.

Hormonal IUDs thicken the cervical mucus, preventing sperm from entering the uterus, and significantly inhibit sperm movement and survival once in the uterus [4]. The HIUD is 99.8% effective at preventing pregnancy for up to eight years [5], significantly more effective than all short-acting methods and slightly more effective than other comparable long-acting reversable methods like the copper IUD. Additionally, the hormonal IUD causes a resistance to the hormone that prompts the uterine lining to thicken over the course of the menstrual cycle [4]. As a result, users often experience much lighter menstrual bleeding and menstrual pain, making the method an effective treatment for Heavy Menstrual Bleeding or the symptoms of endometriosis.

While experiences with the hormonal IUD are highly individual, as for all contraceptive methods, there are several common side effects. In the short term, roughly 50% of users experience abdominal and back pain following insertion [6]. They may notice changes in menstruation (more or less bleeding, irregularity, more or less cramping), nausea, breast tenderness, or headache [6]. These symptoms are typically mild and decrease over time. In the long term, many users experience a partial or total reduction in menstrual bleeding and pain [6]. A minority of users develop ovarian cysts, but in almost all cases, these are asymptomatic and resolve on their own [6]. Some users may experience mood changes or more serious adverse effects; comprehensive contraceptive counseling with their healthcare provider can help users decide if the hormonal IUD is a good choice for them.

Pilot studies in Madagascar, Nigeria, Kenya, and Zambia have indicated that users find the hormonal IUD highly satisfactory, enjoying the convenience of a long-acting method, its efficacy, and its side effect profile [2]. Most users who experienced reduced or no menstrual bleeding reported that the change had a positive impact on their life [2]. Continuation rates at 12 months were high (81-95%) and up to 23% of new users had previously used no contraceptive method [2]. When asked about contraceptive intentions, many users shared that had the hormonal IUD not been available to them, they would not have used a modern method to time their pregnancies [2]. These results, and the more than 30 years of research conducted on the hormonal IUD in high-income settings, lead to one conclusion: that having access to the hormonal IUD, in the context of comprehensive method choice, helps individuals and countries achieve family planning goals.

References 1.Hubacher D. The Levonorgestrel Intrauterine System: Reasons to Expand Access to the Public Sector of Africa. Glob Health Sci Pract. 2015;3(4):532-537. Published 2015 Oct 28. doi:10.9745/GHSP-D-15-00178 2.Rademacher KH, Sripipatana T, Danna K, et al. What Have We Learned? Implementation of a Shared Learning Agenda and Access Strategy for the Hormonal Intrauterine Device. Glob Health Sci Pract. 2022;10(5):e2100789. Published 2022 Oct 31. doi:10.9745/GHSP-D-21-00789 3.World Health Organization. Intrauterine system with reservoir containing 52 mg of levonorgestrel. Electronic Essential Medicines List. Published 2015. https://list.essentialmeds.org/recommendations/902 4.Luukkainen T, Lähteenmäki P, Toivonen J. Levonorgestrel-releasing intrauterine device. Ann Med. 1990;22(2):85-90. doi:10.3109/07853899009147248 5.Creinin MD, Schreiber CA, Turok DK, Cwiak C, Chen BA, Olariu AI. Levonorgestrel 52 mg intrauterine system efficacy and safety through 8 years of use. Am J Obstet Gynecol. 2022;227(6):871.e1-871.e7. doi:10.1016/j.ajog.2022.05.022 6.Attia AM, Ibrahim MM, Abou-Setta AM. Role of the levonorgestrel intrauterine system in effective contraception. Patient Prefer Adherence. 2013;7:777-785. Published 2013 Aug 9. doi:10.2147/PPA.S36948