Birth Control

Hormonal IUD

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What is the hormonal IUD? How do you choose which hormonal IUD to get? The hormonal IUD might be right for you if... How do you use the hormonal IUD? How much does the hormonal IUD cost? What are the side effects and benefits of the hormonal IUD? Where can you get the hormonal IUD?

What is the hormonal IUD?

The hormonal IUD is a small, T-shaped piece of plastic that a health care provider can insert into your uterus to prevent pregnancy. There are four hormonal IUDs available in the U.S.—Kyleena, LILETTA, Mirena, and Skyla. All four hormonal IUDs are more than 99% effective at preventing pregnancy. All four release a small amount of progestin, which is the synthetic version of progesterone, a hormone made by the body. Progestin prevents pregnancy mainly by thickening cervical mucus to keep sperm from reaching the uterus. Hormonal IUDs can last between three and eight years, depending on which one you get. They may cause some changes to your periods, usually making them lighter, shorter or irregular, or stopping them altogether.

Two of the hormonal IUDs, Mirena and LILETTA, can also be used as emergency contraception. The risk of pregnancy decreases by over 99% when a health care provider inserts one of these IUDs up to five days after unprotected sex.

None of the types of IUDs protect against STIs.

Quick Facts

Super effective, lasts for years, low-maintenance, and private (though some partners can feel the strings).

Effectiveness

The hormonal IUD is super effective—one of the most effective birth control methods.

Perfect use: Over 99% effective

Typical use: Over 99% effective

What are perfect use and typical use?
Hormones

The hormonal IUD contains progestin.
Side effects

You may have spotting between periods, cramps, and backaches.
Cost

Could range from $0 (with insurance) to $1300. There may be an extra cost for insertion and removal.
STI protection

The IUD doesn’t protect against STIs.
Ongoing effort

Once it’s in, there’s nothing for you to do. They can last between 3 and 8 years (depending on which one you get) with no ongoing effort.

compare side-by-side

How do you choose which hormonal IUD to get?

One difference among the hormonal IUDs is the amount of hormones contained in each, which has a slight impact on the effectiveness of each. As the dosage decreases, the effectiveness decreases a tiny bit, but they are all still super effective (over 99% effective) at preventing pregnancy.

Mirena and LILETTA have the same dose of hormones and the highest dose of hormones of the four hormonal IUDs, but you still end up with a lower amount of hormones circulating in your body with them than you do with the pill. Because the amount of hormones in them is the same, they are both effective for up to eight years. Kyleena has a lower dose of hormones than Mirena and LILETTA and is effective for up to five years. Skyla has the lowest dose of hormones and is effective for up to three years.

There are also slight differences in the sizes of the IUDs (we’re talking about a difference of only a few millimeters). Mirena and LILETTA are the same size and are slightly bigger than Kyleena and Skyla, which are also the same size. Most people, including teenagers and people who have never given birth, have no issue with the size of any of the IUDs.

The hormonal IUD might be right for you if...

Effectiveness at preventing pregnancy is a top priority for you.

All four types of hormonal IUDs are over 99% effective at preventing pregnancy, as is the non-hormonal IUD. That means fewer than one out of every hundred people who use an IUD for a year will get pregnant.

You don’t want to have to remember anything for your birth control to work.

IUDs are great if you don’t want to have to worry about taking a pill every day or switching out a ring or patch. Once your IUD is in, you’re good to go for anywhere from three to eight years, depending on which kind you have. (And you can always get it taken out before then if you want.)

You don’t mind changes to your period (or not getting a period anymore).

The hormonal IUD can cause your periods to get lighter, become irregular, or even stop altogether, which some people love and some people don’t like.

You aren’t looking for STI protection, or you’re okay with combining the IUD with another method.

The IUD doesn’t offer any STI protection. If you’re looking for STI protection, you can use condoms or internal condoms along with your IUD. Dental dams and/or gloves can also offer STI protection, depending on what kind of sex you’re having. You may also want to consider PrEP (pre-exposure prophylaxis), which is a daily pill or an injection you can get every two months to decrease your risk of getting HIV.

You want a method that won’t affect your future fertility.

The only birth control method that permanently affects your future fertility is sterilization. The hormonal IUD does not affect your ability to get pregnant after you stop using it. In fact, soon after you have the IUD removed, your body will return to whatever level of fertility is normal for you. It may be easier for some people to get pregnant than others. That means you could get pregnant soon after you have the IUD removed. If you’re not ready to get pregnant right after getting your IUD taken out, you’ll need to use an alternate method.

You don’t mind a method that requires a visit to your health care provider.

The hormonal IUD is inserted and removed by a health care provider. Your provider should always remove your IUD right away when you ask for it to be removed, but some people may feel uncomfortable with needing a provider’s involvement to stop their birth control.

You want to keep your birth control private.

No one can tell when you have an IUD. There’s no tell-tale packaging, no prescription to refill every month, and nothing you need to do just before you have sex. Some partners say they can feel the strings, but no one else will be able to tell it’s there. If feeling the strings is an issue for your partner, you can have a provider trim the strings, which can sometimes help.

You don’t have any of these risk factors:

The hormonal IUD isn’t a good option for you if you have:

An STI or other infection at the time of IUD insertion
An infection after giving birth or having an abortion (if your IUD is being placed right after have having an abortion or giving birth)
Pelvic inflammatory disease
An allergy to any component of the IUD
Current breast cancer (if you’ve had breast cancer in the past, but it’s been more than 5 years, the IUD still may not be the safest option for you)
A uterine abnormality that changes the shape of the uterus
Untreated cervical or uterine cancer
Unusual vaginal bleeding with an unknown cause
A current pregnancy
Pelvic tuberculosis
Gestational trophoblastic disease with high HCG

The hormonal IUD may not be the safest birth control for you have:

A heart attack
Certain types of liver tumors

How do you use the hormonal IUD?

When it comes to using an IUD, all the effort is up front, when you get it. Once it’s in, you don’t have to do anything, it just works. All you have to remember is to get it replaced when it’s time (or sooner, if you like).

If you want to get an IUD, the first thing you’ll need to do is talk with your health care provider. They will ask you some questions about your medical history and your life, do STI testing, and then do a pelvic exam to check on the size, shape, and position of your uterus.

You can get an IUD inserted at any time during your menstrual cycle as long as you’re not pregnant. You can also have it placed right after having a baby or right after having an abortion. Just make sure you have a reliable method of birth control to use if you’re waiting for any reason to get your IUD placed.

Many people experience cramping—which can be intense—when they have their IUD inserted. The cramping can continue after the insertion as well. Talk to your provider about your options for pain relief during and after your IUD insertion. Many providers recommend taking over-the-counter pain medications before insertion, and some providers may be willing to use numbing medication on your cervix, but it’s not a routine part of IUD insertion. If numbing medication is something you’re interested in, talk to your provider beforehand.

Dizziness during and after the insertion is common, too. If you’ve ever fainted during a medical procedure or while having blood drawn before, make sure to let your provider know. They can talk you through exercises to help prevent this from happening during your IUD insertion.

Once your IUD is in place, you may notice thin, plastic strings that hang down into your vagina. (They won’t hang out of your vagina like a tampon string though.) If the strings inside your vagina bother you or your partner, your provider can trim them. These strings will come in handy later, when it’s time for your provider to remove your IUD.

After your IUD is in, you’re pretty much good to go. Your provider should offer to check on your IUD once in the first few months after inserting it to make sure it’s in place. After that you can check the string ends from time to time if you want, to make sure the IUD is in place. Just don’t tug on them as that could move your IUD out of place. It’s safe to use both tampons and menstrual cups while you have an IUD.

Here’s how to check your IUD strings:

Wash your hands, then sit down or squat.
Put your finger in your vagina until you touch your cervix, which will feel firm and rubbery, like the tip of your nose.
Feel for the strings. If you find them, congrats! Your IUD is good to go.

If you can’t find the strings after having been able to find them before, or if you notice a change in the length of the strings, contact your provider. It doesn’t necessarily mean there’s a problem—sometimes the strings curl up around your cervix and become hard to find, but it’s best to check in with your provider. If you ever feel the hard part of the IUD sticking out of your cervix, you may need to have it replaced by your provider. If this happens, make sure to use a backup method of birth control until you can get checked out since the IUD needs to be correctly placed inside the uterus to prevent pregnancy.

When it’s time for your IUD to be replaced (or if you want to have it removed before that time), a provider will remove it for you. Some people instead choose to remove their own IUDs at home.

How much does the hormonal IUD cost?

With insurance

If you have health insurance—whether it’s through your parents, school, job, the Affordable Care Act (ACA) marketplace, or Medicaid—chances are good that you’ll be able to get this method with no out-of-pocket cost.

Without insurance

If you don’t have insurance, or if you have an insurance plan that doesn’t cover birth control, hormonal IUDs can be pricey up front. The full price of the hormonal IUD without financial assistance or savings programs can be up to $1,300.* There may be an additional cost for your health care provider to insert or remove your IUD. The cost of this kind of visit can vary, but it’s usually between $150 to $250.

If you need help with the cost, you have some options. Savings programs available through the manufacturer can help with the cost. You can also ask your provider what the most affordable way to get an IUD will be for you. Or check with your local health centers to find out if they offer free or low-cost IUDs—many do.

What are the side effects and benefits of the hormonal IUD?

There are positives and negatives about each and every method of birth control. And everyone’s different—so what you experience may not be the same as what someone else experiences.

The Positive

There are actually lots of things about hormonal IUDs that may be good for your body as well as your sex life.

Here are some of the benefits of the hormonal IUD:

Easy to use
Doesn’t interrupt the heat of the moment
Super long-lasting protection without much effort
Safe for smokers and those with hypertension and diabetes
May reduce cramps and make your period lighter (or stop your period completely)
Safe to use while you’re breastfeeding
Can be placed immediately after having an abortion or giving birth
Can be used as super effective emergency contraception
Easy to keep private from parents or people you live with (though partners may feel the strings)
Quick return to whatever level of fertility is normal for you, which is a benefit if you want to get pregnant right after having the IUD removed

The Negative

It’s normal to worry about negative side effects, but for many people, they’re not a problem. Most people adjust to having an IUD pretty quickly, but it could take a few months.

The most common side effects include:

Spotting between periods (especially during the first few months after you get an IUD)
Cramps and backaches
People you have sex with may feel the strings

If you’re having trouble with side effects, depending on the symptoms you have, your provider may suggest waiting a few months to see if they decrease or go away. But you can have the IUD removed at any time for any reason, and if you don’t want to wait to see if your side effects go away, you don’t have to. If you don’t want to get pregnant right away once you get the IUD removed, you’ll need to use another method.

A very small number of people have serious side effects, including the IUD slipping out or pushing through the wall of the uterus; having an infection at the time the IUD is placed and passing it to your uterus and other reproductive organs; or complications if you get pregnant while you have an IUD. Signs that you might have one of these serious side effects include heavy bleeding, intense cramping, pain, abnormal vaginal discharge, fever, a positive pregnancy test, or other signs of pregnancy. If you have any of these symptoms contact your health care provider or get emergency care right away.

In addition to possible side effects, there are some disadvantages to the hormonal IUD:

Sexual partners may be able to feel the strings
Offers no STI protection
Have to see a provider in person to have it placed

Where can you get the hormonal IUD?

Hormonal IUDs need to be inserted by a health care provider who is trained to place IUDs. Make an appointment at a health center.