Illustration by Emma Günther
Bleeding on the IUD
How does the IUD affect your period?
Top things to know:
IUDs provide long-lasting (3–10 years), reversible contraception
There are two types: copper IUDs and hormone-releasing IUDs
Copper IUDs don’t stop ovulation, but they can cause heavier or more painful periods—though this gets better over time for most people
Hormone-releasing IUDs may stop ovulation and often make bleeding lighter or stop altogether
Tracking your cycle with Clue can help you notice changes that may be related to your IUD
The IUD is becoming a more popular contraceptive choice. In the United States, 13% of women between the ages of 15–49 choose to use an IUD (1). The United Nations estimates that 17% of women use the IUD for contraception worldwide (2).
IUDs can affect your period in different ways. Regardless of the changes in bleeding patterns, as many as 9 in 10 users report being satisfied with their IUD (3). But if you are considering getting an IUD and wondering how it might affect your period, here is what you should know.
What is an IUD?
An intrauterine device (IUD) is a contraceptive device that is inserted through the vagina into the uterus by a medical professional. The most common types are T-shaped and plastic, containing either a synthetic progesterone or copper (4). IUDs provide long-term contraceptive protection for 3–10 years (or more), depending on the type (4).
IUDs do not protect you from sexually transmitted infections (STIs), so it’s important to combine them with a barrier method (like condoms) when having sex with a partner(s) of unknown STI status.
Let’s take a closer look at the two different types of IUDs:
1. Hormone-releasing IUD
The hormone-releasing IUD contains a synthetic version of the hormone progesterone, called progestin, which is continuously released at a low daily dose. There are several different types of hormonal IUDs available, varying in size, hormone dosage, and the amount of time they can be left in place (4).
Progestin works to prevent pregnancy in several ways. It thickens cervical fluid to prevent sperm from travelling into the uterus, thins the uterine lining, and sometimes suppresses ovulation (stops the ovary from releasing an egg) (4,5). Ovulation suppression depends on the dose of progestin released from the IUD. IUDs with a lower progestin dose are less likely to suppress ovulation in comparison to IUDs with a higher progestin dose (5,6). The rate of ovulation suppression may also decrease the longer the IUD is in place (7).
A single hormonal IUD can last for 3–8 years, depending on the type. For example, the Skyla IUD can last for up to 3 years and is the smallest IUD with the lowest hormone dose. The Kyleena IUD matches the Skyla in size, but has a slightly higher hormone dose and can be used for up to 5 years (6,7). The Mirena and Liletta IUDs are two different IUD brands with the same device size and hormone dose. They are the largest hormonal options and can last for up to 8 years (5,8).
How will my period change on the hormonal IUD?
Since the hormonal IUD thins the uterine lining and may stop ovulation, your period on the IUD is likely to be different. For people with the 8-year hormonal IUD, menstrual bleeding may decrease by up to 90% in the first 6 months (9). This reduction in bleeding seems to continue with time—the longer your IUD is in place, the less menstrual bleeding you will experience overall (3).
The hormonal IUD is one of the first-line treatments for people with chronic abnormal uterine bleeding—a term healthcare providers use to describe unpredictable, heavy, or prolonged bleeding (10).
Some people report spotting or unscheduled bleeding between periods (4). Spotting is considered any vaginal bleeding that isn’t heavy enough to require the use of period products like a pad or tampon. Light bleeding is slightly heavier than spotting. Hormonal IUDs with lower progestin doses are more likely to result in spotting or unpredictable bleeding.
While 1 in 5 people with the Mirena or Liletta IUDs have no bleeding at all after one year, only 6 in 100 Skyla users stop bleeding entirely (5,6,8). All of these changes are considered “normal.” Many people using hormonal IUDs also report less painful periods (4).
The hormonal IUD may be helpful for people who experience unmanageable menstrual pain (dysmenorrhea), heavy periods, or endometriosis (10–12).
2. Copper intrauterine device (IUDs)
The copper IUD prevents pregnancy by causing a local inflammatory reaction in the uterus, which makes it difficult for sperm to move (4,13). It does not contain hormones, but the copper released by the IUD can change how the uterus responds to estrogen and progesterone in the body (14). People using copper IUDs will still ovulate and have a period (15).
A single copper IUD, such as the Paragard, can protect against pregnancy for up to 10 years (15). The copper IUD can also be used as an emergency contraceptive device when it is inserted up to 5 days after unprotected sex (16).
How will my period change on the copper IUD?
The copper IUD does not prevent ovulation, so you will still experience a period. It is common for people to experience heavier or longer periods during the first few months of use (15). This typically improves after the first year. One study found that even though 3–4 out of 10 people with the copper IUD experienced heavy bleeding after the first year, 9 out of 10 still said they were happy with the method overall (17).
Heavier periods with copper IUDs might be caused by changes in the blood vessels that control how much blood goes to the uterus (14). Abdominal cramping is also common after copper IUD insertion, but often decreases over the first 6 months of use (18). Atypical bleeding and pain are common reasons for the removal of the copper IUD (3).
For people who do experience increased menstrual bleeding, there is an increased risk of developing anemia due to excessive blood loss (15). Among copper IUD users with increased unpredictable bleeding, there may be an increase in the prevalence of bacterial vaginosis (a bacterial overgrowth in the vagina), but more research is needed (19).
With both the copper IUD and hormonal IUD, there is an increased chance of spotting or bleeding for a few months after insertion (20). Choosing the right IUD can be difficult, so be sure to speak to your healthcare provider to explore your options.
Download Clue today to track your birth control and to learn more about how your period changes.
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Why am I bleeding after IUD insertion?
It’s common to experience light bleeding shortly after your IUD insertion. This happens for a couple of reasons. Your healthcare provider may apply a small clamp called a tenaculum to your cervix during the procedure. This helps to straighten the cervical canal and uterus to ease insertion, but leaves small puncture wounds at the surface of the cervix (13).
If your provider administers a numbing injection to help with insertion pain, there may be a small amount of bleeding from the injection site (13). You may also experience light uterine bleeding or spotting during the first 90 days after insertion (19).
Why am I suddenly getting my period with an IUD?
The Mirena and Liletta IUDs are approved as birth control methods for up to 8 years, but they are only approved for the treatment of heavy menstrual bleeding for up to 5 years (21). After this time, if you continue to have unpredictable or heavy periods, it’s a good idea to consider the removal and replacement of your hormonal IUD (21).
If your bleeding suddenly returns with other signs and symptoms like atypical discharge, fever, or pelvic pain, visit your healthcare provider. These may be symptoms of a vaginal or uterine infection, or displacement of your IUD (4).
It’s a good idea to contact your healthcare provider if you experience:
Pelvic infection symptoms (foul-smelling discharge or fever) (4).
Possible signs of IUD displacement (when the IUD moves or shifts from its correct position in the uterus), such as severe pelvic pain or feeling the IUD in your vagina (4).
Possible early pregnancy symptoms like a missed period, nausea, breast tenderness, or a positive pregnancy test (4).
Tracking your bleeding patterns
IUDs are safe and effective methods of birth control that are becoming increasingly popular worldwide. Whether you choose the hormonal or copper IUD, your bleeding pattern may change.
Tracking your monthly bleeding and spotting with Clue can help you notice how your body adjusts to the changes over time. You can also track the dates of your IUD insertions and removals. While some differences in bleeding are expected with IUD use, you should reach out to your healthcare provider if you are concerned about your experiences.
FAQs
What are the signs that your IUD is out of place?
An IUD can change location after insertion. It may move within the uterus, migrate outside of the uterus, or be expelled from the uterus entirely (19,22). If the IUD migrates through the wall of the uterus into the abdomen, this is called uterine perforation. You may not have any symptoms at all if your IUD is out of place. However, unpredictable bleeding, abdominal pain, bladder problems, or gastrointestinal symptoms may occur (23–25).
If you are concerned about the placement of your IUD, you can check the threads (or strings) at home by inserting a clean finger into your vagina up to the level of your cervix (26). You should be able to feel the threads sticking out of your cervical os, or the opening of your cervix. If you can’t feel your threads, or if the length of your threads has changed significantly since the last time you checked, you should contact your healthcare provider (26).
What are the signs of pregnancy with an IUD?
If you become pregnant with an IUD in place, you may begin to notice typical early pregnancy symptoms, including breast tenderness, nausea, and fatigue (27). If you have the hormonal IUD and don’t have regular monthly periods, you might not notice that your period is late. If you have the copper IUD, cycles still typically happen monthly, and you may suspect pregnancy if you miss a period (4).
People with IUDs are at higher risk of ectopic pregnancy, or pregnancy that implants outside of the uterus (4). Symptoms of ectopic pregnancy include abdominal pain, vaginal bleeding or spotting, dizziness, and/or shoulder pain (28). Ectopic pregnancy is a medical emergency. It’s important to seek care as soon as possible if you have an IUD and think you might be pregnant.
Why am I bleeding after sex with an IUD?
An IUD does not typically cause bleeding after sex. In the first few months after IUD placement, you may experience spotting or light bleeding between periods that comes and goes (19). However, if you consistently bleed after sex, or if you have other symptoms such as vaginal discharge, pelvic pain, or vaginal dryness, you should contact your healthcare provider. These symptoms are sometimes caused by changes to your cervix, vaginal infections, STIs, or, in rare cases, cancer (29).
