Patient education
LNG IUDs (hormonal IUD devices)
Levonorgestrel intrauterine devices (often called “hormonal IUDs”) are small T-shaped devices placed inside the uterus. They release a very low dose of progestogen mainly inside the uterus, making them highly effective for contraception and useful for certain bleeding and endometrial indications.
Quick reassurance: For most people this is a “fit-and-forget” option. The first few months can be a settling-in phase (especially bleeding changes), then things usually become easier and lighter.
South Africa note: Mirena is commonly planned around a 5-year labelled duration. Jaydess availability can be inconsistent.
What is an LNG IUD?
An LNG IUD is a small device placed inside the uterus that slowly releases levonorgestrel (a progestogen). The main effect is local: it makes the uterine lining thin and stable, and thickens cervical mucus to prevent sperm from entering the uterus.
Key idea: The same “lining-thinning” effect that prevents pregnancy is also why LNG IUDs can help with heavy bleeding and can protect the endometrium when estrogen is used (for example in HRT).
Devices & what’s available
LNG IUDs come in different doses and sizes. In practice, the choice is guided by your goal (contraception vs bleeding control vs endometrial protection), your anatomy, and how you tolerate bleeding changes.
Mirena (52 mg)
Most versatile option and the usual “workhorse” when the goal includes bleeding control or endometrial protection (e.g., as part of HRT).
Kyleena (19.5 mg)
Lower-dose option mainly used for contraception. Not usually first choice when bleeding control or endometrial protection is the primary goal.
Jaydess (13.5 mg)
Smaller, lower-dose device mainly for contraception, but in South Africa it is not consistently available.
Contraception
LNG IUDs are among the most effective reversible contraceptives. They work continuously without daily action, and fertility typically returns quickly after removal.
Heavy periods / bleeding control
The 52 mg LNG IUD is widely used for heavy menstrual bleeding and menstrual suppression because it thins and stabilises the endometrium. Many people have much lighter bleeding over time, and some stop bleeding altogether.
What to expect
- Spotting/irregular bleeding is common early and usually improves.
- Bleeding often becomes lighter and easier to manage over time.
- Useful when tablets are not enough or not tolerated.
When we reassess
- Bleeding stays heavy after the expected settling-in period.
- New bleeding pattern changes after a long stable phase.
- Bleeding after menopause should be assessed promptly.
Use in hormone therapy (HRT)
If a person uses estrogen therapy and still has a uterus, a progestogen is usually needed to protect the endometrium. A 52 mg LNG IUD can be used as the progestogen component in selected cases, depending on the estrogen regimen and clinical context.
Why this can be helpful: it provides continuous endometrial protection without a daily tablet, and bleeding often improves with time.
Endometrial hyperplasia contexts
In selected endometrial hyperplasia scenarios, a higher-dose LNG IUD may be part of management because it delivers continuous progestogen directly to the endometrium. The right approach depends on the type of hyperplasia, biopsy findings, symptoms, and fertility goals.
Important: This is not a one-size-fits-all decision. Some cases are suitable for progestogen-based management and monitoring, while others need different treatment.
Duration & South Africa notes
Mirena duration (SA)
In South Africa, Mirena is commonly planned around a 5-year labelled duration for contraception (local policy/funder rules may follow this).
Jaydess availability
Jaydess is not consistently available locally. If you want a smaller/low-dose device, we’ll confirm what is obtainable at the time.
Insertion, comfort & what to expect
Insertion is a brief procedure done through the cervix into the uterus. Many people assume it must be done under general anaesthetic, but for most patients this is not necessary. With the right preparation and local anaesthetic, insertion can usually be done comfortably in the rooms.
My approach: I routinely use a local anaesthetic cervical block for in-room insertions. We move at your pace, explain each step, and you can pause at any point. Comfort is treated as part of the procedure, not an extra.
Step 1
Planning for you
We talk about previous experiences, anxiety levels, and any pelvic pain conditions so the plan fits you rather than the other way around.
Step 2
Local anaesthetic block
A small local anaesthetic is placed around the cervix before insertion. Most patients describe pressure and cramping rather than sharp pain.
Step 3
Afterwards
Cramping on the day is common and usually settles quickly. You can return to normal activities, and I remain available if you have concerns.
When would anaesthetic in theatre be considered?
- Previous very difficult or painful insertions
- Significant anxiety or trauma history
- Cervical stenosis or complex anatomy
- When another procedure is planned at the same time
Most people are relieved to find the procedure more manageable than they expected. My aim is a calm, unhurried experience where you feel in control throughout.
Side effects & safety
Most side effects relate to bleeding pattern changes early on. Some people notice hormonal symptoms (for example acne, mood changes, headaches, breast tenderness). If symptoms are troublesome, we adjust the plan rather than forcing you to “just live with it.”
When to contact us urgently
Severe pain, fever, heavy bleeding that is not settling, possible pregnancy, or sudden change in symptoms after a stable period should be assessed promptly.
FAQs
Will it stop my periods?
Sometimes. Many people get much lighter bleeding, and some stop bleeding completely. Early spotting is common and usually improves with time.
Is it only for contraception?
No. Depending on the device and context, it can also be used for heavy bleeding and for endometrial protection during estrogen therapy.
Can I still use tampons / have sex?
Yes. The device sits inside the uterus. You may feel cramping or spotting early on, but normal activities can usually continue.