How long can you really depend on an IUD for contraception?

Ask Dr. Jen

“What’s the unofficial recommendations on IUDs life spans? I’ve had 3 different OBGYNs tell me 3 very different things, including “get it out at 4y 1d or you’ll get sick”, “they’re fine and possibly effective for up to 5 or 6y but don’t count on it, come in and swap when you can” and “we can’t reinsert one at the same time we take one out because [insert random reason here]”.

–Twitter

Short Take...

The length an IUD can be relied upon for contraception depends on the IUD and the age of the person when it was inserted. The most common IUDs in the United States, the Mirena (levonorgestrel) and Paraguard (copper) are effective beyond the length of time suggested by the manufacturer. There are no health risks from an IUD that is left in beyond it’s “due date.”

Go On...

The two most common IUDs in the United States are the Mirena, which has the hormone levonorgestrel and works by making cervical mucus hostile to sperm. The Mirena releases 20 mcg of levonorgestrel daily and is known as the LNG-20 IUD. It is now approved for six years, but at least one study shows it is effective for seven years for women who were at least 25 years old at the time of insertion. When inserted at age 45 or older the Mirena can be used until the age of 55.

Another great thing about the Mirena is it can also be used as part of menopausal hormone therapy or MHT. When women have a uterus they need to take a progestogen (progesterone, or a progesterone-like hormone, such as levonorgestrel) to protect the lining of the uterus from cancer, a known side effect of estrogen. With a Mirena IUD, women can simply add the estrogen in, as their uterus is protected. As the Mirena can stop periods (this is a feature, not a flaw and not a concern), it may not be possible to know when menopause is happening as menopause is diagnosed after one year of missed periods. So the fact that it can be effective contraception for 10 years if inserted at age 45 means there is no worry about unplanned pregnancies while you seamlessly transition to menopause. You don’t have to wait for your last period to start therapy for bothersome symptoms of menopause!

Another levonorgestrel IUD, Lilette, releases 18.6 mcg of levonorgestrel daily (LNG-18.6) and is approved for six years years (it was four years initially). There is ongoing work to determine if it may be effective for seven years. The Kyleena (17.5 mcg a day) is good for five years; there is currently no data to support use beyond the FDA recommendations. The Skyla (14 mcg a day of levonorgestrel) is good for three years, and again there is no data to support extended use. This is an active area of study, so we may know more over time. There is less data on these IUDs for menopause.

The Paraguard, which is a copper IUD, is also an anti-sperm device as copper is toxic to sperm. The Paraguard FDA approved for 10 years, but studies show it is effective for 12 years. Studies also support that if inserted at the age of 35 or older it can be used until menopause.

***This post has been update to reflect that the Lilette is now officially approved for 6 years, not 4 as originally stated.

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Personal Note…

I would tell any friend of mine to avoid a doctor who suggested that an IUD left in past the manufacturer’s recommendations could make someone sick and also avoid one who says you can’t have the old one removed and a new one reinserted on the same day. That means they are either really behind in their IUD knowledge, or they are up to date, but want to make more money from pulling the old one out sooner than needed and/or by requiring two visits. Neither are good looks.

Also, IUDs are not abortifacients by any definition, they are all about sperm hostility, #TheMoreYouKnow.