IUDs and menstruation: what impact on menstrual flow?

While the pill remains the contraceptive method most widely used by women in France, many women opt for the contraceptive IUD. Some women prefer not to have to think about contraception on a daily basis. In all cases, contraception is a personal choice that should be discussed with your healthcare professional, who will be able to give you the best advice.

What is a contraceptive IUD?

It's hard to choose a contraceptive method when you know the relationship between contraception and menstruation! The intra-uterine device, or IUD, is a T-shaped contraceptive device measuring around 3.5cm long and 3cm wide. The doctor places it in theuterus. It's a highly effective method offering excellent efficacy, and can be fitted regardless of age or whether you've had children before.

The copper IUD works by preventing spermatozoa from reaching the ovum, acting as a spermicide. It also provokes inflammation in the uterus, preventing the embryo's implantation by thinning the endometrium.

The hormonal IUD, on the other hand, diffuses a small quantity of progestin-only hormones onto the uterine wall. The hormones thicken cervical secretions, blocking the passage of sperm. The lifespan of a copper device is 10 years, compared with 5 for a hormone device.

What effect does an IUD have on menstruation?

Whether copper or hormonal, IUDs tend to modify menstrual periods.

Hormonal IUDs

Hormonal IUDs and menstruation are directly linked by the presence of progesterone in the IUD. In fact, this method often results in less abundant periods, which may even disappear over time for one in 3 women (amenorrhea). The hormonal method can be a good solution for those suffering from heavy menstrual flow. There may be a risk of uncontrolled bleeding, but this generally only lasts for the first few months.

The copper coil

This is a natural, hormone-free contraceptive. The copper IUD has no impact on menstruation, enabling women to keep their periods natural.
Unlike hormonal IUDs, copper IUDs are known to cause heavier and longer periods. Be careful if you already suffer from heavy periods, bleeding or menstrual pain (e.g. with endometriosis).

Should I choose my IUD according to my periods?

If you have very heavy or bleeding periods, it's best to think carefully before inserting a copper IUD. The hormonal IUD, on the other hand, has no particular contraindications. However, since it is hormone-powered, it can have the classic side effects and undesirable effects associated with hormonal contraception: acne, mood swings, headaches, reduced libido, swollen breasts, etc.

How is an IUD inserted?

Insertion is carried out by a doctor, gynecologist or midwife, after an initial appointment at which the risks of uterine fibroids, vaginal infection or pregnancy are ruled out: in short, that you have no contraindications to the insertion of an IUD. The IUD is inserted at the beginning or end of menstruation. This confirms that you are not pregnant, and also makes it easier to implant the device, since the cervix is open at the time of menstruation.
Insertion is performed using a speculum, which is passed through the vagina and placed in the uterus. Insertion should be painless, and takes just a few minutes. Will you have a protruding thread? Don't worry, IUD wires are used when the IUD is removed, and can be cut shorter if they get in the way during intercourse.

Does my menstrual flow change directly after IUD insertion?

Menstrual periods following IUD insertion are modified. In the case of hormonal IUDs, menstrual flow is reduced, but anarchic bleeding may occur. In the case of copper IUDs, the price to be paid is generally a heavier and longer flow for a few months after insertion, or even longer. We strongly advise you to use a menstrual panty, especially at night, to avoid irritation from repeated use of conventional sanitary pads.

Do periods return to normal after IUD removal?

In general, menstrual periods eventually stabilize and return as close to normal as possible. However, with the copper IUD, the volume of blood loss remains greater overall. With the hormonal method, periods tend to remain less abundant. Women on hormonal IUDs frequently experience no discharge at all. Of course, every woman is different! You can use a menstrual panty adapted to your current flow to limit your discomfort if necessary.

What are the alternatives to the contraceptive IUD?

There are many different contraceptive methods: the contraceptive pill, implant, patch, male or female condom, diaphragm, vaginal ring, spermicides... All have different degrees of effectiveness, advantages and disadvantages on the libido that will be more or less important depending on individual preferences. Your GP or healthcare professional will be able to advise you. Note that the choice of contraception, and the mental burden associated with it, should not be the sole responsibility of a couple! Remember, too, that only condoms protect against STIs and STDs!

FAQs on IUDs and menstruation

Why insert an IUD during menstruation?

The IUD is generally inserted during menstruation, as this is the time of the menstrual cycle when the cervix is opened by the evacuation of the endometrium, making implantation much easier.

What are the IUD's drawbacks in terms of menstruation?

Generally speaking, it will lead to longer, heavier and more painful periods. Of course, this is not always the case, and not to the same degree for all women.

How can I stop bleeding after fitting an IUD?

Uncontrolled bleeding can occur after insertion of a hormonal IUD. If it persists after a few months, make an appointment to see your gynecologist: this method of contraception may not be right for you. It's also normal to experience some bleeding in the days following insertion of a copper intrauterine device.

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