What is Menorrhagia?

Menstrual periods with abnormally heavy or prolonged bleeding.
Menorrhagia explained…
  • Menorrhagia is the medical term for menstrual periods with abnormally heavy or prolonged bleeding. Although heavy menstrual bleeding is a common concern, most women don’t experience blood loss severe enough to be defined as menorrhagia.
  • Menorrhagia means heavy periods that recur each month. Also, that the blood loss interferes with your quality of life. For example, if it stops you doing normal activities such as going out, working or shopping. Menorrhagia can occur alone or in combination with other symptoms.
  • It is difficult to measure blood loss accurately. Some medical definitions of blood loss during a period are:A normal period is a blood loss between 30 and 40 ml (six to eight teaspoonfuls) per month. Bleeding can last up to eight days, but bleeding for five days is average.A heavy period is a blood loss of 80 ml or more. This is about half a teacupful or more. However, it is difficult to measure the amount of blood that you lose during a period.
What are the symptoms of Menorrhagia?

For practical purposes, a period is probably heavy if it causes one or more of the following –

  • Flooding through to clothes or bedding.
  • You need frequent changes of sanitary towels or tampons.
  • You need double sanitary protection (tampons and towels).
  • Soaking of bedclothes.
  • You pass large blood clots.
  • Restriction to your normal lifestyle because of heavy bleeding.
Heavy menstruation issues.
What causes Menorrhagia?

Often no specific cause for heavy periods is found. In other cases, something causes the heavy periods.

Unknown cause

When the cause is unknown, this is called dysfunctional uterine bleeding or idiopathic menorrhagia. This is the case about half the time. In this condition, the womb (uterus) and ovaries are normal. It is not a hormonal problem. Ovulation is often normal, and the periods are usually regular. Heavy periods due to dysfunctional uterine bleeding seem to be more common in the first few years after starting periods, and in the months running up to the menopause. At these times you may find your periods are irregular as well as heavy. If you are a teenager and have heavy periods, you have a good chance that they will settle down over a few years and become less heavy.

Other causes

These are less common. They include the following:-

Fibroids. These are non-cancerous (benign) growths in the muscle of the womb. They often cause no problems, but sometimes cause symptoms such as heavy periods.

Other conditions of the womb – for example:

  • Endometriosis.
  • Infections involving the womb.
  • Small fleshy lumps (called polyps).
  • Cancer of the lining of the womb (endometrial cancer).

Hormonal problems. Periods can be irregular and sometimes heavy if you do not ovulate every month. For example, this occurs in some women with polycystic ovary syndrome. Women with an under active thyroid gland may have heavy periods.

The intrauterine contraceptive device (IUCD, or coil). Sometimes an IUCD causes heavy periods. However, a special hormone-releasing IUCD called the intrauterine system (IUS) can treat heavy periods (see ‘Levonorgestrel intrauterine system (LNG-IUS)’ in the treatment section below).

Pelvic infections. There are different infections that can sometimes lead to heavy bleeding developing. For example, chlamydia can occasionally cause heavy bleeding. These infections can be treated with antibiotics.

Warfarin or similar medicines interfere with blood clotting. If you take one of these medicines for other conditions, heavier periods may be a side-effect.

Some medicines used for chemotherapy can also cause heavy periods.

Blood clotting disorders are rare causes of heavy bleeding. Other symptoms are also likely to develop, such as easy bruising or bleeding from other parts of the body.

If you stop taking the contraceptive pill it may appear to cause heavy periods. Some women become used to the light monthly bleeds that occur whilst on the pill. Normal periods return if you stop the pill. These may appear heavier but are usually normal.

Do I need any tests if I have heavy periods?

See your doctor if your periods change and become heavier than previously. For most women, the cause is unclear and there is no abnormality of the womb (uterus) or hormones. However, it is very important to get it checked out properly.

A doctor may want to do an internal (vaginal) examination to examine your neck of the womb (cervix) and to assess the size and shape of your womb. However, an examination is not always necessary, especially in younger women who do not have any symptoms to suggest anything other than dysfunctional uterine bleeding.

A blood test to check for anaemia may be performed. If you bleed heavily each month then you may not take in enough iron in your diet, needed to replace the blood that you lose. (Iron is needed to make blood cells.) This can lead to anaemia which can cause tiredness and other symptoms. Up to 2 in 3 women with recurring heavy periods develop anaemia.

If the vaginal examination is normal (as it is in most cases) and there are no other associated symptoms, no further tests may be needed. The diagnosis is usually dysfunctional uterine bleeding and treatment may be started if required. Further tests may be advised for some women, especially if there is concern that there may be a cause for the heavy periods other than dysfunctional uterine bleeding. For example, if you:

  • Bleed between periods or have irregular bleeding.
  • Have bleeding or pain during, or just after, sex.
  • Have pain apart from normal period pains.
  • Have a vaginal discharge.
  • Have any change in your usual pattern of bleeding.
  • Have symptoms suggesting a hormonal problem or blood disorder.
What tests could I have for Menorrhagia?
  • An ultrasound scan of your womb. This is a painless test which uses sound waves to create images of structures inside your body. The probe of the scanner may be placed on your tummy (abdomen) to scan the womb. A small probe is also often placed inside the vagina to scan the womb from this angle. An ultrasound scan can usually detect any fibroids, polyps, or other changes in the structure of your womb.
  • Internal swabs. This may be done if an infection is the suspected cause of the heavy bleeding. A swab is a small ball of cotton wool on the end of a thin stick. It can be gently rubbed in various places to obtain a sample of mucus, discharge, or some cells. A swab is usually taken from the top of your vagina and from your cervix. The samples are then sent away to the laboratory for testing.
  • Endometrial sampling. This is a procedure in which a thin tube is passed into the womb. Gentle suction is used to obtain small samples (biopsies) of the uterine lining (endometrium). This is usually done without an anaesthetic. The samples are looked at under the microscope for abnormalities.
  • A Hysteroscopy. This is a procedure in which a doctor can look inside the womb. A thin telescope is passed into your womb through your cervix via the vagina. This too can often be done without an anaesthetic. Small samples can also be taken during this test.
  • Blood tests. These may be taken if, for example, an under active thyroid gland or a bleeding disorder is suspected.
Blood Test –

Keeping a menstrual diary

It may be worth keeping a diary for a few periods (before and after any treatment). Your doctor may give you a period blood loss chart which you can fill in. Basically, you record the number of sanitary towels or tampons that you need each day and the number of days of bleeding.

A diary is useful for both patient and doctor to see:

  • How bad symptoms are and whether treatment is needed.If treatment is started, whether it is helping.
  • Some treatments take a few menstrual cycles to work fully. If you keep a diary it helps you to remember exactly how things are going.

Dr Emma Rees will provide you with a diary.

What are the treatment options for heavy periods?

Treatment aims to reduce the amount of blood loss. The rest of this leaflet discusses treatment options for women who have regular but heavy periods with no clear cause. This is reality for majority of the cases. If there is an underlying cause, such as a fibroid or endometriosis, treatment options may be different. See the relevant leaflets to read about treatment for these conditions.

  • Not treating -This is an option if your periods do not interfere too much with normal life. You may be reassured that there is no serious cause for your heavy periods, and you may be able to live with them. A blood test may be advised every so often to check for anaemia. Iron tablets can correct anaemia.
  • Tranexamic acid tablets are an option if the LNG-IUS is not suitable or not wanted. Treatment with tranexamic acid can reduce the heaviness of bleeding by almost half in most cases. However, the number of days of bleeding during a period is not reduced and neither is period pain. You need to take a tablet 3-4 times a day, for 3-5 days during each period. Tranexamic acid works by reducing the breakdown of blood clots in the womb. In effect, it strengthens the blood clots in the lining of the womb, which leads to less bleeding. If side-effects do occur they are usually minor but may include an upset stomach.
  • Anti-inflammatory painkillers -There are various types and brands. Most are available only on prescription but you can buy one called ibuprofen from pharmacies. Your doctor may prescribe others such as mefenamic acid or naproxen. These medicines reduce the blood loss by about a quarter in most cases. They also ease period pain. You need to take the tablets for a few days during each period. They work by reducing the high level of prostaglandin in the lining of the womb. This is a chemical which seems to contribute to heavy periods and period pain. However, they do not reduce the number of days the period lasts. Side-effects occur in some people and may include an upset stomach. If you have a history of a duodenal or stomach ulcer, or asthma, you should only take these medicines on a doctor’s advice. Many women take both anti-inflammatory painkillers and tranexamic acid tablets for a few days over each period, as they work in different ways. This combination of tablets can be effective for many women with heavy periods.
  • The combined oral contraceptive (COC) pill -This reduces bleeding by at least a third in most women. It often helps with period pain too. It is a popular treatment with women who also want contraception but who do not want to use the LNG-IUS. If required, you can take this in addition to anti-inflammatory painkillers (described above), particularly if period pain is a problem. Other options which work in a similar way are combined hormonal contraceptive rings or patches.
  • Long-acting progestogen contraceptives – The contraceptive injection and the contraceptive implant also tend to reduce heavy periods. For example, up to half of women on the contraceptive injection have no periods after a year. They are not given as a treatment just for heavy periods. However, if you require contraception then one of these may be an option for you. See separate leaflets called Contraceptive Injection and Contraceptive Implant for more details.
  • Norethisterone is a hormone (progestogen) medicine. It is not commonly used to treat heavy periods. It is sometimes considered if other treatments have not worked, are unsuitable or are not wanted. Norethisterone is given to take on days 5-26 of your menstrual cycle (day 1 is the first day of your period). Taking norethisterone in this way does not act as a contraceptive. The reason why norethisterone is not commonly used as a regular treatment is because it is less effective than the other options. Many women develop side-effects. However, norethisterone may be used as a temporary measure to stop very heavy menstrual bleeding (see ‘Emergency treatment to rapidly stop heavy bleeding’, below).
  • Other medicines -Other hormonal treatments, such as gonadotrophin-releasing hormone (GnRH) analogues, are occasionally used by specialists in hospital. However, they are not routine treatments, due to various side-effects that commonly occur.
  • Surgical treatmentHaving surgery is not a first-line treatment. It is an option if the above treatments do not help or are unsuitable. Removing or destroying the lining of the womb is an option. This is called endometrial ablation. This can be done in a number of ways, using heat, laser or energy waves. It can be done by passing an instrument into the womb through the vagina, or can be done through the tummy, using ultrasound or magnetic resonance imaging (MRI) scans to guide the energy waves to the right place. The aim is to remove as much of the lining of the womb as possible. Usually this is very successful but sometimes it needs to be repeated as it is not permanent.
  • Hysterectomy is the traditional operation where the womb is totally removed. However, hysterectomy is done much less commonly these days since endometrial ablation became available in the 1990s. It is a more major operation, with more possible problems and a longer recovery time. It may be considered if all other treatment options have not worked for you.

It is very important to understand that the different Menorragia management options have various benefits, risks and consequences. Dr Emma Rees uses shared decision making consultations and decision aids to ensure you are able to make important decisions about your own health.

“No decision about you without you”

Please visit website for further information or book a consultation via

Emergency treatment to rapidly stop heavy bleeding

Some women have very heavy bleeding during a period. This can cause a lot of blood loss, and distress. One option as an emergency treatment is to take a course of norethisterone tablets. Norethisterone is a progestogen medicine. Progestogens act like the body’s natural progesterone hormones – they control the build-up of cells lining the womb (uterus).

So, if a period is very heavy or prolonged, your doctor may advise that you take norethisterone tablets. A dose of 5 mg three times daily for 10 days is the usual treatment. Bleeding usually stops within 24-48 hours of starting treatment. If bleeding is exceptionally heavy then 10 mg three times daily may be given. This should then be tapered down to 5 mg three times daily for a week, once your bleeding has stop


References and further articles.

Authored by Dr Mary Harding, Reviewed by Dr Helen Huins | Last edited 24 Feb 2016

Heavy menstrual bleeding – assessment and management; NICE Clinical Guideline (August 2016)

Pitkin J; Dysfunctional uterine bleeding. BMJ. 2007 May 26334(7603):1110-1.

Menorrhagia; NICE CKS, August 2015 (UK access only)

Heavy menstrual bleeding; NICE Clinical Guideline (January 2007)

Lukes AS, Baker J, Eder S, et al; Daily menstrual blood loss and quality of life in women with heavy menstrual bleeding. Womens Health (Lond Engl). 2012 Sep8(5):503-11. doi: 10.2217/whe.12.36.

Lethaby A, Hussain M, Rishworth JR, et al; Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2015 Apr 304:CD002126. doi: 10.1002/14651858.CD002126.pub3.

Middleton LJ, Champaneria R, Daniels JP, et al; Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010 Aug 16341:c3929. doi: 10.1136/bmj.c3929.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up; European Society for Medical Oncology (2013)

Heavy menstrual bleeding: assessment and management; NICE Guideline (March 2018)

Gupta J, Kai J, Middleton L, et al; Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med. 2013 Jan 10368(2):128-37. doi: 10.1056/NEJMoa1204724.

Lethaby A, Duckitt K, Farquhar C; Non-steroidal anti-inflammatory drugs for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Jan 311:CD000400. doi: 10.1002/14651858.CD000400.pub3.

Naoulou B, Tsai MC; Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand. 2012 May91(5):529-37. doi: 10.1111/j.1600-0412.2012.01361.x. Epub 2012 Feb 24.

Farquhar C, Brown J; Oral contraceptive pill for heavy menstrual bleeding. Cochrane Database Syst Rev. 2009 Oct 7(4):CD000154. doi: 10.1002/14651858.CD000154.pub2.

Lethaby A, Irvine G, Cameron I; Cyclical progestogens for heavy menstrual bleeding. Cochrane Database Syst Rev. 2008 Jan 23(1):CD001016.

Hickey M, Higham JM, Fraser I; Progestogens with or without oestrogen for irregular uterine bleeding associated with anovulation. Cochrane Database Syst Rev. 2012 Sep 129:CD001895. doi: 10.1002/14651858.CD001895.pub3.

Tan YH, Lethaby A; Pre-operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Nov 1511:CD010241. doi: 10.1002/14651858.CD010241.pub2.

Marjoribanks J, Lethaby A, Farquhar C; Surgery versus medical therapy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2016 Jan 291:CD003855. doi: 10.1002/14651858.CD003855.pub3.

Fergusson RJ, Lethaby A, Shepperd S, et al; Endometrial resection and ablation versus hysterectomy for heavy menstrual bleeding. Cochrane Database Syst Rev. 2013 Nov 2911:CD000329. doi: 10.1002/14651858.CD000329.pub2

Your Guide to Prolapse

Pelvic organ prolapse

What is it?

A prolapse is the name used when the vaginal walls have somewhat collapsed.  The organs in the pelvis push on the collapsed walls.  There are 3 different types of prolapse and you can have any of these or a combination of them.

A rectocoele

This is when the back wall of the vagina collapses and bowel pushes on the vaginal wall.

A uterine prolapse

The top wall of the vagina collapses and the uterus starts to push on the wall.

A cystocoele

This is when the front wall of the vagina collapses and the bladder starts to push on the wall.

These things are all more likely to happen as you age, after childbirth, if you are constipated and if you do anything which increases the pressure in your abdomen frequently.

How will I know I have one?
  • A prolapse may give you no symptoms at all and your doctor or nurse may mention it when they are doing a smear test.
  • You may feel a dragging sensation in your pelvis or a feeling like you are bearing down.
  • Sometimes you will have problems passing urine.
  • You may notice a lump in your vagina after opening your bowels or when lifting something.
  • You may notice a lump outside your vagina when washing/drying yourself. Often you can push the lump back inside, but it may come out again by itself or if you are lifting things or going to the toilet.
How will it be diagnosed?
  • Your doctor will examine you and may ask you to bear down during an internal examination. This allows them to feel if there is any pressure on the vaginal walls if a prolapse is not initially obvious.
  • You may also be asked to do a urine sample if you are having problems passing urine to make sure you don’t have a urine infection.
What happens next?
  • The aim of treatment is to reduce any discomfort, make sure you can open your bowels and pass urine properly, reduce the risk of incontinence and make sure you can have sex comfortably.
  • If you want to have children, you should also be able to do so.

You don’t necessarily need to do anything if you are not having any problems.

What can I do?
  • If your BMI is over 35, you may improve things by losing some weight.
  • Your health care provider should be able to explain to you how to do pelvic floor exercises.
  • A physiotherapist who specialises in women’s health can help with pelvic floor training if needed. This is a good idea for any woman with prolapse problems regardless of which treatment she chooses to have.
  • You should avoid becoming constipated, drink plenty of fluids and talk to your doctor if you regularly suffer from constipation.
  • Smoking can aggravate the problem by causing a cough and weakening muscles, speak to you doctor or pharmacist if you want to give up smoking.
  • Avoid heavy lifting where possible and anything which causes you to strain.
  • Doctors may suggest a trial of vaginal oestrogen tablets or cream. These can help to ease any discomfort and will usually be trialed for 6 weeks to 3 months alongside pelvic floor exercises.
  • Vaginal pessaries are silicone or plastic devices which can be inserted into the vagina to support the vaginal walls. They are a good option for anyone who would like to avoid surgery if possible. They can also be used for women who haven’t completed their families. They are usually removed and replaced every 6 months. They should not be uncomfortable, and you should be able to do your normal activities, pass urine, open your bowels and have sex with a pessary.
ring pessary
  • I have developed tools to assist with pessary options for patients in my clinic.
pessary fitting guide.
  • Surgery can be used as a long-term treatment for vaginal prolapse but most women will need to do pelvic floor exercises, ensure their BMI is below 30 and they have discussed all options for treatment before taking this route.
  • There are a variety of surgical options and the choice of operation will depend upon your individual condition and the advice and recommendations of your surgeon. Surgeries include vaginal repair (reinforcing the vaginal walls), hysterectomy and operations to lift the uterus or vagina up and fix it in place. Recovery after an operation may take up to 6-8 weeks depending upon the procedure.
Will it come back after treatment?

Sometimes after surgery a prolapse can come back. This is more likely in women who are older and overweight, whilst figures vary it can happen in up to 29% of women.

A final word from Dr Emma Rees.

This post can only give you basic information. It is based on evidence-guided research from the World Health Organization and the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists and National Institute for Health and Clinical Excellence Guidance. Different people may give you different information and advice on certain points.


Jelovsek JE, Chagin K, Lukacz ES, et al; NICHD Pelvic Floor Disorders Network. Models for predicting recurrence, complications, and health status in women after pelvic organ prolapse surgery. Obstet Gynecol 2018;132:298-309.

Helping you to choose the method of treatment that is best for you

The Coil – Intrauterine System (IUS)

Your Guide To the Intrauterine System –

IUS Coil

What is the (IUS) intrauterine system?

The IUS is a small, flexible, plastic device which sits inside the womb (uterus). There are two threads attached to it which pass out through the neck of the womb (cervix) and lie in your vagina (see diagram below). These allow you to check it is still there. They also mean it can be removed easily. They do not hang outside the body and your partner should not be able to feel them during sex (intercourse).

The IUS looks like an intrauterine contraceptive device (IUCD) – also known as the “contraceptive coil” or copper intrauterine device (Cu-IUD). However, the IUS does not contain copper; it contains slow-release progestogen hormone called levonorgestrel (LNG). It is therefore called an intrauterine ‘system’ (IUS) and not an IUCD. Modern IUCDs are very effective. Only 1-2 of every 100 women using the IUCD as contraception will become pregnant over five years of use. By comparison to this, more than 80 of every 100  sexually active women who do not use contraception become pregnant within one year.

How does the intrauterine system work as a contraceptive?

The IUS works differently to the Cu-IUD because instead of copper it contains levonorgestrel, a progestogen hormone. The hormone thickens the mucus in the neck of the womb (cervix). This forms a plug which stops sperm getting through to the womb (uterus) to fertilise an egg. The hormone also makes the lining of your womb very much thinner. This makes it unlikely that if an egg does manage to get fertilised, it will be able to implant there. (Also, as a consequence, it makes your periods very much lighter – indeed they may disappear altogether.) In some women the IUS prevents an egg being released as well, so that it happens less often or not at all. However, this is usually not the case, even if your periods are absent when using the IUS, particularly with the lower-dose IUS.

Why would I choose an intrauterine system?

Effective contraception

Once an IUS is inserted you no longer need to use other contraception for between three and five years. So, unlike users of the contraceptive pill, you do not have to think about contraception every day. The IUS does not interfere with having sex (intercourse) or with sex drive (libido). Although it contains progestogen, the quantity of the hormone which gets into your general system is very low. It does not usually therefore cause the side-effects which can occur with higher doses of hormones (for example, in progestogen-only injectable contraceptives).

Period problems improve

Periods usually become lighter, less painful and often stop, unlike with the copper IUD. After 12 months most users only have a light bleed for one day per month or so, and about 1 in 5 users of the IUS have no bleeding at all. This is why an IUS can be so good at treating heavy periods (menorrhagia), painful periods (dysmenorrhoea) and endometriosis.

Easily reversible

Fertility returns as soon as the IUS is removed, although regular periods (menstruation) sometimes take a few months to return.

Other uses and benefits

The 52 mg LNG-IUS Mirena® does not have to be used as contraception. It can also be used as a treatment for –

Heavy periods, Endometriosis and Fibroids.

What are the side-effects or risks of the intrauterine system?

Although the majority of women with an IUS have no problems, the following may occasionally occur as side-effects or consequences

Irregular bleeding

You may have irregular bleeding for the first three to six months. This usually settles down. It is usually a light “spotting” of blood which women can find a nuisance. Heavier bleeding can occasionally occur. If you experience heavy bleeding or a marked change in bleeding pattern you should discuss this with your doctor. It may mean the IUS has come out without you realising, or could be a sign of infection or pregnancy.


There is a risk of worsening an existing infection of the womb (pelvic infection) when you have an IUCD inserted. A check for infection of the vagina or neck of the womb (cervix) may be advised by taking a sample (swab) before an IUCD is inserted. The doctor or nurse fitting the device may ask you some ntimate questions about your sex life in order to determine whether it might be sensible to do a swab or urine tests. If there is thought to be a risk, you may be given antibiotics at the time the IUCD is fitted.

Ectopic pregnancy

A pregnancy developing outside the womb (uterus), usually in the Fallopian tube, is known as an ecoptic pregnancy and is very unusual with the IUS. This is because the IUS protects against this sort of pregnancy. However, if you do develop one-sided tummy (abdominal) pain with bleeding you should discuss this with a doctor.


The IUS may come out without you noticing (expulsion). This happens to 1 woman in every 20. It usually happens in the first year, particularly in the first three months, during your period. It seems it is slightly more likely to happen if it has happened to you before.

It is a good idea to check you can feel the threads of the IUS after your period. If you cannot feel them, you should use extra precautions such as a condom, until your doctor or nurse has checked the IUS is still there. If the IUS has come out in the previous few days you may need emergency contraception. If the IUS could have come out more than a few days previously, and you are sexually active, the doctor or nurse will need to make sure you are not already pregnant before fitting another one or starting alternative contraception.

Damage to the womb

The fitting of an intrauterine contraceptive can (very rarely) make a small hole in the womb – this is called perforation. It protrudes through the wall of the womb and can escape into your tummy. This happens in fewer than 2 women per 1,000, usually at the time of fitting. It can cause pain, but this is not usually severe and often there is no pain. The main symptom is not being able to feel the threads. Your womb will heal on its own but you may need an operation to remove the IUS from your tummy.

You should tell your doctor or nurse if you can no longer feel the threads of your IUS. This can mean perforation has occurred. However, far more commonly it means that the threads are tucked up inside the neck of the womb (cervix). Rarely, it can be because the threads have come off the IUS. An ultrasound scan will be carried out to find a lost IUS. If ultrasound does not find the IUS, an X-ray will be ordered.

Hormonal side-effects

Hormonal side-effects are uncommon. The progestogen released by the IUS mainly stays around the womb and very little gets into the bloodstream. So hormone side-effects are less common than with the progestogen-only pill and the contraceptive injection or implant. If side effects do occur, they tend to develop in the first few months. They tend to ease and go

Examples of possible side-effects include:

Mood swings.

Reduced sex drive (libido).

Fluid retention.

Increase in acne.

Breast discomfort.

A slight increase in breast size – this can occur in the first few months but is usually temporary.

There is no evidence that women with an IUS put on weight.

The IUS does not protect you against any sexually transmitted infections (STIs). If you have a new sexual partner, you should always use a condom, until you have both been checked for any STI.

How effective is the intrauterine system for contraception?

The IUS is extremely effective. Around 2 women in 1,000 using the IUS will become pregnant each year. (Compare this with rates of pregnancy when no contraception is used. More than 800 in 1,000 sexually active women who do not use contraception become pregnant within one year. This figure rises to 950 in two years.)

How is the intrauterine system fitted?

This is usually done towards the end of a period or shortly afterwards, as this tends to be more comfortable for you. Also, the doctor can be sure that you are not pregnant. However, it can be fitted at any time provided that you are certain you are not pregnant.

You will need to have a vaginal examination.

The doctor will pass a small instrument into your womb (uterus) to check its size and position. A clip is put on to the neck of your womb (cervix) and the inside of your uterus is measured. The IUS is then fitted using a small plastic insertion device.

You will be taught how to feel the threads of the IUS so you can check it is in place. It is best to check the threads regularly – for example, once a month just after a period. The procedure can be painful, like an intense period cramp, but the pain usually lasts only a minute or two. After the IUS is fitted, some women have crampy pains like period pains for a few hours. These can be eased by painkillers such as paracetamol or ibuprofen. Light vaginal bleeding may also occur for a short while.

Integriti – uterus and ovaries, organs of female reproductive system
Does the intrauterine system work straightaway?

If the IUS is fitted within seven days after the start of a period, it is immediately effective as a contraceptive. If it is fitted after the seventh day then you need to use extra protection such as condoms for seven days.

Note: the IUS is not effective as emergency contraception.

Who cannot use the intrauterine system?

The IUS cannot be used as emergency contraception.

If you think you need emergency contraception contact your health professional as soon as you can; you can then be fitted with a copper intrauterine device (Cu-IUD) or be given emergency contraceptive pills.

Your doctor or family planning nurse will discuss your medical history and will need to ask you some personal questions about your sex life. You may need to have tests done to look for STIs, such as chlamydia and gonorrhoea, but you will probably still be able to have an IUS fitted while you are waiting for the results, unless you have symptoms.

If you have recently been pregnant, it is recommended that you wait four weeks to have your IUS fitted (although it can safely be fitted at the time of an abortion or within 48 hours of the birth of a baby, but it may be slightly more likely to come out).

Some illnesses may mean you cannot use progestogen-based contraceptives, such as the IUS.

These include:

An infection which has not been treated.

Recent (in the preceding five years) breast cancer.

Cancer of the lining of the womb (endometrial cancer).

Cancer of the neck of the womb (cervical cancer).

Very large fibroids.

HIV: some women with HIV may not be able to use an IUS if the medicines they take might interfere with the hormone in the IUS.

In practice, the number of women who cannot have the IUS inserted is small.

Do I need any follow-up?

The doctor or nurse will usually want to check that there are no problems a few weeks after fitting your IUS. It is best done after your next period. After this, there is no need for any routine check until it is time to remove the IUS. However, see your doctor or nurse at any time if you have any problems or queries.

Most women have no problems and the IUS can remain in place for between three and five years, depending on the device fitted. However, if you are 45 years or over at the time of fitting, it can safely be left in place (and will remain effective) until your menopause. If you are younger than this and you wish to continue to use this form of contraception, the IUS needs to be replaced every:

Five years – Mirena®

If you are using a 52 mg LNG-IUS as part of HRT (and not for contraception), most doctors are happy for it to be left in place for five years, although the manufacturer recommends replacing it after four years. If you are using it only to treat heavy periods, you can keep it in place for as long as it continues to be effective (although generally it is removed once you are 55).

Removing and changing the intrauterine system

The IUS can be removed at any time by a trained doctor or nurse.

You will be able to get pregnant as soon as it is removed. If you plan to have it removed, but do not want to get pregnant, use other methods of contraception (such as condoms) from seven days before it is removed. This is because sperm can last up to seven days after you have had sex (intercourse) and can fertilise an egg AFTER the IUS is removed.

If you have had your IUS for its maximum effective time, it will need to be changed. You will need to use other forms of contraception from seven days before it is removed. This is because occasionally when the IUS is removed the neck of your womb (cervix) clamps tightly shut for a while. The doctor cannot therefore immediately insert the new IUS. As sperm can last up to seven days in the womb (uterus) they could therefore fertilise an egg whilst you are waiting for your replacement IUS fitting.

You can use sanitary towels or tampons for your period with an IUS in place. A cervical smear can also be taken with an IUS in place. Sometimes, the smear result may show that there is an organism in the cervix; these are called actinomyces-like organisms (ALOs). These are normal and do not mean the IUS should be removed. However, if you have had pelvic pain together with signs of infection, such as a temperature, your doctor may consider removing the IUS.

You should consult a doctor if any of the following occur:

Prolonged tummy (abdominal) pain after an IUS is inserted.

Vaginal discharge with or without pain. This may indicate infection.

You can’t feel your threads and suspect that the IUS has come out or is coming out. If you cannot feel the threads or feel something that feels like the head of a match, then use other contraception (such as condoms or not having sex) until you have been checked by a doctor or nurse.

  • Authored by Dr Mary Harding, Reviewed by Dr Jacqueline Payne | Last edited 30 Oct 2017
  • Long-acting reversible contraception; NICE Clinical Guideline (September 2014)
  • Trussell J; Contraceptive failure in the United States, Contraception, 2011
  • UK Medical Eligibility Criteria Summary Table for intrauterine and hormonal contraception; Faculty of Sexual and Reproductive Healthcare, 2016
  • Contraception – progestogen-only methods; NICE CKS, July 2016 (UK access only)
  • Intrauterine Contraception; Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit (2015)
A final word from Dr Emma Rees.

This post can only give you basic information. It is based on evidence-guided research from the World Health Organization and the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists and National Institute for Health and Clinical Excellence Guidance. Different people may give you different information and advice on certain points. All methods of contraception come with a Patient Information Leaflet which provides detailed information about the method.

Please contact me on the below integriti links to discuss further.

Remember – contact your doctor, practice nurse or a contraception clinic if you are worried or unsure about anything.

Integriti – Bespoke Women’s Health & Contraception.

Clinic launched October 2019 in Port Macquarie

Find Integriti on Google maps.


I am excited to announce that the Integriti – Bespoke Women’s Health clinic is now open for consultations. We have a purposely fitted, newly equipped treatment room. We are based within Port Macquarie Medical and Dental Centre!

“Empowering women to make high quality decisions about their healthcare is the fundamental ethos of integriti. I’ve established a bespoke women’s health clinic in Port Macquarie offering a variety of screening, contraception, treatment and referral pathways in a professional and discreet manner. We aim to provide a tailored outcome for each individual client”  Dr Emma Rees

We offer a range of contraception including

  • Copper and IUS Coil,
  • Contraceptive implants,
  • Contraceptive injection,
  • Combined contraceptive pill (COCP)
  • Progestogen only Pill (POP)

Also available are a full range of women’s health consultations including:-

  • Menopause management,
  • Prolapse management (Pessary),
  • Menorrhagia,
  • Sexual health advice
  • Sexual health screening.
  • Cervical smear test.
  • Breast Examination.

Kind Regards, Dr Emma x.

Click here to Contact us.

Bespoke Women’s Health on Google!