The Progesterone IUD

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• 0:04Introduction
• 0:27How it works
• 1:32Effectiveness
• 1:55Advantages
• 3:27Disadvantages
• 4:37Insertion

Full transcript

1. 0:04Introduction

   Hi, I'm Dr. Taz Varkey. Welcome back to GynoTalks. Today I'm going to talk to you guys about the progesterone IUD. So the progesterone IUD is a T-shaped device that's about the size of the palm of my hand, and it has progesterone implanted on the device, and this progesterone is released slowly over several years. There's three different, actually four different progesterone IUDs on the market, and they all have different amounts of progesterone that'll affect how much you get per day and how long it lasts.

2. 0:27How it works

   And it's out of the scope of this video for me to explain the differences between those, but maybe someday I will for you guys. But just understand that they all have the same mechanisms of action. So what does that mean? Well, what I mean is, how does the progesterone IUD keep you from getting pregnant?

3. 0:49

   And this is going to be the same as what you've heard, perhaps, in my prior videos for progesterone-only methods. The progesterone-only IUD works by thickening cervical mucus, so it makes it hard for the sperm to get through. That's the first way. The second way is by being a barrier, sitting as a T. This T-shaped device is sitting in your uterus, it's going to keep the sperm from getting through sometimes, and even if the sperm gets through and meets the egg, it's gonna keep that embryo from implanting because it's physically there.

4. 1:12

   And lastly, the progesterone thins out the uterine lining so much that there's nowhere for this embryo to implant. There's no pushing. So it's a very effective form of contraception for this reason, over 99.5% effective.

5. 1:32Effectiveness

   It's the most effective contraceptive option on the market, and even compared to tying a woman's tubes, it is technically equally or even a little bit more effective, but it's reversible. So I love this method because it's as effective as tying your tubes, but you can change your mind. You could pull this IUD out at any time and you can get pregnant the next month.

6. 1:55Advantages

   It doesn't affect your fertility. This is another common concern patients have. So what are some of the advantages of a progesterone IUD over other contraceptive methods? Well, it helps with bleeding patterns. So if women have heavy, painful periods, this will often help lessen the amount of blood you see during your period once a month.

7. 2:18

   And some, they don't even see a period anymore. About 30% of women will stop seeing a period by about the three-month mark after insertion, and this is considered a big benefit. Some patients don't like the idea of this and consider it a negative, but most people love it once they get used to the concept of that. It can also be used to help manage endometriosis-related pain.

8. 2:41

   So we think as many as 1 in 10 women have endometriosis that can cause significant pelvic pain during your periods, and having this progesterone IUD inserted will help with that for many patients. I will make the caveat that there are some patients that if they have even light bleeding with endometriosis, they can get pretty severe pain, and in those patients the progesterone IUD could make things a little worse because there's more spotting the first few months it's put in.

9. 3:04

   So this is something to talk about it with your doctor and consider. And lastly, there are some studies that show that there's a decreased risk in both ovarian and uterine cancer in women who've used the progesterone IUD. Now, for most young women the risk of uterine and ovarian cancer are very low, so this reduction is probably not that significant, but it's important to know about, and it's great.

10. 3:27Disadvantages

    In terms of the disadvantages, the first few months it's in you can have an irregular spotting. I tell women it can last up to three months. I had one or two patients where it lasted longer than that, but generally it's gone away by even within a month after insertion.

11. 3:49

    For about five to ten percent of women their acne could get worse, so that's important to know about. There's an increased risk of bloating, or formation of small ovarian cysts from these progesterone IUDs. It's mostly a local effect, so that's why they'll notice it locally, but most of these ovarian cysts will resolve with observation, and rarely do I have to pull one out because of an ovarian cyst being present.

12. 4:13

    And most patients don't want me to. They like it so much that even if I see an ovarian cyst, they'll ask me to just leave it in, and when I bring them back the next month, it's often gone. So that's it for the main, you know, advantages and disadvantages. As I mentioned earlier, when we pull it out, you can get pregnant right away, and if you don't like it, we can pull it out the next day or the next month, whenever you want.

13. 4:37Insertion

    Most of these progesterone IUDs are good for three to five years, though. And lastly, I want to touch base on how it's put in because this is a big concern and fear for patients. I mentioned this in a prior video for the copper IUD, it's the same insertion process. You go to your gynecologist, she or he puts your feet up in stirrups, they'll put a speculum in and then they'll slowly dilate the cervix, open the cervix up just to get anywhere from three to five millimeters, and then they'll insert the IUD, sitting it folded with the arms folded in a straw-like device.

14. 4:58

    Then they'll insert the straw in through the cervix, and then we can release the IUD once it's in the uterus and the arms open up, so you'll feel a few minutes of discomfort.

15. 5:20

    Most patients will compare it to severe menstrual cramps, or moderate to severe menstrual cramps, for just a few minutes, and then it all comes down quickly. I usually premedicate my patients with some Motrin about an hour before, if they're able to and if it's safe for them to take it. But then those cramps just settle down very quickly after insertion as I'm talking to them and as I'm observing them.

16. 5:43

    So it's a pretty easy process to put in, and just for that few minutes of discomfort, you may have three to five years of excellent contraception. So that's it. I hope this was helpful. I'm going to remind you that this video doesn't substitute for medical advice. You have to go talk to your doctor because your individual medical conditions and situation will affect how they counsel you. Thanks for tuning in, and don't forget to subscribe.