First-lineMirena (52 mg) / Kyleena (19.5 mg) / Jaydess (13.5 mg)
Levonorgestrel IUS
Intrauterine progestogen system (LARC)
First-line for HMB and endometrial protection on HRT.
Intrauterine
First-line for
- Heavy menstrual bleeding
- Contraception (LARC)
- Endometrial protection with oestrogen HRT
- Endometrial hyperplasia without atypia
Mechanism
Local LNG release → profound endometrial atrophy; some anovulation (dose-dependent); mucus thickening.
"Local, low-dose, long-acting"
- Mirena 52 mg → 8 y contraception / 5 y HMB & HRT
- Kyleena 19.5 mg → 5 y
- Jaydess 13.5 mg → 3 y
Dosing
- Insertion
- Any time if reasonably certain not pregnant; immediate cover if within days 1–7
Contraindications
- AbsoluteCurrent pelvic infection, unexplained uterine bleeding, distorted cavity, current breast cancer
Side effects
- Irregular bleeding → oligo-/amenorrhoea
- Ovarian cysts (usually functional)
- Perforation ~1/1000
- Expulsion 3–5%
Fetal & maternal notes
- • Remove if pregnancy — ↑ ectopic and miscarriage risk if retained
Key interactions
Enzyme inducers
OKNo effect (local delivery)
Clinical pearls
- 💡 Endometrial protection: only 52 mg IUS licensed
- 💡 Check threads at 4–6 weeks post-insertion
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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