Long-acting intrauterine hormonal system (LARC)
Updated · Methodology
First line
Long-acting reversible contraception for 3–5 years. Per SEGO 2023, FSRH 2017, NG88 2018, first-line, including nulliparous women. Mirena is also approved for heavy menstrual bleeding (90% reduction by month 6). Office insertion, 5–10 minutes with mild discomfort.
Sources
ICD-10: Z30.0 · ICD-11: QA21
First line
Contraception during breastfeeding. MEC 2015 category 2 in first 4 weeks postpartum (theoretical perforation risk, acceptable in practice), category 1 from week 4. Local levonorgestrel exposure minimally affects lactation. RID about 1.3% (via maternal systemic circulation). Does not reduce milk supply.
Sources
ICD-10: Z30.0 · ICD-11: QA21
First line
Heavy menstrual bleeding (Mirena 52 mg). Per NG88 2018 and SEGO 2023, first-line. 70–90% blood loss reduction by month 6. Effective alternative to hysterectomy and endometrial ablation in women with preserved reproductive function.
Sources
ICD-10: N92.0 · ICD-11: GA20.50
T-shaped device with levonorgestrel reservoir. Locally releases 12–20 µg/day – systemic exposure 100× lower than POPs. Acts via endometrial thinning, cervical mucus thickening, partial ovulation suppression (25–50% of women). Pearl Index 0.2. Three options: Mirena 52 mg (5 years), Kyleena 19.5 mg (5 years), Jaydess 13.5 mg (3 years).
Remove as soon as possible if pregnancy occurs due to infection and miscarriage risk.
WHO MEC 2015 category 2 in first 4 weeks postpartum, then 1. Local levonorgestrel release is minimally systemic. RID about 1.3% (for the systemic portion), Hale L2. Does not reduce milk supply.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
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Levonorgestrel (intrauterine system) is evaluated for the following indications with varying evidence strength: Contraception during breastfeeding (evidence tier A), Contraception (evidence tier A), Heavy menstrual bleeding (evidence tier A). See the full indication matrix with dosing and citations above on this page.
Common side effects of Levonorgestrel (intrauterine system) (≥ 1 in 100): Pelvic pain on insertion, Irregular bleeding in first 3–6 months, Amenorrhea (20–50% by year 1), Acne, Breast tenderness, Functional ovarian cysts. See the Safety section for uncommon and serious reactions.
Remove as soon as possible if pregnancy occurs due to infection and miscarriage risk.
WHO MEC 2015 category 2 in first 4 weeks postpartum, then 1. Local levonorgestrel release is minimally systemic. RID about 1.3% (for the systemic portion), Hale L2. Does not reduce milk supply.
Levonorgestrel (intrauterine system) is contraindicated in: Confirmed or suspected pregnancy; Active pelvic inflammatory disease (PID); Uterine cavity anomalies (fibroid >4 cm, septum); Cervical or endometrial cancer; Unexplained uterine bleeding. Full list in the Safety section.
Black cohosh (Cimicifuga racemosa), Copper intrauterine device, Dong quai (Angelica sinensis), Etonogestrel + Ethinylestradiol (vaginal ring)