Although there is no proven cure for endometriosis, there are several treatment options that help provide relief from the pain, fatigue, and discomfort. Pain medications (over-the-counter or prescription), hormonal therapy (oral contraceptives or injections), or surgery can be helpful. An intrauterine device, or IUD, is another hormonal treatment option for endometriosis.

What Is an Intrauterine Device?

An IUD is a T-shaped device that’s inserted into the uterus by your healthcare provider as a form of long-acting birth control. IUDs prevent pregnancy in different ways depending on what type you have. Copper IUDs work by making the uterus an environment where sperm don’t survive well, which prevents fertilization. Hormonal IUDs release a small amount of progestin that thickens cervical mucus and also thins the uterine lining. In many people, this is enough to prevent pregnancy. Some people may also find that they ovulate less often, but that isn’t the main way hormonal IUDs work.

An IUD does not disrupt an established pregnancy. However, if a pregnancy were to occur while using an IUD, it does come with an increased risk of serious complications, including miscarriage and ectopic pregnancy. The U.S. Food and Drug Administration (FDA) has approved hormonal IUDs for three to eight years, depending on the device.

Types of IUDs

In the United States, five types of IUDs are currently available and approved by the FDA for contraception for the following lengths of time:

• Kyleena — Prevents pregnancy for up to five years
• Liletta — Prevents pregnancy for up to eight years
• Mirena — Prevents pregnancy for up to eight years
• Paragard — Prevents pregnancy for up to 10 years
• Skyla — Prevents pregnancy for up to three years

Only Paragard, a copper IUD, does not release hormones. Because it doesn’t have hormones, it can last longer (10 years). All of the others release the hormone progestin to prevent pregnancy.

Both Liletta and Mirena are approved for up to five years to treat heavy menstrual bleeding (and up to eight years for those who choose an IUD for birth control).

An IUD can be removed at any time before its natural useful life is over, and fertility is typically restored soon thereafter.

How Are IUDs Used To Treat Endometriosis?

Because the exact cause of endometriosis is still unknown, treatment focuses on relieving symptoms rather than curing the condition. IUDs are one treatment option. Mirena and Liletta are FDA-approved hormonal IUDs that treat heavy menstrual bleeding, so they may be more commonly chosen when heavy periods are part of the problem.

A key effect of progestin is that it thins the lining of the uterus. It can also reduce endometriosis-related tissue growth and bleeding, which may ease pain in some cases. However, endometriosis-related adhesions (bands of scar tissue) usually require surgery to remove.

While researchers don’t fully understand how progestin improves endometriosis symptoms, many people experience relief with this treatment. In some cases, using a progestin-releasing IUD can also stop menstrual periods altogether — a condition known as amenorrhea.

Who’s a Good Candidate for an IUD?

Most women can safely use an IUD, according to Mayo Clinic. Your healthcare provider will make sure you aren’t pregnant and will review your health history before placing an IUD. STI screening is recommended for some people, but it isn’t required for everyone right before insertion, and it can often be done the same day.

If you’ve had a baby, you can get an IUD anytime after giving birth, as long as you’re not currently pregnant. An IUD can sometimes be placed right after delivery, but the chance of expulsion (the IUD coming out on its own) is higher with immediate postpartum placement. For many people, expulsion risk is lower when insertion is done after the early postpartum period.

A past ectopic pregnancy usually doesn’t prevent someone from using an IUD. But if pregnancy happens with an IUD in place, it needs urgent medical evaluation because the chance of an ectopic pregnancy is higher. If you have liver disease or breast cancer, you may not be a good candidate for hormonal IUDs, as hormones in the IUD may affect the treatment of these conditions.

In the past, conventional wisdom was that if you hadn’t had a child, you were not a good candidate for an IUD. However, modern IUDs are safe, effective, and convenient for most people who might conceive, including those who have never had a child.

Potential Benefits of IUDs for Endometriosis

Why use an IUD instead of another form of progestin to help with endometriosis symptoms? Many people with endometriosis choose the IUD because they do not want to take a daily pill or schedule shots on a quarterly basis. If IUD placement is successful and does not have complications, one appointment for an IUD insertion might be the only necessary treatment for years, other than annual pelvic exams.

Similar to other progestin treatment options, in some cases, the hormonal IUD might have the following benefits:

• Reduces heavy menstrual bleeding
• Reduces endometriosis pain
• Does not affect bone density in young individuals, unlike other hormonal birth control methods (like hormonal injections)

The hormonal IUD also provides greater than 99 percent effective contraception.

Feedback on Benefits of IUDs From Members of MyEndometriosisTeam

Several members of MyEndometriosisTeam have said that the Mirena IUD has helped them with their endo symptoms. “I have one, and it helped a bit. I’ve had it for nearly 12 months. The spotting is a little annoying, but I guess we take the good with the bad,” said one member.

Another member described a positive experience with an IUD for several years: “I have now had the IUD in place for almost four years, so it must be doing something right! I wouldn’t say it has had a groundbreaking impact on my pain, but my periods are MUCH lighter (albeit completely irregular),” they said. “These are easier to deal with, and the side effects are much, much less than any I have ever experienced on other forms of hormonal treatment for endometriosis.”

“At first, I had a lot of heavy bleeding, but that was pretty much my only side effect. My pain and bleeding have settled down heaps. It’s probably the best decision that I’ve made regarding my endo journey,” said another member.

“I use an IUD, and it stopped my periods altogether!” said another user of the site. “It has helped quite a bit, but make sure every few months it is still in place by getting your doctor to check. I still have pain, but I have seen at least a 40 percent difference.”

Possible Challenges of IUDs for Endometriosis

Using an IUD can present important drawbacks to consider as well. Some people who use the IUD for endometriosis have reported a number of downsides. For example, there have been reports of greater pain than expected during insertion and removal, difficulty with the device remaining in place or being expelled from the body, and increased unscheduled bleeding or spotting during the first few months of use.

Depression, nausea, and bloating are all possible IUD side effects. Serious but rare complications include perforation of the uterus during insertion and severe infection. Additional surgery may be necessary if perforation of the uterus occurs.

While the likelihood of an ectopic pregnancy is much lower with an IUD in place, in the very rare event that you do get pregnant, the probability of complications like a miscarriage or an ectopic pregnancy is much higher. The mechanism of action of today’s IUDs is well understood, and it has been observed to be safe over the past 40 years.

Feedback on Challenges of IUDs From Members of MyEndometriosisTeam

Unfortunately, not everyone with endometriosis finds relief from a hormonal IUD. Some members of MyEndometriosisTeam reported painful periods, heavier bleeding, expulsion of the device, and other difficulties.

“It’s great if you don’t have a preexisting condition, but if you do, the IUD can aggravate it,” one member said. “I tried it, and my condition got worse. I went back to my gynecologist to remove it, and the strings broke. I had to have it surgically removed because it was embedding itself in the uterine wall.”

“I was having pelvic pain so much, I was in and out of the emergency room just for them to tell me nothing was wrong. I ended up having to get it taken out,” explained another member.

Unexpected side effects were reported by another member who tried a hormonal IUD to help with endometriosis: “I tried an IUD. It helped with the endo pain, but I had other side effects. … I also experienced really terrible cramping and pain, acne, and weight gain.”

Given the pros and cons of an IUD for treating endometriosis, it’s important that you work with your healthcare provider to decide if it’s an appropriate treatment option for you.

Join the Conversation

On MyEndometriosisTeam, people come together to share their experiences with endometriosis, get advice, and find support from others who understand.

What has your experience been using an IUD as a treatment for endometriosis? Let others know in the comments below.