Precautions and Warnings With Levonorgestrel-Releasing Intrauterine System

Specific Levonorgestrel-Releasing Intrauterine System Precautions and Warnings

Some warnings and precautions to be aware of prior to using this drug include the following:
  • This form of birth control does not protect against HIV, AIDS, or other sexually transmitted infections (STIs), and therefore may not be a good choice for people who are not in a mutually monogamous relationship.
  • While pregnancy is rare with proper use, up to half of pregnancies that do occur in women being treated with levonorgestrel-releasing intrauterine system occur outside the womb. This is known as an ectopic pregnancy. An ectopic pregnancy is unable to proceed as normal, may be life-threatening to a woman, and can cause permanent damage that results in infertility.

    Let your healthcare provider know right away if you develop signs of an ectopic pregnancy, such as severe abdominal (stomach) pain and unusual vaginal bleeding. Women who have had an ectopic pregnancy or pelvic infection in the past have a higher risk for this complication.
  • If a normal pregnancy occurs, levonorgestrel-releasing intrauterine system should be removed. Leaving the device in place increases the risk for miscarriage, premature birth, and serious infections. In addition, the developing infant will be exposed to the hormone levonorgestrel. Removing the device may also cause miscarriage, but is generally recommended over leaving it in place. 
  • Although rare, the insertion of this medication could cause a potentially life-threatening infection. Contact your healthcare provider if you have signs of infection, such as severe pain or fever, in the first few days after the device has been inserted. It is important that you are treated promptly.
  • Levonorgestrel-releasing intrauterine system can increase the risk for serious pelvic infections, including pelvic inflammatory disease (PID). PID can cause damage that results in infertility or an ectopic pregnancy and, in rare cases, can require surgery or cause death. The risk for PID may be highest in the first 20 days after insertion. Women who have multiple sexual partners or who have had PID in the past have a higher risk for getting it. Let your healthcare provider know immediately if you have signs of this condition, such as:
    • Prolonged or heavy vaginal bleeding
    • Unusual vaginal discharge
    • Lower abdominal (stomach) pain, pelvic pain, or tenderness
    • Pain during sex
    • Fever or chills.
  • You may have irregular periods, bleeding, and spotting, especially during the first three to six months of using this medication. With continued use, bleeding and spotting usually decrease. However, your periods may continue to be irregular. Some women stop having monthly periods altogether. Let your healthcare provider know the first time you do not have a monthly period for six weeks so your healthcare provider can make sure you're not pregnant.
  • It is possible for levonorgestrel-releasing intrauterine system to attach to or perforate (go through) the wall of the uterus. If this happens, it may not prevent pregnancy and may need to be surgically removed. Perforation usually occurs when the device is being inserted. To help reduce the risk for this, your healthcare provider will likely recommend you wait until your uterus has returned to normal to start treatment if you have recently given birth or had a second-trimester miscarriage or abortion. This usually takes at least six weeks.
  • Levonorgestrel-releasing intrauterine system can come out by itself. This is known as expulsion. Expulsion may cause pain and increased bleeding, but can also go unnoticed. You should check the device strings each month to check that the device is still in place. If you don't feel the strings, feel plastic, or believe the device may have come out, contact your healthcare provider right away.
  • Ovarian cysts are common in women using this medication. Most of the time the cysts are painless, don't require treatment, and disappear on their own within two to three months.
  • Women who currently have breast cancer or have a history of breast cancer should not use levonorgestrel intrauterine device because some breast cancers are hormone-sensitive. This means hormones can cause the cancer cells to grow.
  • Your healthcare provider will do a complete medical exam before starting treatment, which will likely include asking you questions, performing a physical exam, and doing a Pap smear. This is to make sure levonorgestrel-releasing intrauterine system is appropriate and safe for you.
  • Levonorgestrel-releasing intrauterine system should be used with caution in certain people, or may need to be removed early in certain situations. Let your healthcare provider know about any new medical conditions you develop during treatment, including genital or sexually transmitted infections, cervical or endometrial cancer, or if you become pregnant. Also let your healthcare provider know if you are no longer in a mutually monogamous relationship.
  • Women who have certain types of heart disease or heart valve problems are at risk for heart infections and may need monitoring during the insertion or removal of the levonorgestrel-releasing intrauterine system. In addition, women who have diabetes or who require chronic steroid treatment should be carefully monitored for infection after the device is inserted or removed.
  • Levonorgestrel, the active ingredient in this medication, may affect blood sugar levels. If you have diabetes, your healthcare provider may recommend you monitor your blood sugar levels more closely.
  • Let your healthcare provider know you are using levonorgestrel-releasing intrauterine system before you have a magnetic resonance imaging (MRI). The device can only be safely scanned under certain conditions.

More Headlines in Precautions and Warnings With Levonorgestrel-Releasing Intrauterine System

↶ What Should I Tell My Healthcare Provider?
‣ Who Should Not Use Levonorgestrel-Releasing Intrauterine System?
‣ Final Thoughts
Last reviewed by: Kristi Monson, PharmD
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