Levonorgestrel (Intrauterine)


Levonorgestrel (lee-voe-nor-JES-trel)

This is an intrauterine device (IUD), which is a reversible form of birth control. This type of IUD slowly releases levonorgestrel, a hormone. It is used to prevent pregnancy and to treat heavy menstrual bleeding. An IUD works best in women who have had at least one child.

Brand Name(s)

Mirena, Skyla

When This Medicine Should Not Be Used

How to Use This Medicine


  • The IUD is usually inserted by your doctor during your monthly period. You will need to see your doctor within 4 to 12 weeks after the IUD is placed and then once a year.
  • Your IUD has a string or "tail" which is made of plastic thread. About one or two inches of this string hangs into your vagina. You cannot see this string, and it will not cause problems when you have sex. Check your IUD after each monthly period. You may not be protected against pregnancy if you cannot feel the string or if you feel plastic. Do the following to check the placement of your IUD:
    • Wash your hands with soap and warm water. Dry them with a clean towel.
    • Bend your knees and squat low to the ground.
    • Gently put your index finger high inside your vagina. The cervix is at the top of the vagina. Find the IUD string coming from your cervix. Never pull on the string. You should not be able to feel the firm plastic of the IUD itself. Wash your hands after you are done checking your IUD string.
  • Your doctor will need to replace your IUD if it comes out of your uterus. You will also need to have it replaced when the medicine it contains wears off. This could be as long as 3 years for Skyla or 5 years for Mirena, but you must follow what your doctor says.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

  • Make sure your doctor knows if you are also using insulin, a blood thinner (such as warfarin, Coumadin®, Jantoven®), or a steroid medicine (such as hydrocortisone, methylprednisolone, prednisolone, prednisone). Tell your doctor if you are using St John's wort, bosentan (Tracleer®), rifabutin (Mycobutin®), rifampin (Rifadin®, Rimactane®), medicine for seizures (such as carbamazepine, felbamate, oxcarbazepine, phenytoin, topiramate, Dilantin®, Felbatol®, Tegretol®, Topamax®), medicine to treat fungus infection (such as griseofulvin, itraconazole, ketoconazole, Gris-peg®, Nizoral®), or medicine to treat HIV/AIDS (such as atazanavir, delavirdine, efavirenz, lopinavir, nevirapine, ritonavir, Atripla®, Crixivan®, Kaletra®, Lexiva®, Norvir®, Prezista®, Rescriptor®, Reyataz®, Sustiva®).

Warnings While Using This Medicine

  • Make sure your doctor knows if you are breastfeeding, or if you have had a baby, miscarriage, or abortion in the past 3 months. Tell your doctor if you have heart or blood circulation problems, including a history of heart valve problems, heart disease, blood clotting problems, stroke, heart attack, or high blood pressure. Make sure your doctor knows if you have diabetes, problems with your immune system, or have had surgery on your female organs (especially fallopian tubes).
  • There is a small chance that you could get pregnant when using an IUD, just as there is with any temporary birth control. If you get pregnant, your doctor may remove your IUD to lower the risk of miscarriage or other problems.
  • You have a higher risk of an ectopic pregnancy if you get pregnant while your IUD is in place. An ectopic pregnancy can be serious, even life threatening. An ectopic pregnancy can also cause problems that may make it harder for you to become pregnant in the future.
  • You might have some blood spotting and cramping during the first weeks after the IUD has been inserted. These symptoms should decrease or go away within a few weeks up to 6 months. Call your doctor if your pain or bleeding is severe.
  • You could have less bleeding or even stop having periods by the end of the first year. Call your doctor if you have a change from the regular bleeding pattern after you have had your IUD for awhile. This includes if you start to have more bleeding or if you miss a period (and you were having periods even with your IUD).
  • Rarely, the IUD may make a hole in the wall of your uterus when it is inserted. If this happens, it could cause serious problems.
  • An IUD increases your risk of pelvic inflammatory disease (PID). PID can be serious, even life threatening. This infection could cause scarring of the female organs, which may make it hard for you to become pregnant in the future and can increase your risk of ectopic pregnancy. Call your doctor right away if you have flu-like symptoms, fever, chills, cramps, pain, bleeding, or fluid leaking from your vagina. These may be signs of infection
  • This IUD will not protect you from HIV/AIDS, herpes, or other sexually transmitted diseases. If this is a concern for you, talk with your doctor.
  • MRI (magnetic resonance imaging): Tell your healthcare provider that you have an IUD if you need to have an MRI or other medical test.
  • An IUD can slip partly or all of the way out of your uterus. If this happens, you will have no protection against getting pregnant. You might also have a higher risk for serious problems. This is more likely during the first year that you have your IUD, but it can happen at any time. Check the string of your IUD regularly to make sure your IUD is still in place.
  • This medicine may raise or lower your blood sugar level.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

  • Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
  • Abdominal or pelvic pain, tenderness, or cramping that is sudden or severe
  • Change in bleed pattern after the first few months
  • Chest pain, problems with speech or walking, numbness or weakness in your arm or leg or on one side of your body
  • Heavy bleeding from your vagina
  • Pain during sex, or if your partner feels the hard plastic of the IUD during sex
  • Severe headache, vision changes
  • Vaginal discharge has a bad smell, fever, chills, sores on your genitals

If you notice these less serious side effects, talk with your doctor:

  • Acne or other skin changes
  • Breast pain
  • Dizziness or lightheadedness after IUD is placed
  • Mild headache
  • Mild itching around your vagina and genitals
  • Mood changes
  • Nausea or vomiting
  • Spotting, less bleeding during periods

If you notice other side effects that you think are caused by this medicine, tell your doctor

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088

Version Info

  • Last reviewed on 8/4/2014

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