I’m 41 years old and have been using the Kyleena IUD for five years, due to replace it next week. As a result of the IUD, my periods have been very light spotting for a couple of days. However, my last two periods have been much heavier and longer, lasting seven or eight days. Is this the result of Kyleena needing to be replaced or a sign of perimenopause?
—Anonymous
One of many women’s favorite things about progestin-eluting IUDs like Kyleena is that they often experience light periods or may not have menstrual bleeding at all while the IUD is in place. There are many studies that look at changes in menstrual bleeding patterns before and after IUD placement. However, there is less data regarding changes in menstrual bleeding at the end of the IUD’s lifespan.
One study looked at bleeding patterns in more than 1,400 women over the full five-year lifespan of Kyleena — referred to in the paper as LNG-IUS 12. The researchers found that the mean average bleeding and spotting days decreased over time. The biggest decrease in bleeding and spotting was from the first three months after the IUD was placed to the second three-month time period. More than 20% of women had no bleeding or spotting with low-dose IUDs. There is no trend in the data suggesting that bleeding increases at the end of the lifespan of the device.
As you suggest, heavier periods can be a sign of reproductive aging. During the late-reproductive stage, older eggs require more signal from the pituitary gland to mature for ovulation. That signal — follicle-stimulating hormone — also stimulates the ovaries to make estrogen. Estrogen supports the buildup of the uterine lining. If estrogen levels are higher, more uterine lining can build up and you will experience heavier periods.
You should tell your doctor that your periods changed. There are other changes that might lead to a different bleeding pattern. It is rare and often near the time of insertion, but it is possible to expel your IUD. Without an IUD properly placed, heavier bleeding might occur. Fibroids and uterine polyps can also cause heavy uterine bleeding. If heavy bleeding persists, your doctor may recommend imaging to try to determine the cause.
The takeaway: The data does not suggest that increased uterine bleeding at the end of your IUD’s lifespan is common. While entering the late-reproductive stage can lead to heavier periods, it is worthwhile to discuss changes in your period with your doctor so other causes can be explored if needed.
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