Hormonal Coils (IUS) : A Complete Guide for Women in Perimenopause and Menopause
Article written by Dr Emma Ginns, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025. This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
This guide covers hormone coils, what they are and how they may be used in perimenopause and menopause.
Hormonal Coils (IUS): What are they?
A hormonal coil is a small, flexible T-shaped device placed into the womb. It releases a steady dose of levonorgestrel, a well-established synthetic progestogen. Common brands include Mirena, Levosert, Benilexa, Jaydess and Kyleena.
Once fitted, the coil sits inside the womb and releases hormone locally. It has two soft threads at the top of the vagina to allow for removal.
Only the higher-dose coils - Mirena, Levosert and Benilexa, are suitable for HRT endometrial protection and for managing heavy periods.
How can a hormonal coil help in perimenopause and menopause?
If you take oestrogen systemically (not just vaginally) and still have a womb, you also need a form of progestogen to keep the womb lining thin and reduce the risk of bleeding or womb cancer.
A higher-dose hormonal coil can:
Provide the endometrial protection part of HRT for five years (UK guidance)
Keep the womb lining thin
Reduce unscheduled bleeding on HRT
Replace the need for daily progesterone tablets
Offer stable hormone levels with fewer whole-body side effects
For many women, this makes the coil one of the simplest and best-tolerated progestogen options for HRT.
Hormonal coils are one of the most effective long-acting contraceptive methods.
Higher-dose coils can be used for:
Up to eight years for contraception
Until age 55 if fitted at age 45 or older
This is especially important because HRT alone is not contraception.
The levonorgestrel coil is the only progestogen option that provides both contraception and HRT womb-lining protection.
Many women in their 40s experience heavy bleeding, flooding, irregular cycles or symptoms related to adenomyosis or endometriosis, which can all be very hard to manage. A hormonal coil can significantly reduce bleeding and often stops periods altogether.
The lower-dose coils (Jaydess and Kyleena) are not recommended for HRT or for treating heavy bleeding.
Because hormone release is mainly local to the womb, most women experience fewer whole-body side effects compared with oral progesterone tablets, which are also used as part of HRT.
Any side effects experienced with the hormone coils usually settle within 3-6 months and may include:
Breast tenderness
Acne
Headaches
PMS-type symptoms
Irregular bleeding or spotting
Occasionally mood changes
What are the possible risks of a hormonal coil?
They can be difficult to insert, in some women. This is more likely if you have not had a vaginal birth, have a narrow cervix, have had cervical surgery or if fibroids change the shape of the womb. Most insertions are manageable with standard techniques.
A very rare ( around2 in 1000 insertions) complication is a perforation, which causes a small hole in the womb wall. This usually heals on its own and severe pain is uncommon.
The coil can occasionally shift or come out completely. You’ll be advised how to check the threads and what to do if they cannot be felt.
There is a small risk of infection within the first few weeks after fitting. You would be advised to seek medical advice if you develop a temperature, unusual discharge or persistent pelvic pain.
Pregnancy with a coil in place is rare, but if it occurs the chance of ectopic pregnancy is slightly higher. Any positive pregnancy test requires urgent assessment.
Is a Hormonal Coil Right for You?
A hormonal coil may be helpful if you are:
Experiencing heavy periods or frequent bleeding on HRT
Using or considering HRT
Looking for reliable, long-acting contraception
Sensitive to other forms of progestogen
Wanting a low-maintenance, long-term option
Your menopause specialist can help determine whether it’s the most suitable option for your symptoms and health history.
Here is a summary of the main advantages and disadvantages of hormonal coils
The advantages:
Highly effective contraception
Reliable endometrial protection with oestrogen HRT
Can improve heavy or painful periods
Lower systemic hormone absorption
Long-lasting: five years for HRT, eight years for contraception
Convenient and low-maintenance
Cost-effective over time
Useful in perimenopause for managing erratic or heavy bleeding
Suitable for many women who cannot tolerate oral progesterone
The disadvantages:
Insertion can be uncomfortable, especially if you have not had a vaginal birth
Irregular bleeding or spotting is common initially
Small risks of expulsion, uterine perforation (very rare), or infection
Not suitable for women with certain uterine conditions or active pelvic infection
Some women experience acne, breast tenderness or mood changes
Here are a few answers to some of the commonly asked questions on hormonal coils:
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No. Levonorgestrel is a synthetic progestogen, designed to mimic the natural effects of progesterone.
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Higher-dose coils (Mirena, Levosert, Benilexa) can be used for:
Up to eight years for contraception
Up until age 55 if fitted at age 45 or later (current UK guidance)
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Higher-dose coils provide endometrial protection for five years.
After this, you can:
Replace the coil
Or leave it for contraception and use another form of progesterone for HRT
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Most removals are quick and straightforward.
A speculum is inserted, the threads are gently pulled, and the coil slides out easily.
If threads are not visible, removal may require additional steps or a scan.