01/15/2026
“Something to Talk About”: Considering Hormonal IUDs for Endo and Adeno
💛By Jennifer Jaggi, MD
For some patients living with endometriosis or adenomyosis, hormonal suppression can play an important role in symptom management. One commonly discussed option is a levonorgestrel-releasing intrauterine device (IUD), such as Mirena® or Liletta®. While the hormone in these IUDs does not make endometriosis or adenomyosis go away, it can suppress disease activity and make it less biologically active—often leading to meaningful improvements in pain or bleeding for the right patient.
Levonorgestrel IUDs deliver a progestin (synthetic form of progesterone) directly to the uterus, resulting in much lower hormone levels in the bloodstream compared with oral options like birth control pills or norethindrone. Because of this localized delivery, many patients experience fewer systemic side effects. In younger patients with adenomyosis who are not ready to consider hysterectomy, an IUD can be a very reasonable temporizing measure, offering symptom relief while preserving future options.
These IUDs can be especially helpful for heavy menstrual bleeding, a major issue for many patients with adenomyosis and, for some, even more disruptive than pain itself. Many patients experience significantly lighter periods—and sometimes no periods at all—with a levonorgestrel IUD. That said, because adenomyosis affects the uterine muscle, some patients do not tolerate having a device in the uterus well and may experience increased cramping, particularly early on. Others do extremely well and find the improvement in bleeding to be one of the most meaningful benefits.
It is also important to understand the limitations. Levonorgestrel IUDs do not reliably suppress ovulation, the way oral contraceptive pills can, so some patients will continue to ovulate. Because of this, ovarian cyst formation can occur and occasionally be problematic. Another consideration is that younger patients who have not had a pregnancy may not tolerate a standard-sized IUD. Kyleena® is a physically smaller alternative that may be better tolerated, but the tradeoff is that it releases a lower dose of hormone, which can make it less effective at reducing bleeding.
For patients planning surgery for endometriosis, the time of surgery can be an excellent opportunity to consider IUD placement. Placement during surgery avoids the pain of insertion—an especially important consideration for patients with chronic pelvic pain—and can reduce the chance of malposition or suboptimal placement. Ultimately, whether an IUD is the right choice for you depends on your individual symptoms, treatment goals, prior experiences, and personal preferences. Everyone responds differently, so it is key to have an open conversation with your provider about the pros and cons of each option. At Pacific Endometriosis and Pelvic Surgery, we encourage patients to ask questions and take an active role in deciding what is the best option for them.
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