Hormone Spiral: Navigating the Intricate Pathways of Hormonal Influence

 The hormone coil, also known as the intrauterine system (IUS), is a plastic body about three centimetres in size, usually T-shaped, which is inserted into the uterus like the conventional coil . While contraception in the latter is ensured by the released copper ions, among other things, the hormone IUD releases a small amount of the synthetically produced hormone levonorgestrel into the body. The hormone spiral is one of the safest contraceptive methods. The risk of an unwanted pregnancy, despite the IUS, is roughly the same as that of sterilization.

Hormone spiral: effect

Contraception is effective from the first day of use and for up to five years. Unlike the pill, the hormone spiral releases the hormone locally, which means that only tiny amounts get into the circulatory system.

The IUS has a contraceptive effect in several ways:

• The corpus luteum hormone levonorgestrel makes the mucus in the cervix thick. This makes it more difficult for sperm to pass through.
• The sperm that do come through are inhibited in their activity by the hormone.
• Ovulation and egg maturation are influenced and even suppressed.
• The lining of the uterus changes, making it difficult for a fertilized egg to implant.

 

Insert hormone spiral

Insertion of the hormone spiral is similar to that of the copper spiral. First, a gynaecological examination is carried out, in which possible diseases are ruled out and risks are discussed. The size of the uterus is also measured to make it easier to determine the optimal position of the hormonal IUD.

The IUS is inserted into the uterus with a unique applicator after the genital area has been sterilized.

The threads attached to the hormone coil are used for self-monitoring and later for removal. The doctor shortens the threads to a convenient length. Since the insertion of the hormone spiral can cause a slight pulling or even severe pain, patients should discuss with the doctor in advance whether an anaesthetic makes sense or is desirable.

Hormone spiral: Side effects not insignificant

The hormone spiral, which has been approved in Germany since 1996, can cause several side effects. Doctors must, therefore, provide detailed information about the hormone spiral. Since 2007, physicians have also been obliged to provide patient information about the IUS and its side effects to interested patients.

If a woman decides to have the IUS, she must provide written consent and confirmation of the possible risks before insertion. Side effects include (frequency particularly pronounced in the first six months of the adjustment phase):

• Menstrual cycle disorders: Irregular or no menstrual bleeding (or bleeding between periods )
• Pain: headache, migraine, abdominal pain, chest tightness or pain, back pain
• Skin rash, itching, eczema, acne (in individual cases also adverse effects on the hair, increased body hair can occur)
• Nervousness, mood swings and depressive moods (up to suicidal thoughts), loss of libido
• Weight gain, water retention in the tissues
• Ovarian cysts (usually benign)
• Possible increased risk of breast cancer and thrombosis (roughly equivalent to that of combined oral contraceptives)
• Inflammation: pelvic area, uterus, cervical mucus, vaginal lining and outer labia

 

Hormonal coils are also for young women and nursing mothers.

The hormonal spiral is a relatively common contraceptive method in Germany and is particularly popular with women who

• have given birth one or more times
• want to prevent in the long term
• unable to tolerate the estrogen in certain contraceptives
• have a hefty menstrual period

In countries like the USA or Sweden, IUSs are also a standard contraceptive method for young, childless women. In Germany, however, many gynaecologists advise against a hormone spiral in this group of people. The reason for this is not the risk of infection, which has since been disproved, but the pain that can arise when inserting and pulling the spiral and the other side effects mentioned.  

There are now extra small hormone spirals, so these can also be an option for young women without children. A detailed consultation and explanation by the gynaecologist is recommended in any case.

A hormone IUD can also be used during breastfeeding, as it does not affect milk production and the child. However, the insertion should not occur until six to eight weeks after birth, when the uterus has completely receded. 

Hormone spiral: costs and price

The costs for the hormone spiral are only covered for women up to the age of 20 and for women entitled to social assistance. If you want to have the hormonal spiral used, you should be sure that contraception is desired over a more extended period. The initially relatively high costs of the hormone spiral of up to 400 euros, however, pay off after the planned period of five years compared to the pill.   

The half-yearly ultrasound checks to check the correct position of the hormonal spiral are not paid for by health insurance, except the first one after four to six weeks.

 Since the IUS is also used to treat menstrual problems and to treat hefty menstrual bleeding, the costs for the IUS are covered by health insurance in this case – provided that the IUS is prescribed exclusively for this reason.

Remove hormone spiral

After five years, hormones become less effective, and contraception becomes less reliable. Women who now wish to have a child can become pregnant again in the next cycle after the hormone coil has been removed. If you want to continue using the IUS for contraception, you can have a new IUS inserted immediately after removing the old one.

The change should occur during the menstrual period; the IUS can be changed at any time in women who no longer menstruate. More than half of all women who have the hormone spiral inserted for the second time no longer have a menstrual period. If the hormone spiral is changed directly, the side effects of the adjustment phase do not occur.