The Uterine Renovation: A Gynecologist’s Guide to Why You’re Bleeding With an IUD and How to Navigate the Noise

As a gynecologist, I’ve had the privilege of guiding thousands of individuals through their reproductive health journeys.

But my understanding of the challenges that can come with menstruation isn’t just clinical; it’s deeply personal.

For years, my own life was dictated by debilitating periods—heavy, painful, and unpredictable cycles that left me anemic and exhausted.¹

I remember the constant anxiety, the strategic planning around my cycle, and the feeling of being a passenger in my own body.

Like many of my patients, I turned to an intrauterine device (IUD) with a profound sense of hope, envisioning a future of freedom and control.²

For many, that future arrives.

But often, the path to get there is unexpectedly rocky.

The initial excitement of a “set it and forget it” solution can quickly curdle into panic and confusion when, instead of peace, you experience weeks or even months of unpredictable bleeding.³

You might find yourself frantically searching online, reading a mix of horror stories and dismissive reassurances, feeling more alone than ever.⁵

If this is you, I want you to take a deep breath.

What you’re experiencing is not only common but, in most cases, a predictable part of a process.

The most helpful way to understand this is through an analogy I share with my patients every day: think of your uterus as a home, and getting an IUD is like starting a major renovation.

When you decide to renovate a room, you don’t expect it to be perfect overnight.

There’s an initial phase of disruption—dust, noise, unfamiliar workers, and a general sense of chaos.

This is your body’s adjustment period to the IUD.

The bleeding and cramping are the “dust and noise” of this renovation.

It can be messy and unsettling, but it’s the necessary work being done before you can enjoy your beautifully stable, newly remodeled space.

This guide is your project blueprint.

It’s designed to walk you through every stage of your uterine renovation.

We will explore the different construction plans for hormonal and copper IUDs, lay out a realistic project timeline, and provide a complete toolkit for managing the disruption.

Most importantly, we will teach you how to distinguish the normal sounds of construction from a real alarm bell that means it’s time to call the foreman—your doctor.

My goal is to replace your fear of the unknown with the power of clear, actionable knowledge, so you can navigate this process with confidence and peace of mind.

Part I: The Blueprint for Disruption — Why Your Uterus is Reacting

Understanding the “why” behind your bleeding is the first and most critical step in managing the anxiety that comes with it.

The bleeding isn’t random; it’s a direct and logical consequence of the specific “renovation plan” your chosen IUD is executing inside your uterus.

The two main types of IUDs—hormonal and copper—are like two different contractors with entirely different approaches to remodeling.

Meet the Contractors: Two Different IUDs, Two Different Renovation Plans

At the heart of your experience is a fundamental choice: did you hire a hormonal contractor or a copper one? This decision dictates the entire renovation process, from the tools used to the type and duration of the disruption.

• The Hormonal IUDs (Mirena, Kyleena, Liletta, Skyla): These devices are the “remodelers.” They work by releasing a small, steady dose of a progestin hormone called levonorgestrel directly into the uterus.⁸ This hormone is the primary tool. Its main job is to thicken the mucus at the cervix, creating a barrier that sperm can’t penetrate, and to significantly thin the uterine lining (the endometrium).⁸
• The Copper IUD (Paragard): This device is the “demolition crew.” It is non-hormonal and works through a different mechanism entirely.¹² The copper wire coiled around the T-shaped frame creates a sterile inflammatory response within the uterus. This local inflammation makes the uterine environment toxic to sperm, effectively acting as a spermicide.⁸

The critical takeaway here is that the mechanism of action is directly tied to the side effect profile you experience.

The bleeding pattern with a hormonal IUD is caused by the progestin’s transformative effect on your uterine lining.

The bleeding pattern with a copper IUD is caused by the inflammatory reaction to the copper itself.

Understanding which contractor is at work in your body is the key to deciphering the noise of your renovation.

The Copper IUD Pathway: An Inflammatory Demolition and Rebuild

If you have a copper IUD, your uterus is undergoing a controlled, sterile, inflammatory demolition.

This process, while highly effective at preventing pregnancy, is inherently disruptive to the uterine lining and its blood vessels, leading to the heavier, crampier periods that are the hallmark of this device.¹²

Here is the step-by-step biological blueprint for this process:

1. The Foreign Body Response: Your body is incredibly smart. When the plastic and copper IUD is placed, your immune system immediately recognizes it as a foreign object.¹⁰ It mounts a defense, sending an influx of inflammatory cells like lymphocytes and macrophages to the endometrium.¹⁷ This isn’t an infection; it’s a sterile, localized inflammatory state designed to protect the body.
2. A Surge in Prostaglandins: This inflammatory cascade triggers a significant increase in the production of local chemical messengers called prostaglandins.¹⁴ Prostaglandins are key players in inflammation, pain, and uterine muscle function. The elevated levels caused by the copper IUD make the uterine muscles contract more forcefully and frequently than they normally would during your period. The result is the more intense, painful cramping many users experience.¹⁸
3. Increased Blood Flow and Fragile Vessels: The inflammatory process doesn’t just cause cramping; it also changes the “plumbing” of the uterine lining. Research shows that the copper IUD leads to an increase in the number and size of blood vessels (angiogenesis) within the endometrium.¹⁷ More pipes mean more potential for water to flow.
4. Impaired Clotting: This is perhaps the most crucial piece of the puzzle. To stop menstrual bleeding, your body needs to form tiny blood clots at the sites of shedding blood vessels. However, the copper IUD significantly increases local fibrinolytic activity.¹⁷ “Fibrinolysis” is the process that breaks down clots. By ramping up this process, the copper IUD makes it harder for your uterus to effectively stop the bleeding, leading to a heavier flow that lasts longer.²⁰

For some individuals, these factors can create a challenging feedback loop in the initial months.

The heavy bleeding caused by the IUD can, over time, lead to iron-deficiency anemia.¹⁸

What’s less commonly known is that iron deficiency itself can impair the contractility of smooth muscles, including the uterus.

A weakened uterine muscle may not be able to clamp down on blood vessels as effectively to control bleeding.²²

This can create a vicious cycle: the IUD causes heavy bleeding, which depletes iron stores, and the resulting iron deficiency may then contribute to even more bleeding.

This explains why the initial adjustment can feel so overwhelming.

However, it is vital to remember that for most users, the body adapts.

Studies show that bleeding and cramping tend to decrease significantly after the first 3 to 6 months as your system adjusts to its new normal.²³

The Hormonal IUD Pathway: A Hormonal Remodel of the Landscape

The hormonal IUD presents a paradox that can be particularly confusing.

Many people choose it specifically to treat heavy, painful periods, only to be met with months of frustrating, unpredictable spotting.⁴

This feels like a bait-and-switch, but it’s actually a sign that the renovation is proceeding exactly as planned.

Your hormonal IUD is a meticulous remodeler, and the initial spotting is the unavoidable mess that comes with completely redesigning the uterine landscape.

Here’s the biological blueprint for the hormonal IUD’s process:

1. The Progestin Effect: The device releases a continuous, low dose of the hormone levonorgestrel directly onto the uterine lining.⁸ Unlike birth control pills, which deliver hormones systemically through your bloodstream, the IUD’s action is overwhelmingly local.
2. Endometrial Atrophy (The Great Thinning): This local progestin has a profound effect: it causes the endometrium to become dramatically thinner and less developed over time, a process called atrophy.⁸ A thin lining doesn’t build up each month, so there is very little to shed. This is the ultimate goal and the reason why hormonal IUDs are so effective at reducing menstrual flow, with many users eventually experiencing extremely light periods or no periods at all (amenorrhea).⁹
3. Vascular Fragility (The Transition Phase): Herein lies the paradox. As the endometrium undergoes this dramatic thinning process during the first 3 to 6 months, the blood vessels near the surface become fragile and unstable. The supportive structure around them is being dismantled and rebuilt. Without the thick, stable lining to support them, these vessels are prone to breaking and leaking unpredictably.
4. Breakthrough Bleeding (The Disorganized Shed): This fragile, unstable vascular state is the direct cause of the irregular spotting and light bleeding—known as breakthrough bleeding—that is so common in the initial months.¹² The lining isn’t shedding in the organized, cyclical way of a normal period. Instead, it’s shedding in a disorganized, patchy manner as it transitions to its new, permanently thin state.

The most empowering shift in perspective you can make is to reframe this frustrating spotting.

The noise is proof that the work is getting done.

Every day of spotting is a sign that the endometrium is responding to the hormone, thinning out, and moving closer to the final goal: the “silence” of lighter, less painful, or even absent periods.

It’s the sound of the remodeling crew working diligently to give you the peaceful, low-maintenance living space you signed up for.

Part II: Your Renovation Survival Guide — A Framework for Navigating the Process

Knowledge of the “why” is your foundation.

Now, we build upon it with the “how”—a practical, evidence-based framework for managing the renovation process.

This guide will provide you with a realistic timeline, a toolkit for comfort and control, and a clear system for knowing when to call your doctor.

The Project Timeline: What to Expect in the First Six Months (and Beyond)

Setting realistic expectations is paramount to navigating the IUD adjustment period successfully.

The most common theme in both clinical data and personal stories is that the first 3 to 6 months are the most challenging, but that patience is rewarded.⁹

As one user on a forum shared after a difficult start, “My doc told me, ‘you’ll get so sick of the bleeding you’ll be getting ready to call me to take it out and then the bleeding will stop.’ She was right”.⁶

Here’s a general timeline for your renovation:

• Months 1-3: Peak Disruption. This is when bleeding and cramping are typically at their most intense and unpredictable for both IUD types. For copper IUD users, periods may be significantly heavier and more painful than their baseline.²⁸ For hormonal IUD users, this is the prime time for persistent, irregular spotting or light bleeding.⁹
• Months 3-6: Settling In. During this phase, most users begin to see a noticeable improvement. The “construction noise” starts to die down. For copper IUD users, while periods may remain heavier than pre-IUD, the intensity of cramping and flow often begins to decrease.²³ For hormonal IUD users, the spotting becomes less frequent and periods start to become noticeably lighter and shorter.⁹
• Month 6 and Beyond: The New Normal. By the six-month mark, your body has largely adapted to the IUD.

• Hormonal IUDs: Your periods are likely to be very light, very short, or may have stopped altogether. By the end of the first year with a Mirena IUD, approximately 20% of users experience amenorrhea (no period), and that number rises to over 34% by year eight.⁹
• Copper IUDs: Your periods will have established their new pattern. For many, this means a period that is still heavier and longer than it was before the IUD, but the extreme bleeding and cramping of the first few months have subsided.¹²

It’s also important to understand that not all IUDs are created equal.

The specific brand, size, and hormone dosage of your device can influence your individual experience.

The table below provides a head-to-head comparison of the most common IUDs available in the United States.

Table 1: The IUD Bleeding Profile: A Head-to-Head Comparison

Brand Name	Type	Active Ingredient	FDA-Approved Duration	Size (width x length)	Typical Initial Bleeding (First 3-6 Months)	Typical Long-Term Bleeding Pattern
Paragard	Copper	Copper	Up to 10 years	32 mm x 36 mm	Heavier, longer, and more painful periods; spotting between periods 29	Periods may remain heavier and crampier than pre-IUD baseline, but often improve after the initial months 12
Mirena	Hormonal	52 mg Levonorgestrel	Up to 8 years (5 for heavy bleeding)	32 mm x 32 mm	Irregular bleeding and spotting are common; periods may be heavier at first before becoming lighter 9	Periods become significantly lighter and shorter; about 20% of users have no period after 1 year, rising to 34% by year 8 9
Liletta	Hormonal	52 mg Levonorgestrel	Up to 8 years	32 mm x 32 mm	Irregular menstrual periods and spotting 29	Similar to Mirena; periods become much lighter, shorter, or stop
Kyleena	Hormonal	19.5 mg Levonorgestrel	Up to 5 years	28 mm x 30 mm	Irregular periods and spotting 29	Periods become lighter and shorter; about 12% (1 in 8) of users have no period after 1 year 32
Skyla	Hormonal	13.5 mg Levonorgestrel	Up to 3 years	28 mm x 30 mm	Irregular bleeding, spotting, and changes to periods are common 29	Periods become lighter and shorter; about 6% of users have no period after 1 year 31

Sources: ⁹

The Self-Management Toolkit: Your On-Site Tools for Comfort and Control

Feeling out of control is one of the most distressing parts of dealing with persistent bleeding.¹⁹

The good news is that you are not powerless.

There is a robust toolkit of evidence-based strategies you can use to manage your symptoms, reduce discomfort, and regain a sense of agency over your body during the renovation process.

Medical Management Strategies:

• Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): This is your first line of defense. Medications like ibuprofen (Advil, Motrin) and naproxen (Aleve) work by inhibiting your body’s production of prostaglandins—the very chemicals responsible for the intense cramps and increased bleeding associated with the copper IUD.¹⁸ For best results, they should be taken on a schedule (e.g., 400 mg of ibuprofen two to three times a day for up to 5 days) starting when heavy bleeding or cramping begins.²¹
• Tranexamic Acid: For very heavy bleeding, particularly with the copper IUD, your doctor may prescribe tranexamic acid. This medication works differently from NSAIDs. It is an “antifibrinolytic,” meaning it helps stabilize blood clots at the uterine lining, directly counteracting the IUD’s tendency to promote bleeding.²¹
• Iron Supplementation: If you have a copper IUD or are experiencing significant bleeding, it is crucial to be mindful of iron levels. Ask your doctor about taking an iron supplement to prevent or treat anemia. This is not just for your overall energy and health; as discussed, it may help break the “vicious cycle” where iron deficiency itself can worsen bleeding.²¹
• Supplemental Hormones (for Hormonal IUDs): In some cases of persistent, bothersome spotting with a hormonal IUD, a doctor might prescribe a short course of oral estrogen. This can help to stabilize the fragile, thinning endometrium and give it a chance to “reset,” reducing the irregular bleeding.³⁵

Holistic and Lifestyle Strategies:

• Heat Therapy: Never underestimate the power of a heating pad or hot water bottle. Applying heat to your lower abdomen can help relax the uterine muscles and provide significant relief from cramping.³⁷
• Dietary Support: Your diet can play a supportive role. Focus on iron-rich foods like lean meats, lentils, and dark leafy greens to counteract blood loss.²¹ Foods high in vitamin C (citrus fruits, bell peppers) enhance iron absorption. Some evidence suggests that B vitamins can support the liver in metabolizing hormones, and bioflavonoids may help strengthen capillaries, potentially reducing bleeding.²²
• Stress Management: The emotional toll of constant bleeding is real and can create a stress response in the body. Practices like meditation, gentle exercise, and ensuring adequate rest can help manage the psychological impact and support your overall well-being during this adjustment.

By actively using these tools, you shift from being a passive recipient of symptoms to an active manager of your renovation project.

This sense of control is powerful and can make all the difference in successfully navigating the first few months.

Sounding the Alarm: When the Noise is a Real Warning Sign

While most of the disruption you experience is normal “construction noise,” it is essential to know how to recognize the sound of a real alarm.

Complications with IUDs are rare, but they can be serious and require prompt medical attention.²⁵

Your renovation blueprint must include a clear guide to the red flags that mean it’s time to stop and call your doctor.

The following are signs of potential complications that go beyond normal side effects:

• Expulsion (The IUD is Slipping Out): While uncommon (affecting 2-5% of users), your uterus can push the IUD out, partially or completely. If this happens, it is no longer effective. Signs include being able to feel the hard plastic tip of the IUD in your cervix or vagina, your strings suddenly feeling much longer or shorter than usual, or your partner being able to feel the IUD during sex.²⁶
• Perforation (A Hole in the Uterine Wall): This is a very rare complication (less than 0.7% of insertions) where the IUD pushes through the wall of the uterus, usually during the insertion procedure itself.¹⁰ The primary symptom is severe, sharp, and persistent pelvic pain that starts after insertion and does not get better with over-the-counter pain medication.⁴⁰
• Infection (Pelvic Inflammatory Disease – PID): The risk of infection is highest in the first 20 days after insertion and is typically related to a pre-existing, undiagnosed STI.⁴⁰ Symptoms to watch for include persistent lower abdominal pain, a fever, and vaginal discharge that has a foul or unusual odor.²⁵
• Ectopic Pregnancy: In the extremely rare event that you become pregnant with an IUD in place, there is a higher risk that the pregnancy will be ectopic (implanted outside the uterus, usually in a fallopian tube).⁴⁰ This is a life-threatening emergency. The story of Lily, who experienced an ectopic pregnancy with her IUD, highlights the urgency: she initially dismissed her severe abdominal pains as IBS before a positive pregnancy test revealed the dangerous reality.⁴³ Any positive pregnancy test with an IUD requires an immediate call to your doctor.

In a moment of anxiety, it can be hard to parse paragraphs of text.

Use this checklist to help you quickly triage your symptoms.

Table 2: Red Flag Symptom Checklist: Is It Time to Call the Doctor?

Symptom	Is This Normal?	When to Call Your Doctor
Irregular spotting or bleeding	Yes, especially in the first 3-6 months.	Call for an appointment if it persists without improvement beyond 6 months or is severely impacting your quality of life.
Cramping with your period	Yes, this is a common side effect, especially with the copper IUD.	Call for an appointment if it’s unmanageable with NSAIDs or persists long after your period ends.
Very Heavy Bleeding (soaking through a pad or tampon every hour for 2 or more hours)	No. This is excessive.	Call your doctor or seek immediate care. 37
Severe Pelvic Pain (sharp, persistent, and not relieved by pain medication)	No. Normal cramping should respond to medication.	Call your doctor or seek immediate care. This could be a sign of perforation or ectopic pregnancy. 37
Fever (unexplained) accompanied by pelvic pain	No. This is a classic sign of infection.	Call your doctor or seek immediate care. 27
Foul-smelling vaginal discharge	No. Discharge should not have a strong, unpleasant odor.	Call your doctor for an appointment. This can be a sign of infection. 25
You cannot feel your strings, or they feel longer/shorter	No. This may indicate the IUD has moved or been expelled.	Call your doctor for an appointment and use a backup birth control method in the meantime. 26
You think you might be pregnant or have a positive pregnancy test	No. This is extremely rare but requires immediate medical evaluation.	Call your doctor immediately. 37

Sources: ²⁵

Conclusion: Moving Into Your Newly Renovated Space

The journey through a uterine renovation can be challenging.

It demands patience, self-compassion, and an understanding that significant change often involves a period of messy, uncomfortable transition.

But by now, you are no longer navigating in the dark.

You have the blueprint.

You understand that the bleeding you’re experiencing is a logical, biological process—either an inflammatory demolition by a copper IUD or a hormonal remodel by a progestin one.

You have a realistic 3-to-6-month timeline, a toolkit of strategies to manage the disruption, and a clear set of alarm bells to listen for.

This knowledge is power.

It transforms you from a passive observer into an active, informed participant in your own healthcare.

You are now equipped to have a confident, collaborative conversation with your doctor, advocating for the management strategies that feel right for you.

You have the agency to decide whether to see the renovation through or to choose a different path altogether if the IUD proves not to be the right fit for your body.⁴¹

I remember the day I realized my own renovation was complete.

It wasn’t a sudden event, but a gradual dawning of peace.

The constant cramping was gone.

The endless spotting had ceased.

I could go about my day, my week, my month without the background hum of anxiety about my period.

The freedom was, and continues to be, glorious.¹

As one woman so beautifully put it after finding relief with her IUD, “My Mirena has helped me reclaim my life in a way nothing else single-handedly has”.²

That is my hope for you.

While the process can be trying, the final result—a body you can trust and a life free from the tyranny of disruptive cycles—is a truly beautiful space to live in.

Works cited

1. A Doctor’s Love Letter to Her Mirena IUD – MacArthur Medical Center, accessed August 12, 2025, https://macarthurmc.com/mirena-iud/
2. Getting An IUD Was The Best Health Decision I Ever Made – The Good Trade, accessed August 12, 2025, https://www.thegoodtrade.com/features/mirena-iud-reviews/
3. IUD experiences? – Triathlon Forum – Slowtwitch Forum, accessed August 12, 2025, https://forum.slowtwitch.com/t/iud-experiences/735769
4. IUD: What I Wish I Knew – WebMD, accessed August 12, 2025, https://www.webmd.com/sex/birth-control/features/iud-wish-knew
5. Bleeding after intercourse with an IUD – Women’s Health Interactive, accessed August 12, 2025, https://www.womens-health.com/boards/forum/sex-sexual-health/reproductive-health/11656-bleeding-after-intercourse-with-an-iud/page2
6. Mirena IUD: never ending period, all new blood. I’m kind of freaking out – Reddit, accessed August 12, 2025, https://www.reddit.com/r/TwoXChromosomes/comments/3p8yu2/mirena_iud_never_ending_period_all_new_blood_im/
7. My IUD insertion: a kind-of boring story, accessed August 12, 2025, https://helloclue.com/articles/sex/my-iud-insertion-a-kind-of-boring-story
8. Copper vs. Hormonal IUDs | Women’s Health Specialists, accessed August 12, 2025, https://whsobgyn.com/copper-vs-hormonal-iuds/
9. Bleeding Data – Mirena® IUD, accessed August 12, 2025, https://www.mirenahcp.com/about-mirena/bleeding-data
10. Intrauterine Device (IUD): Birth Control, Use & Side Effects – Cleveland Clinic, accessed August 12, 2025, https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud
11. Hormonal IUD (Mirena) – Mayo Clinic, accessed August 12, 2025, https://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354
12. What are the side effects of IUDs? – Planned Parenthood, accessed August 12, 2025, https://www.plannedparenthood.org/learn/birth-control/iud/iud-side-effects
13. Types of IUDs: Which One Is Right for You? – WebMD, accessed August 12, 2025, https://www.webmd.com/sex/birth-control/types-of-iuds-which-one-is-right-for-you
14. Intrauterine device – Wikipedia, accessed August 12, 2025, https://en.wikipedia.org/wiki/Intrauterine_device
15. Non-Hormonal IUDs – Planned Parenthood, accessed August 12, 2025, https://www.plannedparenthood.org/learn/birth-control/iud/non-hormonal-copper-iud
16. Can an IUD Cause a Heavy Period? – Healthline, accessed August 12, 2025, https://www.healthline.com/health/birth-control/iud-heavy-period
17. Effects of Copper-Containing Intrauterine Devices on the Endometrium – MedNexus, accessed August 12, 2025, https://mednexus.org/doi/10.4103/2096-2924.309791
18. Why Does A Copper IUD Cause Heavier Periods? – Fibroid Fighters Foundation, accessed August 12, 2025, https://www.fibroidfighters.org/blog/why-does-a-copper-iud-cause-heavier-periods/
19. Continuous bleeding with an IUD – Natural Womanhood, accessed August 12, 2025, https://naturalwomanhood.org/continuous-bleeding-iud/
20. Treatment of increased menstrual blood loss in IUD users – PubMed, accessed August 12, 2025, https://pubmed.ncbi.nlm.nih.gov/3311623/
21. Managing Any Problems – Family Planning, accessed August 12, 2025, https://fphandbook.org/managing-any-problems
22. Natural Treatment of Heavy Periods – Walnut Creek Naturopathic, accessed August 12, 2025, https://www.walnutcreeknaturopathic.com/blog/natural-treatment-of-heavy-periods
23. Bleeding, cramping, and satisfaction among new copper IUD users: A prospective study, accessed August 12, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC6221252/
24. IUD AFTERCARE INSTRUCTIONS – UW Medicine, accessed August 12, 2025, https://www.uwmedicine.org/sites/stevie/files/2018-11/IUD-Aftercare-Instructions.pdf
25. Side effects and risks of an IUS (intrauterine system) or hormonal coil – NHS, accessed August 12, 2025, https://www.nhs.uk/contraception/methods-of-contraception/ius-hormonal-coil/side-effects-and-risks/
26. What’s an IUD insertion like? – Planned Parenthood, accessed August 12, 2025, https://www.plannedparenthood.org/learn/birth-control/iud/whats-an-iud-insertion-like
27. IUD post insertion information, accessed August 12, 2025, https://shvic.org.au/assets/resources/SHV_IUD_Post_InsertionIInfo_Jan23.pdf
28. Copper IUD – Wikipedia, accessed August 12, 2025, https://en.wikipedia.org/wiki/Copper_IUD
29. Comparing Hormonal and Nonhormonal IUD Brands – Healthline, accessed August 12, 2025, https://www.healthline.com/health/birth-control/mirena-paragard-skyla
30. Copper IUD (ParaGard) – Mayo Clinic, accessed August 12, 2025, https://www.mayoclinic.org/tests-procedures/paragard/about/pac-20391270
31. Skyla vs. Mirena IUD: Side Effects, Pros, and Cons Compared – GoodRx, accessed August 12, 2025, https://www.goodrx.com/conditions/birth-control/the-tale-of-two-iuds-mirena-vs-skyla
32. Comparing Intrauterine Devices (IUD) – Michigan Medicine, accessed August 12, 2025, https://www.med.umich.edu/1libr/Gyn/IUDChart.pdf
33. Can a hormonal IUD help with heavy bleeding? – Stella, accessed August 12, 2025, https://us.onstella.com/the-latest/your-body/what-is-it-like-having-a-hormonal-iud-for-heavy-periods/
34. What to do for heavy bleeding from an Intrauterine Device (IUD)? – Dr.Oracle AI, accessed August 12, 2025, https://www.droracle.ai/articles/115750/what-to-do-for-heavy-bleeding-from-iud
35. IUD_Complications_Abnormal_B, accessed August 12, 2025, https://www.michigan.gov/-/media/Project/Websites/mdhhs/Folder1/Folder99/IUD_Complications_Abnormal_Bleeding_Zika_2017FINAL.docx?rev=82e9d01262c74043b26f64cea38ecd78
36. What are the treatment options for breakthrough bleeding on an Intrauterine Device (IUD)?, accessed August 12, 2025, https://www.droracle.ai/articles/163603/breakthrough-bleeding-on-iud
37. Intrauterine Device (IUD) for Emergency Contraception: Care …, accessed August 12, 2025, https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abk7039
38. Intrauterine Device (IUD) Insertion: Care Instructions – MyHealth Alberta, accessed August 12, 2025, https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=uh4130
39. Side effects of an IUD (intrauterine device) or copper coil – NHS, accessed August 12, 2025, https://www.nhs.uk/contraception/methods-of-contraception/iud-coil/side-effects/
40. Intrauterine Device (IUD) Complications – Emergency Care BC, accessed August 12, 2025, https://emergencycarebc.ca/clinical_resource/clinical-summary/intrauterine-device-iud-complications/
41. Intrauterine Device Placement and Removal – StatPearls – NCBI Bookshelf, accessed August 12, 2025, https://www.ncbi.nlm.nih.gov/books/NBK557403/
42. Mirena® Effectiveness for Birth Control, accessed August 12, 2025, https://www.mirena-us.com/about-mirena/mirena-effectiveness
43. Lily’s experience of an ectopic pregnancy while using an IUD (Intrauterine device or coil), accessed August 12, 2025, https://ectopic.org.uk/stories/lilys-ectopic-pregnancy-with-an-iud