Yes, over the method’s 50+ year history, it has been extensively evaluated outside of trial settings. User satisfaction and method continuation have consistently been found to be high, with 90-95% of users in cohort studies indicating high satisfaction at one year of use and pilot studies conducted in Ghana, Nigeria, Kenya, Zambia, and Madagascar showing similar results, with 80-95% of users indicating they were “very satisfied” with their method. In these pilots, adopters showed strong interest in recommending the method to others.

Much like implants and the copper IUD, users are interested in the hormonal IUD’s long duration and high contraceptive efficacy. The method’s unique impact on bleeding also appears to drive user interest. In pilot studies conducted in Kenya and Zambia, about 1 in 3 adopters respectively referenced bleeding reduction as one of their motivations for choosing the method. Half of new adopters in Kenya and 1in 5 adopters in Zambia indicated that if they were to recommend the method to other women, they would reference reduced bleeding as a benefit, though also selected its potential for fewer side effects, convenience, duration, and efficacy as important characteristics to share. Similar findings have emerged in Nigeria and Madagascar.

In “real world” studies (e.g., not clinical trials), the most commonly referenced reason for removing the hormonal IUD in the first year of use is pain/cramping and bleeding irregularity, both of which are common side effects which generally resolve within 6 months of method insertion. After the first year, people discontinuing use are more likely to reference a desire to become pregnant than negative side effects as their primary motivation. Comprehensive method counseling may help potential adopters decide whether the method’s short-term side effects align with their needs and reassure adopters that side effects in the first 6 months of use are normal and likely temporary.

After insertion, clients should return if: 1. They are unable to locate their IUD strings during regular self-checks 2. They know or suspect their IUD was expelled or imbedded in the uterus 3. They begin to experience increasing or severe pain, unusual vaginal discharge, fever, chills, nausea, or vomiting 4. They know or suspect that they are pregnant 5. They want the IUD removed, for any reason Providers should reassure clients that they are welcome to return to talk about the hormonal IUD or their experiences any time, and that they can get their IUD removed for any reason.

Under normal circumstances, no, a sexual partner will not be able to feel the hormonal IUD. The IUD is placed fully within the uterus, where it is protected and held in place by the cervix. If the IUD were to partially expel and enter the cervical canal, a sexual partner may be able to feel the device – this is a method failure and the client should return to the clinic to have the IUD fully removed. While a sexual partner may be able to feel the short IUD strings, these are soft and would not be uncomfortable.

A comprehensive review of IUD research has found that hormonal IUDs may have a positive impact on sexual pain (meaning sexual pain is decreased in hormonal IUD users) and a positive-to-neutral effect on sexual desire. IUDs did not appear to have any impact on other areas of sexual function.