From the Guidelines
It is generally not recommended to take Combined Oral Contraceptives (COCs) with a Hormonal Intrauterine System (IUS) as it may increase the risk of adverse effects without providing additional benefits 1. The hormonal IUS is a highly effective form of contraception on its own, and adding COCs may increase the risk of hormonal side effects, such as breast tenderness, mood changes, and nausea, without enhancing contraceptive efficacy.
Key Considerations
- The U.S. Selected Practice Recommendations for Contraceptive Use, 2024 does not provide explicit guidance on the use of COCs with a hormonal IUS 1.
- However, it does suggest that hormonal treatment (e.g., low-dose COCs or estrogen) may be considered for managing heavy or prolonged bleeding in women using a hormonal IUS 1.
- In certain situations, such as managing heavy menstrual bleeding or endometriosis, a healthcare provider may recommend using both a hormonal IUS and COCs under close supervision.
- It is essential to consult a healthcare provider to determine the best contraceptive option for individual needs and medical history, as they can assess the potential benefits and risks of using COCs with a hormonal IUS 1.
Important Factors to Consider
- Contraceptive efficacy: The hormonal IUS is a highly effective form of contraception, and adding COCs may not provide additional benefits.
- Hormonal side effects: The use of COCs with a hormonal IUS may increase the risk of hormonal side effects, such as breast tenderness, mood changes, and nausea.
- Individual needs and medical history: A healthcare provider should assess the individual's needs and medical history to determine the best contraceptive option.
From the Research
Combined Oral Contraceptives (COCs) and Hormonal Intrauterine System (IUS)
- There is no direct evidence in the provided studies that addresses the use of Combined Oral Contraceptives (COCs) with a Hormonal Intrauterine System (IUS) simultaneously.
- The studies primarily discuss the effectiveness, risks, and benefits of various contraceptive methods, including COCs and IUS, but do not explore their combined use 2, 3, 4, 5, 6.
Contraceptive Methods
- COCs are a commonly used reversible method of contraception, with pregnancy rates of 4% to 7% per year 2.
- Hormonal IUS is a long-acting method with failure rates of less than 1% per year 2.
- Progestin-only pills (POPs) are an alternative to COCs, with similar contraceptive effectiveness to COCs in some cases, but may have variable bleeding patterns 3.
Safety and Risks
- Estrogen-containing methods, such as COCs, increase the risk of venous thrombosis 2.
- Progestin-only and nonhormonal methods, such as implants and condoms, are associated with rare serious risks 2.
- The use of COCs in women who do not smoke does not result in an increased risk of cardiovascular disease 4.