Can I experience breakthrough bleeding with the Kyleena (levonorgestrel-releasing intrauterine system) IUD after having it for one year?

Breakthrough Bleeding with Kyleena IUD After One Year

Yes, it is possible to experience breakthrough bleeding with the Kyleena IUD after having it for one year, as unscheduled spotting or light bleeding can occur throughout the duration of use, though it typically decreases over time. 1

Understanding Bleeding Patterns with Levonorgestrel IUDs

• Unscheduled spotting or light bleeding is most common during the first 3-6 months of LNG-IUD use but can occur at any time during use 2
• Bleeding patterns generally improve over time, with many women experiencing lighter menstrual bleeding or amenorrhea by the end of the first year 1
• After one year of treatment with a levonorgestrel-releasing IUD, plasma concentrations of levonorgestrel decrease (from a mean of 260 pg/ml in the first three months to 129 pg/ml after one year), which may influence bleeding patterns 3
• In the Kyleena Satisfaction Study, despite high overall satisfaction rates (86.1%), some users still experienced bleeding pattern changes throughout the duration of use 4

Evaluation of New-Onset Bleeding After One Year

If you experience new or changed bleeding patterns after a period of stable bleeding with your Kyleena IUD, consider the following:

Potential Causes to Investigate:

• IUD displacement or malposition 1
• Development of STIs or PID 2
• Pregnancy (although rare with Kyleena) 2
• New pathologic uterine conditions such as polyps or fibroids 1

Recommended Actions:

1. Check for the presence of IUD strings to confirm proper placement 1
2. Evaluate for signs of infection 1
3. Consider pregnancy testing if bleeding pattern has changed abruptly 2
4. Consult with your healthcare provider for a thorough evaluation 2

Management Options

• If an underlying gynecological problem is found, your provider will treat the condition or refer you for appropriate care 2
• If no underlying cause is identified, reassurance that these bleeding irregularities are generally not harmful is appropriate 1
• NSAIDs may be considered for short-term management of bleeding, though evidence is stronger for copper IUDs than for hormonal IUDs 2
• If bleeding persists and is unacceptable to you, your provider may discuss alternative contraceptive methods 2

Important Considerations

• Don't assume breakthrough bleeding means the IUD is "wearing off" or failing 1
• New-onset spotting after a period of stable bleeding warrants evaluation 1
• Despite some bleeding irregularities, continuation rates with Kyleena remain high (81.4% at 12 months), suggesting most women find these changes acceptable 4
• Bleeding profile satisfaction with Kyleena remains high (approximately 70%) regardless of age or parity 5

Common Pitfalls to Avoid

• Don't remove the IUD without first investigating potential underlying causes of spotting 1
• Don't ignore persistent or heavy bleeding, as this could indicate a problem requiring treatment 2
• Don't assume all bleeding is normal - while some spotting can occur throughout use, significant changes in bleeding patterns warrant evaluation 1
• Remember that amenorrhea (absence of periods) is a common and normal occurrence with LNG-IUDs and does not require treatment 2