Amenorrhea with Levonorgestrel IUD is Normal and Expected
Yes, having no menses (amenorrhea) with a levonorgestrel-releasing IUD (LNG-IUD) like Mirena is completely normal and does not require any medical treatment. 1
Expected Bleeding Pattern Changes
The LNG-IUD causes predictable changes in menstrual bleeding that are not harmful:
- Approximately 50% of LNG-IUD users will experience amenorrhea or oligomenorrhea (very light periods) by 2 years of use 1, 2
- Bleeding generally decreases progressively over time, with many women eventually experiencing only light menstrual bleeding or complete amenorrhea 1, 2
- During the first 3-6 months, unscheduled spotting or light bleeding is common and expected, but this decreases with continued use 1, 3
Clinical Management of Amenorrhea
When a patient develops amenorrhea with an LNG-IUD, provide reassurance that this is a normal, expected effect and requires no treatment. 1
When to Consider Evaluation
- If a woman's regular bleeding pattern changes abruptly to amenorrhea, consider ruling out pregnancy if clinically indicated 1
- Check for pregnancy only if there are other clinical indicators suggesting this possibility 1
If Patient Finds Amenorrhea Unacceptable
- Counsel the patient on alternative contraceptive methods 1, 3
- Offer another method if desired 1
- Note that amenorrhea itself is not a medical problem and represents the therapeutic effect of the device 1
Mechanism and Benefits
The LNG-IUD works by:
- Locally releasing levonorgestrel within the endometrial cavity, causing strong suppression of endometrial growth 4
- Making the endometrium insensitive to ovarian estradiol 4
- Reducing menstrual blood loss by approximately 90% from pretreatment levels during the first year 4
- Increasing body iron stores due to reduced menstrual blood loss 4
Important Counseling Points
Pre-insertion counseling about expected bleeding changes, including the possibility of amenorrhea, significantly improves continuation rates and patient satisfaction. 1, 2