Menstrual Blood Reduction with Kyleena and Skyla
Both Kyleena (19.5mg LNG-IUS) and Skyla (13.5mg LNG-IUS) significantly reduce menstrual blood loss over time, with most users experiencing light menstrual bleeding or amenorrhea, though the exact percentage reduction is not well-defined in the literature for these specific lower-dose formulations.
Expected Bleeding Pattern Changes
Bleeding generally decreases progressively with both Kyleena and Skyla use, with many women ultimately experiencing only light menstrual bleeding or amenorrhea. 1 The reduction occurs gradually after an initial period of irregular spotting or light bleeding during the first 3-6 months of use. 1
Initial Phase (First 3-6 Months)
- Unscheduled spotting or light bleeding is expected and normal during the first 3-6 months 1
- This irregular bleeding is generally not harmful and decreases with continued use 1
- Heavy or prolonged bleeding during this phase is uncommon 1
Long-Term Pattern (After 6 Months)
- Progressive reduction in menstrual blood loss occurs over time 1
- Approximately half of LNG-IUD users experience light menstrual bleeding or amenorrhea 1
- The bleeding reduction continues throughout the duration of use 1
Comparison to Higher-Dose LNG-IUS
While specific quantitative data for Kyleena and Skyla are limited, the higher-dose levonorgestrel IUD (Mirena) achieves 71% to 95% reduction in menstrual blood loss 2, with 22% of users achieving amenorrhea 3. Kyleena and Skyla, containing lower doses of levonorgestrel (19.5mg and 13.5mg respectively versus Mirena's 52mg), would be expected to produce somewhat less dramatic reductions, though still clinically significant. 4
Clinical Implications
Counseling Points
- Pre-insertion counseling must include discussion of expected bleeding pattern changes 1
- Reassure patients that initial irregular bleeding is normal and temporary 1
- Set expectations that bleeding reduction occurs gradually, not immediately 1
When to Evaluate Further
- If clinically indicated, rule out LNG-IUD displacement, sexually transmitted infections, pregnancy, or new pathologic uterine conditions (polyps or fibroids) 1
- If bleeding persists beyond 3-6 months and the patient finds it unacceptable, counsel on alternative contraceptive methods 1
Management of Persistent Bleeding
- NSAIDs for 5-7 days during bleeding episodes can be offered as first-line treatment 2
- If amenorrhea develops and the patient finds it unacceptable, reassurance is appropriate, though pregnancy should be ruled out if the bleeding pattern changes abruptly 1
Important Caveat
The clinical research on Kyleena and Skyla is limited and manufacturer-sponsored, with no independent studies adequately defining when these lower-dose systems should be used versus higher-dose alternatives. 4 The terminology and clinical positioning of these devices remains inconsistent in the literature. 4