Two small studies, limited to studying BMD in the forearm, show no decrease in BMD. One of the studies showed at seven years of use, similar BMD at the midshaft of the ulna and at the distal radius as nonusers matched by age and BMI. In addition, BMD measurements were similar to the expected values for women in the same age group as the participants. The authors of the study said their results were predictable, since it is well established that the main factor responsible for bone loss in women is hypoestrogenism, and, in agreement with previous reports, they found estradiol levels in Mirena users to be normal. Composition and hormonal release
The hormonal IUD is a small T-shaped piece of plastic, which contains levonorgestrel, a type of progestin. The cylinder of the device is coated with a membrane that regulates the release of the drug. Bayer markets Skyla as Jaydess in the United Kingdom. Jaydess releases six micrograms per day and lasts for three years. In comparison, oral contraceptives can contain 150 micrograms of levonorgestrel. The hormonal IUD releases the levonorgestrel directly into the uterus, as such its effects are mostly paracrine rather than systemic. Most of the drug stays inside the uterus, and only a small amount is absorbed into the rest of the body. Insertion and removal
The hormonal IUD is inserted in a similar procedure to the nonhormonal copper IUD, and can only be inserted by a qualified medical practitioner.
Before insertion, a pelvic exam is performed to examine the shape and position of the uterus. A current STI at the time of insertion can increase the risk of pelvic infection. However, routine screening for gonorrhea and chlamydia prior to insertion is not recommended. If a person needs screening and there is no evidence of infection on examination or has been previously screened, insertion of the IUD does not need to be delayed. Insertion
During the insertion, the vagina is held open with a speculum, the same device used during a pap smear. A grasping instrument is used to steady the cervix, the length of the uterus is measured for proper insertion with a uterine sound for decreasing chance of uterine perforation with the IUD, and the IUD is placed using a narrow tube through the opening of the cervix into the uterus. A short length of monofilament plastic/nylon string hangs down from the cervix into the vagina. The string allows physicians and patients to check to ensure the IUD is still in place and enables easy removal of the device. Mild to moderate cramping can occur during the procedure, which generally takes five minutes or less. Insertion can be performed immediately postpartum and post-abortion if no infection has occurred.Misoprostol is not effective in reducing pain in IUD insertion. Removal
Removal of the device should also be performed by a qualified medical practitioner. After removal, fertility will return to previous levels relatively quickly. One study found that the majority of participants returned to fertility within three months.