For those in extended use who are wanting to plan a pregnancy and unable to have their IUD/IUS removed due to restrictions, it would be advisable to use additional contraception until you are able to have the device removed rather than risk any complications by conceiving when it is still inside.

Extended use within guidelines makes the likelihood of pregnancy very low but there is still a risk, that’s why the advice is to either use condoms or if suitable another hormonal method until you can have your implant or IUS replaced. If you think you might be pregnant you should take a test 3 weeks after any risk and use condoms until sure. If you are worried your IUD or IUS might have fallen out and are unable to find your threads, then you should also use condoms until you are able to get it checked.

It is not uncommon for your bleeding pattern to gradually change towards the end of the lifespan of the device. If your bleeding pattern changes very suddenly with the IUS, check that your IUS is still in place by checking for threads. Lots of users have sporadic bleeding when using implant or IUS, however if this is unusual for you and you are beyond your replacement date it is recommended to use additional contraception such as condoms or have a chat with your Dr. about adding hormonal contraception. Although in the first year after the “change date” of an implant and some IUS it is highly unlikely you will get pregnant, it is not guaranteed.

The amount of hormones present in the body with either the implant or the hormonal IUS is extremely small. In addition, progestogen, which is the type of hormone used in both the implant and hormonal IUS is a very safe hormone and one that almost every woman can use even if they have other health problems. It will therefore not harm you to take other hormones as well. When starting any new hormone however it is always important to check that it is safe for you to use.

It is safe for your expired device to be left until you can get into see your doctor again. The only risk is of an unintended pregnancy so make sure you use additional precautions such as condoms or contraceptive pills to provide protection.

Those using a 10-year banded copper IUD can continue to use this device for 12 years after insertion. The risk of pregnancy remains extremely low, although full protection cannot be guaranteed. Some people may therefore choose to use additional precautions after 10 years have passed. 5-year IUDs should not be assumed to be effective after the 5 years has passed.

People who are more than 45 when they have the Mirena or Levosert inserted can use the device for contraception until the age of 55 as it will continue to provide protection against pregnancy. After this age, contraception is no longer needed. People who are using the Mirena IUS as part of their hormone replacement therapy (HRT) taken with oestrogen, still need to change the IUS after 5 years. Levosert is not currently licensed to be given as part of an HRT regime. However, for those using the lower dose or shorter use hormonal IUS (eg Kyleena, Jaydess) it is not currently recommended that you extend the use of these products. This is because there is not enough research to say how long they will continue to work well. If you have one of these devices you are advised to use additional contraception if it has reached its expiry date.

If you are using a 5-year hormonal IUS, it is likely to be either Mirena or Levosert. The risk of getting pregnant a year after one of these 5-year devices expire (that is, during the 6th year of use) is very low. In fact, Levosert is now actually licensed for 6 years of use, and it is likely that this will also be true in the near future of Mirena. This is because there is now enough evidence that shows it works well as a contraceptive in the sixth year. However, since at this time the guidance is still under review, if it is critical for you not to get pregnant you may still opt to use additional contraceptive cover.