For most people with a hormonal IUD, leaving it in past the five-year mark does not trigger an immediate crisis. The device continues releasing hormone, and multiple studies show it remains highly effective at preventing pregnancy for several years beyond its labeled lifespan. But “still works” and “nothing changes” are not the same thing. Hormone output drops steadily each year, the physical device accumulates mineral deposits, and certain uncommon risks creep upward with time. What actually happens depends on which type of IUD you have, how long past its expiration you go, and whether you stay in touch with a provider along the way.
Hormonal IUDs Keep Working, but the Hormone Fades
The 52-mg levonorgestrel IUD (sold as Mirena, Liletta, and others) is the most common type affected by this question. These devices start out releasing roughly 20 micrograms of levonorgestrel per day and decline from there. One pharmacokinetic study of the Liletta system measured an average release rate of about 19.5 mcg/day initially, dropping to around 9.8 mcg/day by the end of year five.1Contraception. Levonorgestrel release rates over 5 years with the Liletta® 52-mg intrauterine system That is roughly half the starting dose. The hormone does not vanish at the five-year mark, but it is clearly on a downward slope, and that trajectory continues into years six, seven, and beyond.
Despite this declining output, pregnancy rates remain very low through extended use. The Mirena Extension Trial followed women using the 52-mg levonorgestrel IUD for up to eight years and found a cumulative failure rate of just 0.68% across years six through eight. Only two pregnancies occurred in that window, one of which was ectopic.2PubMed. Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: findings from the Mirena Extension Trial A separate chart review of 776 women in Brazil who kept their 52-mg IUDs in for up to 15 years found zero pregnancies over more than 1,400 cumulative woman-years of exposure.3Contraception. Pregnancy outcomes associated with extended use of the 52-mg 20 μg/day levonorgestrel-releasing intrauterine system beyond 60 months: A chart review of 776 women in Brazil A systematic review that pooled data from multiple studies found no pregnancies in nine of the included studies at various time points between year six and year 15, with only a handful of pregnancies across all the research combined.4PubMed Central. Extended duration of use of long-acting reversible contraceptives
So if you are past the five-year mark with a 52-mg hormonal IUD, the evidence suggests you are still well protected against pregnancy. That said, these studies enrolled women who were generally healthy and monitored. They are not blanket permission to ignore your IUD indefinitely, and there is an important caveat: researchers have not been able to enroll enough participants using the IUD specifically for heavy menstrual bleeding to know whether extended use remains effective for that indication.2PubMed. Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: findings from the Mirena Extension Trial If your IUD was placed primarily to manage heavy periods rather than prevent pregnancy, the picture is less clear.
What About Copper IUDs?
Copper IUDs operate on a completely different mechanism. Instead of releasing a hormone, the copper itself creates an environment hostile to sperm. The ParaGard T-380A is already approved for up to 10 years in the United States, and real-world data shows its effective life may stretch far beyond that. Studies of collared copper IUDs found no pregnancies through 15 years of continuous use, and a small number of women used the same device through 20 years without a pregnancy.5PubMed. Utility and drawbacks of continuous use of a copper T IUD for 20 years The copper T-380A has been described as providing contraception as effective as surgical sterilization for up to two decades.6Clinical Medicine Insights: Women’s Health. Safety, Efficacy, and Patient Acceptability of the Copper T-380A Intrauterine Contraceptive Device
If you have a copper IUD, the five-year question is less pressing. Your device was designed to last at least twice that long. The more relevant concern for copper IUD users is what happens physically to the device over a decade or more, which is covered below.
Bleeding and Period Changes Over Time
One of the most noticeable shifts when a hormonal IUD stays in past five years is what happens to your bleeding pattern. In the early years, many users experience lighter periods or lose them entirely. That trend actually continues with extended use. The Brazilian chart review noted that the most common bleeding pattern among women using the 52-mg IUD beyond five years was amenorrhea, meaning no periods at all. During extended use up to eight years, roughly half of participants experienced either no bleeding or very infrequent spotting.3Contraception. Pregnancy outcomes associated with extended use of the 52-mg 20 μg/day levonorgestrel-releasing intrauterine system beyond 60 months: A chart review of 776 women in Brazil
This is actually reassuring for many people. The fear is that as hormone levels drop, periods will come roaring back with a vengeance. For most users, that does not seem to happen abruptly. The lining of the uterus has been suppressed for years, and it takes time for it to rebuild even as the hormone wanes. Some women do notice a gradual return of light spotting or irregular bleeding in years six through eight, but a sudden return to heavy periods while the device is still in place is uncommon. If you do notice a dramatic change in bleeding, that is worth a conversation with a provider rather than something to shrug off.
What Happens to the Device Physically
An IUD is a foreign object sitting inside your uterus, and your body responds to it the way bodies respond to foreign objects: it tries to wall it off. Over time, mineral deposits build up on the device’s surface. Research on removed IUDs found a linear relationship between the duration of use and the amount of calcified material on the plastic components. Inflammation accelerated the buildup.7PubMed. Characterization of calcified deposits on contraceptive intrauterine devices
For copper IUDs specifically, this calcification can begin within six months and becomes significant over years. Older research using electron microscopy found that calcium deposits on copper-bearing IUDs could interfere with the release of copper ions, which is the whole mechanism by which the device prevents pregnancy.8PubMed. Intrauterine deposition of calcium on copper-bearing intrauterine contraceptive devices That said, the long-term pregnancy data for the T-380A still shows exceptional effectiveness at 15 and even 20 years, so the calcification may not meaningfully undermine contraceptive efficacy in practice for newer copper designs. The bigger concern is that a heavily calcified device may be more difficult to remove. It can embed partially into the uterine wall, or the plastic components can become brittle.
Device fracture is rare but documented. In one case report, a woman who had a copper IUD in place for 10 years went for removal, and during the procedure a wing of the device broke off and remained lodged in the uterine wall. The retained fragment ultimately led to a hysterectomy.9PubMed Central. Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report This is an extreme outcome, but it illustrates a real risk that increases the longer a device stays in. Plastic and metal fatigue over many years, and removal becomes a more involved procedure than the quick office visit it usually is when the device is within its approved lifespan.
Actinomyces Colonization
One of the more obscure risks that comes up with long-term IUD use involves a type of bacteria called Actinomyces. About 7% of IUD users may have Actinomyces-like organisms show up on a routine Pap test.10PubMed. IUDs and colonization or infection with Actinomyces For most people, this is a finding on paper with no real-world consequences. The bacteria colonize the device surface, but in the absence of symptoms they do not require treatment or IUD removal.
The story shifts with prolonged use. A retrospective analysis of 259 patients found that the duration of IUD use was the most significant risk factor for Actinomyces colonization, and that the relationship was statistically significant. The most common complaints in that group were vaginal discharge and pelvic pain, though a substantial number had no symptoms at all.11Journal of Endometriosis and Pelvic Pain Disorders. Long-term copper intrauterine device use and risk of Actinomyces colonization: Retrospective analysis The practical takeaway: if your IUD has been in for many years and you develop persistent pelvic pain or unusual discharge, Actinomyces colonization is one possibility your provider should evaluate. In the vast majority of cases it is harmless, but it does become more likely the longer the device stays in place.
Serious Infections and Pelvic Complications
Beyond Actinomyces, there are rarer but more serious infection-related complications linked to prolonged IUD use. A case series examining outcomes of extended IUD use found that among patients who presented with complications, nearly all had chronic pelvic pain or severe abdominal pain. The most common diagnoses were tubo-ovarian abscess and pelvic inflammatory disease. Among the more serious outcomes, some patients developed peritonitis or sepsis requiring intensive care.12The Journal of Sexual Medicine. (546) The Grave Sequalae of the Prolong IUD Use
It is important to put this in context. These were patients who presented with problems, not a representative sample of all long-term IUD users. The overwhelming majority of people who leave an IUD in past its labeled duration do not develop a tubo-ovarian abscess. But the case series does highlight that when things go wrong with a very old IUD, they can go seriously wrong. If you have had an IUD for many years and develop new or worsening pelvic pain, fever, or unusual discharge, do not dismiss it as normal.
What If You Get Pregnant with an Old IUD Still in Place
While rare, pregnancy can occur with any IUD, and the risk edges upward once you are past the device’s approved lifespan. When a pregnancy does happen with the IUD still inside the uterus, the stakes are considerably higher than a typical unplanned pregnancy. A national-level assessment of pregnancy outcomes with a retained IUD found significantly elevated risks across multiple categories. Compared to pregnancies without an IUD, those with a retained device had roughly triple the odds of preterm premature rupture of membranes, triple the odds of placental abruption, and more than double the odds of fetal death in utero. The odds of losing a pregnancy before 22 weeks were more than five times higher.13American Journal of Obstetrics & Gynecology MFM. Pregnancy with retained intrauterine device: national-level assessment of characteristics and outcomes
A systematic review of earlier research confirmed the broader pattern. Women with a retained IUD faced the greatest risk of spontaneous abortion, preterm delivery, septic abortion, and infection of the membranes surrounding the fetus. When the IUD was a hormonal one, the odds were even worse: in one case series, eight out of ten pregnancies with a retained hormonal IUD ended in spontaneous abortion. Removing the IUD early in a pregnancy reduced these risks but did not eliminate them entirely.14Contraception. Pregnancy outcomes with an IUD in situ: a systematic review
The message here is not that extended IUD use commonly leads to these outcomes, because pregnancy itself remains unlikely. The message is that if you do become pregnant with an old IUD in place, the pregnancy carries elevated risks that warrant prompt medical attention. Ectopic pregnancy is also a concern. In the Mirena Extension Trial, one of the two pregnancies that occurred during years six through eight was ectopic.2PubMed. Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: findings from the Mirena Extension Trial
Fertility After Removal
A common worry is that leaving an IUD in for years beyond its expiration might damage your ability to conceive later. The reassuring news is that current evidence does not support that fear for most people. A systematic review and meta-analysis found that about 83% of people who stopped using contraception, including IUD users, became pregnant within 12 months. Pregnancy rates were not significantly different between those who had used hormonal methods and those who had used IUDs.15PubMed Central. Return of fertility after discontinuation of contraception: a systematic review and meta-analysis
There is, however, a gap in the research that is worth being honest about. Most studies on return to fertility after IUD removal have focused on people who used the device within its approved window. Very limited data exists on what happens to the uterine lining after prolonged use beyond five years, and studies have not adequately examined fertility outcomes in people who have never been pregnant before or who used a hormonal IUD for many years past its labeled duration.16PubMed Central. Levonorgestrel IUD: is there a long-lasting effect on return to fertility? The general expectation is that fertility returns normally, but the specific population most likely to be reading this article, people who have had their IUD in for a long time, is precisely the group with the thinnest evidence.
The Psychological Side of Leaving It In
Research into the experiences of women who kept their IUDs past the recommended duration reveals a pattern that goes beyond biology. A qualitative study identified three recurring themes among long-term users. Some described a progression from mild anxiety to genuine fear about the device, particularly around stories of embedding or lost strings. Others described a sense of reliable protection that made them reluctant to disrupt what was working. And a third group moved from feeling emotionally attached to the convenience of the IUD to outright neglecting it, forgetting it was there and losing track of when it was supposed to come out. The study concluded that prolonged use was often associated with insufficient information from providers and inadequate follow-up.17PubMed Central. The Experiences of Women Who Have Used Intrauterine Devices for a Long Time
That last point resonates. Many people get an IUD placed and are told to come back in five years. There is no alarm that goes off, no automatic reminder system in most health care settings. If you move, change providers, or simply have a busy life, it is remarkably easy to lose track. The device keeps working silently, and the absence of problems can become its own reason for inaction. Recognizing this pattern is useful, not as a source of guilt, but as a reason to set a calendar reminder or ask about extended-use timelines at your next visit.
When Removal Gets Complicated
One practical consequence of leaving any IUD in for a very long time is that taking it out can become harder. Under normal circumstances, removal is fast and straightforward: a provider grasps the strings and pulls. But when a device has been in place for many years, several things can interfere. The strings may retract into the cervical canal or uterus, making them invisible on exam. The device may partially embed into the uterine wall as tissue grows around it. Calcification can make the device rigid and prone to breaking during extraction.
Case reports describe fully embedded IUDs requiring hysteroscopy, a procedure where a small camera is inserted into the uterus, to locate and remove the device. In one documented case, a fully embedded Mirena IUD was discovered when the patient reported unusual electric-type pain months after a separate uterine surgery, and the strings were no longer visible at the cervix.18Annals of Case Reports. Fully Embedded IUD: Hysteroscopic Management Using X-ray Cases like this do not happen often, but they underscore the advantage of removing or replacing a device on schedule rather than waiting until a problem forces the issue.
Copper IUDs appear especially prone to mechanical complications during late removal because the plastic T-frame becomes increasingly brittle over a decade or more. The case of a broken ParaGard wing retained in the uterine wall, which ultimately required a hysterectomy, involved a device that had been in place for 10 years.9PubMed Central. Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report Extended-use copper IUD data shows no pregnancies through 20 years, but the physical integrity of the device is a separate question from its contraceptive efficacy. Discussing a replacement plan with your provider before you reach the outer edge of the approved lifespan can help avoid a scenario where the device has to be removed under less favorable conditions.
Low-Dose Hormonal IUDs Are a Different Story
Not all hormonal IUDs are the 52-mg variety. Smaller, lower-dose options like Kyleena (19.5 mg) and Skyla (13.5 mg) release less hormone and are approved for shorter durations, typically five years for Kyleena and three years for Skyla. The extended-use data discussed above applies specifically to the 52-mg formulation. If you have one of the lower-dose devices, there is substantially less published evidence about what happens if you leave it in past its approved timeframe, and it would be unwise to assume the same reassuring failure rates apply. These devices start with less hormone, so the decline over time leaves a thinner margin of contraceptive protection much sooner.
The systematic review that compiled data on extended hormonal IUD use focused on the 52-mg devices and drew from studies spanning up to 15 years of use.4PubMed Central. Extended duration of use of long-acting reversible contraceptives None of the included studies examined low-dose IUDs at comparable extended durations. If you have Kyleena or Skyla and are approaching their expiration, the safe move is replacement on schedule unless your provider has specific guidance otherwise.