How to Tell If You're Ovulating With a Progestin IUD

This has actually been one of my most asked questions recently, which I love — because it tells me that women are really prioritizing their hormone health and wanting to understand their cycles.

Many women want the pregnancy protection of birth control while still experiencing the natural hormonal benefits of ovulation. If that’s you, the IUD can be a great option.

Unlike the oral contraceptive pill, which primarily works by preventing ovulation, most women with IUDs continue to ovulate.

This is important because when you ovulate, your body forms the corpus luteum, a temporary endocrine structure that produces progesterone during the luteal phase of your cycle. Progesterone plays many important roles in the body, and our physiology is designed to experience these natural cyclic exposures.

But if you’re using a progestin IUD and no longer getting a monthly period, you may wonder how you can tell if you’re still ovulating?

Let’s walk through it together.

If you prefer video format, I’ve uploaded a video recording of this topic too:

How Do IUDs Work?

Many people assume IUDs suppress ovulation the same way “the pill” does. This is a very common misconception.

Fortunately, IUDs are actually more effective at preventing pregnancy than oral contraceptive pills, while still allowing ovulation to occur in most users.

*An important note, according to the American College of Obstetricians and Gynecologists (ACOG), both the copper and progestin IUDs are not classified as abortifacients. This means they work to prevent pregnancy, and current research does not suggest that they disrupt an already established pregnancy.

There are two main categories of IUDs:

Copper IUD

The copper IUD (Paragard) is non-hormonal and releases copper locally in the uterus.

Copper affects sperm motility and function, preventing fertilization from occurring.

Progestin IUDs

Most IUDs used today are progestin IUDs, which release levonorgestrel locally within the uterus.

These IUDs prevent pregnancy primarily by:

• Thickening cervical mucus, which creates a barrier preventing sperm from entering the uterus
• Thinning the endometrial lining, which prevents implantation

Because the hormone acts mostly locally, ovulation is typically not suppressed the way it is with systemic hormonal contraception.

That said, some women — especially during the first year of use or with higher-dose IUDs like Mirena or Liletta — may experience occasional ovulation suppression. Overall, however, the majority of users continue to ovulate, according to the American College of Obstetricians and Gynecologists (ACOG).

The four progestin IUDs currently available include:

• Mirena
• Liletta
• Kyleena
• Skyla

Mirena and Liletta release slightly higher doses of levonorgestrel, while Kyleena and Skyla release lower doses.

Why Many Women Stop Getting Periods With a Progestin IUD

One reason many women love the progestin IUD is due to its effect on the endometrial lining.

Because the lining stays thin, there is often very little tissue available to shed during a menstrual cycle.

As a result:

• Many women stop having periods altogether
• Others experience very light spotting
• Almost everyone has significantly lighter bleeding

For many women this is a welcome side effect.

However, when you no longer get a period, it becomes more difficult to tell whether you’re still ovulating.

How to Tell If You're Ovulating With a Progestin IUD

Here are two practical ways you can track ovulation even if you aren't getting a monthly bleed.

1. Tracking Basal Body Temperature

After ovulation occurs, the progesterone produced by the corpus luteum causes a small increase in body temperature. Typically this rise is about 0.5°F – 1.0°F.

Once ovulation occurs, this slightly higher temperature usually remains elevated throughout the ~14-day luteal phase before dropping again right before your period. If you have the Oura ring, it’'ll track your basal body temp for you. Or, you can purchase a thermometer (ideally with two decimal points for accuracy), and every morning before getting out of bed, you can take your temperature and manually track it. If you go the thermometer route, be sure to take your temperature before getting out of bed, brushing your teeth, eating, or drinking because doing these before taking your temperature can throw off your temperature reading.

2. Urine LH Testing

Another way to track ovulation is with urine LH test strips. About 24–48 hours before ovulation, the body releases a surge of luteinizing hormone (LH) that triggers the follicle to rupture and release an egg. These are the same tests often used when people are trying to conceive, because the days surrounding the LH surge are the most fertile.

If you don’t get a period with your IUD, you could try using LH test strips daily for a few months, recording when they turn positive, and tracking the number of days between positive tests. This can help you identify your natural cycle length, and also confirm that you are ovulating.

Pro tip: LH surges often occur earlier in the day, so testing in the afternoon or evening tends to be most reliable.

A Note on Cervical Mucus

Some women track ovulation using egg-white cervical mucus, which normally increases around ovulation. However, with a progestin IUD, this method is less reliable. This is because the levonorgestrel in the IUD thickens the cervical mucus, which can prevent the egg white cervical mucus from being present.

To Summarize

The progestin IUD is a unique form of birth control because it offers very effective pregnancy prevention while still allowing many women to continue ovulating. If you’re someone who values understanding your cycle and hormone health, tracking tools like basal body temperature and LH testing can give helpful insights into if/when you are ovulating, even if you no longer get a period.

Understanding your body’s beautiful physiology is empowering, and I hope this blog post helped clarify how ovulation works, and how to detect it with a progestin IUD.

If you'd like to work together, I'd love to support you in your health journey.

If you are interested in learning more, you can schedule an Individualized Educational Consultation with me here, or join my waitlist here to be one of the first to be notified about openings when I open my practice in 2027!

*Of course, this is educational content only. Not a substitute for medical care. Views are my own and separate from my institution and employer. Always discuss individual health concerns with your personal healthcare provider.