Mirena (hormonal IUD)

Definition

Mirena is a hormonal intrauterine device (IUD) that's inserted into the uterus for long-term contraception. A T-shaped plastic frame that releases the hormone progestin, Mirena thickens the cervical mucus and thins the lining of the uterus (endometrium) — preventing sperm from entering the fallopian tubes. Mirena also partially suppresses ovulation. After insertion, Mirena's plastic strings protrude from the cervix.

Mirena is the only hormonal IUD that has Food and Drug Administration (FDA) approval in the U.S.

Mirena prevents pregnancy for up to five years after insertion. Mirena doesn't offer protection from sexually transmitted infections (STIs).

Mirena

Mirena

Mirena is a hormonal intrauterine device (IUD) that's inserted into the uterus for long-term contraception. A T-shaped plastic frame that releases the hormone progestin, Mirena prevents pregnancy for ...

Why it's done

Mirena offers effective, long-term contraception. Among various benefits, Mirena:

• Eliminates the need to interrupt sex for contraception or seek partner compliance
• Can remain in place for up to five years
• Can be removed at any time, followed by a quick return to fertility
• Decreases menstrual bleeding after three to six months of use
• Decreases severe menstrual pain and pain related to endometriosis
• Decreases the risk of pelvic inflammatory disease caused by sexually transmitted infections (STIs)
• Decreases the risk of endometrial cancer
• Can be used while breast-feeding — though there may be an increased risk of uterine perforation
• Doesn't carry the risk of side effects related to birth control methods containing estrogen

Mirena isn't appropriate for everyone, however. Your health care provider may discourage use of Mirena if you:

• Had or have breast cancer
• Have uterine, cervical or liver cancer
• Have liver disease
• Have uterine abnormalities, such as fibroids, that interfere with the placement or retention of Mirena
• Have a pelvic infection or have a history of pelvic inflammatory disease
• Have an abnormal Pap smear
• Have unexplained vaginal bleeding
• Have inflammation of the vagina or cervix or a lower genital tract infection
• Are allergic to any component of Mirena
• Have or are at high risk of a sexually transmitted infection
• Had previous problems with an IUD

In addition, tell your health care provider if you have:

• Diabetes
• A heart condition
• Migraines
• Blood-clotting problems
• High blood pressure
• A history of stroke or heart attack
• Recently given birth or had an abortion

Risks

Side effects associated with Mirena include:

• Headache
• Acne
• Breast tenderness
• Breakthrough bleeding
• Absence of periods (amenorrhea), especially after one year of use
• Mood changes
• Weight gain
• Nausea
• Ovarian cysts
• Abdominal or pelvic pain

It's also possible to expel Mirena from your uterus. You may be more likely to expel Mirena if you:

• Have never been pregnant
• Have heavy or prolonged periods
• Have severe menstrual pain
• Previously expelled an IUD
• Are younger than age 20
• Had Mirena inserted immediately after childbirth or an abortion

Mirena doesn't offer protection from sexually transmitted infections (STIs).

An estimated 1 out of 100 women who use Mirena for one year will get pregnant. If you do conceive while using Mirena, you're at higher risk of an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. Removing Mirena during pregnancy poses a risk of miscarriage. However, the risks of leaving Mirena in place during pregnancy are greater, including miscarriage, premature delivery, infection and septic shock.

In addition, your health care provider may recommend removal of Mirena if you develop:

• A pelvic infection, such as endometritis
• Endometrial or cervical cancer
• Uterine or cervical perforation
• A significant increase in blood pressure

How you prepare

Your health care provider will evaluate your overall health and do a pelvic exam before inserting Mirena. Talk to your health care provider about any medications you're taking, including nonprescription and herbal products.

You can have Mirena inserted anytime during your menstrual cycle if you've been consistently using another birth control method or you haven't had sex since your last period. If you have Mirena inserted more than seven days after the start of your period, use backup contraception for one week. If you're breast-feeding, have irregular periods or haven't been consistently using birth control, you may need to take a pregnancy test before Mirena is inserted.

What you can expect

Mirena is typically inserted in a health care provider's office.

During the procedure
Your health care provider will insert a speculum into your vagina and cleanse your vagina and cervix with an antiseptic solution. Then he or she will use a special instrument to gently align your cervical canal and uterine cavity and another tool to measure the depth of your uterine cavity. Next your health care provider will fold Mirena's horizontal arms and place the device inside an applicator tube. He or she will insert the tube into your cervical canal and carefully place Mirena in your uterus. When the applicator tube is removed, Mirena will remain in place. Your health care provider will trim Mirena's strings so they don't protrude too far into the vagina and may record the length of the strings.

During Mirena insertion, you may experience dizziness, fainting, low blood pressure or a slower than normal heart rate (bradycardia). It's also possible for the IUD to perforate the uterine wall or cervix.

After the procedure
After every period, check to feel that Mirena's strings are protruding from your cervix. Don't pull on the strings. Four to six weeks after Mirena is inserted, your health care provider may re-examine you to make sure Mirena hasn't moved and check for signs and symptoms of pelvic inflammatory disease, which can cause tubal damage or infertility.

After the procedure
After every period, check to feel that Mirena's strings are protruding from your cervix. Don't pull on the strings. Four to six weeks after Mirena is inserted, your health care provider may re-examine you to make sure Mirena hasn't moved.

Mirena can remain in place for up to five years. To remove Mirena, your health care provider will use forceps to grasp the device's strings and gently pull. The device's arms will fold upward as it's withdrawn from the uterus. Light bleeding and cramping is common during removal. Rarely, Mirena may become embedded in your uterine wall. If this happens, you may need local anesthesia and cervical dilation to have the device removed.

While you're using Mirena, contact your health care provider immediately if you have:

• Signs or symptoms of a heart attack or stroke
• Signs or symptoms of pregnancy
• Unusually heavy vaginal bleeding
• Foul vaginal discharge
• Worsening pelvic pain
• Severe abdominal pain or tenderness
• Unexplained fever
• Unusual vaginal discharge, lesions or sores
• Migraines
• Jaundice
• A sexually transmitted infection

It's also important to contact your health care provider immediately if you think Mirena is no longer in place. Signs and symptoms that you've partially or completely expelled Mirena include:

• Painful sex for you or your partner
• Suddenly long or missing strings
• Presence of the device's hard plastic at your cervix or in your vagina
• Return of normal periods

Your health care provider will check the location of Mirena and if it's displaced, remove it if necessary — either by hand or with the help of a thin tube equipped with a camera lens and light (hysteroscope). If Mirena or its strings aren't visible, you may need an ultrasound and X-ray to confirm that Mirena isn't in your abdomen or pelvis. If you want to have a new IUD inserted, you may need to take a pregnancy test first.

Insertion of Mirena

Insertion of Mirena

Mirena is a hormonal intrauterine device (IUD) that's inserted into the uterus by a health care provider. Mirena prevents pregnancy for up to five years. ...