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By Mayo Clinic staff
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 that 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, nausea, 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, or every two months if you're not having flow, 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.
While you're using Mirena, contact your health care provider immediately if you:
- Have signs or symptoms of a heart attack or stroke
- Think you may be pregnant
- Have unusually heavy vaginal bleeding
- Have abdominal pain or pain during sex
- Have an unexplained fever
- Have unusual or foul-smelling vaginal discharge, lesions or sores
- Develop very severe headaches or migraines
- Have yellowing of the skin or eyes (signs of jaundice)
- Were exposed to a sexually transmitted infection
It's also important to contact your health care provider immediately if you think Mirena is no longer in place. Call you doctor if:
- Sex is painful for you or your partner
- The IUD strings are missing or suddenly seem longer
- You feel part of the device's hard plastic at your cervix or in your vagina
- Your normal periods return
Your health care provider will check the location of Mirena, and if it's displaced, remove it if necessary.
Removal
Mirena can remain in place for up to five years. To remove Mirena, your health care provider will likely 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. In some cases, removal may be more complicated. For example, Mirena may become embedded in your uterine wall. If this happens, you may need local anesthesia and cervical dilation or hysteroscopy to have the device removed.
- Dean G, et al. Approach to intrauterine contraception. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2011.
- Kottke M. Nondaily contraceptive options: User benefits, potential for high continuation and counseling issues. Obstetrical & Gynecological Survey. 2008;63:661.
- Dean G, et al. Management of problems related to intrauterine contraception. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2011.
- Carusi DA, et al. Insertion and removal of an intrauterine contraceptive device. http://www.uptodate.com/home/index.html. Accessed Nov. 3, 2011.
- Mirena (prescribing information). Wayne, N.J.: Bayer Healthcare Pharmaceuticals Inc.; 2009. http://mirena-us.com/hcp/index.jsp?WT.mc_id=MIS119497&WT.srch=1. Accessed Nov. 8, 2011.
- Castellsague X, et al. Intrauterine device use, cervical infection with human papillomavirus, and risk of cervical cancer: A pooled analysis of 26 epidemiological studies. The Lancet Oncology. 2011;12:1023.
- Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, Ga.: Bridging the Gap Communications; 2010:82.
- Birth control methods fact sheet. U.S. Department of Health and Human Services. http://www.womenshealth.gov/publications/our-publications/fact-sheet/birth-control-methods.cfm. Accessed Nov. 3, 2011.
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