Hormonal IUD (Mirena)

Mirena offers effective, long-term contraception. It can be used in premenopausal women of all ages, including teenagers.

Among various benefits, Mirena:

• Eliminates the need to interrupt sex for contraception
• Doesn't require partner participation
• Can remain in place for up to seven years
• Can be removed at any time, followed by a quick return to fertility
• Can be used while breast-feeding — although you may need to wait six to eight weeks after having a baby so that you don't risk injuring the uterus during placement
• Doesn't carry the risk of side effects related to birth control that contains estrogen

Mirena can decrease menstrual bleeding after three or more months of use. About 20 percent of women stop having periods after one year of using Mirena.

Mirena can also decrease:

• Severe menstrual pain and pain related to the growth of uterine-lining tissue outside the uterus (endometriosis)
• The risk of pelvic infection
• The risk of endometrial cancer

Because of these noncontraceptive benefits, Mirena is often prescribed for women with:

• Heavy menstrual bleeding
• Cramping or pain with periods
• Endometriosis
• Unusual growth of the lining of the uterus (endometrial hyperplasia)
• Unusual growth of uterine-lining tissue into the muscular wall of the uterus (adenomyosis)
• Anemia
• Fibroids

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

• Breast cancer, or have had it
• Uterine or cervical cancer
• Liver disease
• Uterine conditions, such as fibroids, that interfere with the placement or retention of Mirena
• A pelvic infection or current pelvic inflammatory disease
• Unexplained vaginal bleeding

Tell your health care provider if you:

• Take any medications, including nonprescription and herbal products
• Have diabetes or high blood pressure
• Have a heart condition or have had a heart attack
• Have migraines
• Have blood-clotting problems or have had a stroke
• Recently gave birth or are breast-feeding

Less than 1 percent of women who use Mirena will get pregnant in a year of typical use.

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. However, because Mirena prevents most pregnancies, women who use it are at lower risk of having an ectopic pregnancy than are other sexually active women who are not using contraception.

Mirena is generally safe. But it's important to remember that:

• Mirena doesn't protect against STIs.
• Rarely, insertion of Mirena causes perforation of the uterus. The risk of perforation might be higher when inserted during the postpartum period.

Side effects associated with Mirena include:

• Headache
• Acne
• Breast tenderness
• Irregular bleeding, which can improve after six months of use
• Mood changes
• Cramping 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

Your health care provider may recommend removal of Mirena if you develop:

• A pelvic infection
• Inflammation of the endometrium (endometritis)
• Endometrial or cervical cancer
• Pelvic pain or pain during sex
• Very severe migraine
• A significant increase in blood pressure, or have a stroke or heart attack
• Possible exposure to an STI

Your health care provider will evaluate your overall health and do a pelvic exam before inserting Mirena. You may be screened for STIs.

Mirena can be inserted:

• Anytime during your menstrual cycle if you're not pregnant. You might need to take a pregnancy test to confirm you're not pregnant.
• Immediately after a pregnancy termination.
• Immediately after delivering a baby vaginally or by cesarean section — although insertion immediately after vaginal delivery increases the risk of expelling Mirena.

If you have Mirena inserted more than seven days after the start of your period, be sure to use backup contraception for one week.

Taking a nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin IB, others), one to two hours before the procedure can help reduce cramping.