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The Mirena intrauterine device (IUD) is an implant that people can use as a birth control method for up to 6 years. It may also offer up to 5 years of relief to those who have heavy periods.

This IUD works by releasing a hormone that prevents pregnancy. This form of birth control might be a good option for people who find it difficult to remember to take a pill every day. However, it can cause various side effects.

This article explores the Mirena IUD in more detail and answers some frequently asked questions. It also looks at the differences between Mirena and the copper IUD and lists some alternative contraceptive methods.

The Mirena IUD is a small, T-shaped plastic device that a qualified healthcare professional places inside a person’s uterus. The device prevents pregnancy and can treat heavy periods.

Preventing pregnancy

Mirena contains 52 milligrams of levonorgestrel, a type of hormone that alternative birth control pills typically use. Mirena works by releasing the levonorgestrel into the uterus very slowly over 6 years.

Levonorgestrel enters the bloodstream and stops a person from becoming pregnant by thickening the cervical mucus so that sperm cannot penetrate it. The hormone inhibits sperm movement and thins the uterine lining, making an egg less likely to attach.

Helping heavy periods

Mirena can help those with heavy periods by making the lining of the uterus thinner. The company claims that females using Mirena to ease heavy menstrual bleeding showed an 80% reduction in bleeding after 3 months. After 6 months, this reduction increased to more than 90%.

Learn more about heavy menstrual bleeding here.

Mirena states that the IUD is 99% effective for pregnancy prevention for up to 6 years. Fewer than one pregnancy occurs in every 100 people each year.

The company also claims that its product is the only hormone-releasing IUD that the Food and Drug Administration (FDA) has approved to treat heavy periods.

A 2019 survey found that 39% of respondents had forgotten to take their birth control pill at least once in the last month. As the Mirena IUD is in position at all times, a person does not need to rely on remembering to take pills.

A person should consider the following advantages and disadvantages of the Mirena IUD.

Pros

  • It provides protection for up to 6 years.
  • It may treat heavy periods.
  • It is reportedly 99% effective at preventing pregnancy.
  • Health insurance plans may cover the cost of the Mirena IUD.

Cons

  • It can be expensive.
  • It uses hormones, which is not suitable for everyone.
  • It may cause side effects, including pain, heavy vaginal discharge, and infections.
  • Insertion can be painful for some people.

Mirena claims that a person may experience bleeding, pain, or dizziness during and after the placement of the device. If symptoms persist for 30 minutes after the device fitting, Mirena suggests that a person inform a doctor as soon as possible. The doctor will ensure that the device is in the correct place and has not dislodged.

Common side effects of the Mirena IUD include:

  • Bleeding changes: This includes bleeding or spotting between periods, particularly in the first few months.
  • Missed periods: Sometimes, periods stop entirely after approximately 1 year. If a person thinks that they may be pregnant, they should take a urine-based pregnancy test.
  • Ovarian cysts: These cysts can be painful, but they do not often require medical intervention. However, surgical removal may be necessary in some cases.
  • Pain: Pain can occur in the abdomen or ovaries.
  • Headaches or migraine episodes: These can sometimes be severe or come on suddenly.
  • Vulvovaginitis: This is an infection of the outer part of the vagina.
  • Vaginal discharge: Some people may experience excessive discharge.

Some of the more severe risks when using the Mirena IUD include:

If a person does not have healthcare insurance, the upfront cost of Mirena IUD can be high.

Planned Parenthood states that getting an IUD can cost up to $1,300.

However, many health insurance providers cover the cost of an IUD device. Additionally, health plans are typically required to cover FDA-approved birth control under The Affordable Care Act (ACA).

A person should contact their plan provider to confirm coverage.

If a person does not have insurance, they may be eligible to apply for the Bayer US Patient Assistance Foundation. If they meet the criteria, the organization may cover the full cost of any medications, including an IUD device.

Learn more about the cost of the Mirena IUD.

Anyone considering a Mirena IUD should first discuss it with a healthcare professional. If they decide to go ahead with the fitting, this will take place in a primary care physician’s office or clinic.

A person will first need to remove all clothing from below the waist and lie on their back, usually placing their feet in stirrups. A healthcare professional may cover the lower part of the individual’s body to make them feel more comfortable.

A doctor can also numb the uterus with local anesthesia. They will then use ultrasound to help them place the IUD. This also prevents perforating the uterus.

During the fitting, the doctor will clean the vagina and cervix. They will then slide a plastic tube containing the Mirena IUD into the uterus. The doctor will remove the tube, leaving the Mirena inside. Threads hang from the IUD to aid removal later, but the doctor will cut the threads to an appropriate length for now.

The doctor may also show a person how to do a thread check, which involves checking that the Mirena IUD is still in place. If an individual cannot feel the threads or feels more than just the thread, they should contact their doctor right away.

A doctor will typically offer a follow-up appointment 4—6 weeks after placement.

A person must go to the doctor to get an IUD removed. They can have a new one fitted at the same time.

To remove an IUD, a doctor will pull on the strings attached to the IUD. The device will contract to make it easier to remove.

In some cases, the IUD becomes embedded in the uterus, which makes it harder to remove. A doctor may use a hysteroscope or ultrasound to locate the IUD and remove it. A person may receive pain medication or an anesthetic during this procedure.

A person may experience mild cramping during removal. Afterward, they may have some pain and bleeding.

Generally, people can expect their periods to return to their typical heaviness and length once a doctor removes their IUD.

Some people experience what is anecdotally called a “Mirena crash.” This may be due to the sudden drop in progesterone. Reported symptoms may include:

However, there are no scientific studies on the symptoms, duration, or severity of the symptoms associated with a Mirena crash.

A person can get pregnant as soon as a doctor removes their IUD. If they decide not to replace their IUD and do not want to become pregnant, they should alternative methods of birth control.

Learn more about Mirena IUD removal.

The Centers for Disease Control and Prevention (CDC) list the following alternative birth control options:

  • Implant: A doctor will insert this device under the skin in a person’s arm. It will release hormones over 5 years.
  • Injections: A person will receive an injection of hormones into the arm or buttocks every 3 months.
  • Oral birth control pills: People take these pills daily.
  • Skin patch: A person wears this on the abdomen, buttocks, or upper body, and it releases hormones into the bloodstream.
  • Vaginal ring: This device sits inside the vagina for 3 weeks and releases hormones.
  • Condoms: Both male and female condoms are available.
  • Diaphragm or cervical cap: This device covers the cervix and blocks sperm from entering. A person must place the lid at the correct position just before having sex.
  • Spermicides: These are available in the form of tablets, creams, or suppositories. A person must apply spermicides inside the vagina about an hour before having sex.
  • Sterilization: This permanent form of birth control involves surgery to close or tie together a person’s fallopian tubes.

The table below compares alternative methods of birth control.

CondomsBirth control shotBirth control implant
Effectiveness98%96–99%99%
Lasts forone-time use3 months5 years
STI protectionyesnono
Side effectsirritation from latex condoms• menstrual changes
• nausea
• weight gain
• headaches
• breast tenderness
• depression
• bruising at injection site
• headaches
• nausea
• breast pain
• weight gain
• ovarian cysts
• pain or bruising at insertion site
• infection at insertion site
Pricearound $0–20$0–150$0–1,300

Both hormonal and nonhormonal IUDs are very effective at preventing pregnancy, but they work in different ways. They are convenient, reversible, and last for years.

However, some people may find they cannot use one type of IUD, but they can use another.

Neither type protects a person against HIV or sexually transmitted infections (STIs). A person should use a condom or other barrier birth control methods to practice safer sex.

Hormonal IUDs

Hormonal IUDs work by releasing hormones that stop sperm from reaching an egg.

The hormone in Mirena, levonorgestrel, thickens the cervical mucus, which reduces sperm’s ability to move.

A person may also stop ovulating while using a hormonal IUD.

Mirena releases 20 micrograms of levonorgestrel into the uterus each day. After 5 years, this amount decreases progressively until it is halved.

This type of IUD is suitable for people who cannot take the combined birth control pill.

Hormonal IUDs are not suitable for people with:

Side effects from hormonal IUDs may include:

Nonhormonal IUDs

Nonhormonal IUDs release copper into the womb. This causes an inflammatory response that reduces sperm’s ability to reach an egg. It can also stop a fertilized egg from implanting in the womb.

Research states that this can make nonhormonal IUDs effective for emergency contraception if they are inserted within 5 days of sex without barrier birth control. Mirena cannot be used as an emergency contraceptive.

IUDs can last up to 10 years.

Nonhormonal IUDs are suitable for people who cannot use birth control that contains estrogen. They also do not cause hormonal side effects, such as acne, breast tenderness, or headaches.

However, people cannot use nonhormonal IUDs if they have:

  • an untreated STI
  • a pelvic infection
  • unexplained bleeding between periods or after sex

People who have had an ectopic pregnancy or who have an artificial heart valve should speak with a doctor before trying an IUD.

Nonhormonal IUDs may make a person’s periods heavier. A small number of people may also experience vaginal pain or bleeding.

Other risks of nonhormonal IUDs include:

  • thrush
  • damage to the womb
  • rejection
  • ectopic pregnancy

Below, we answer some of the top frequently asked questions about the Mirena IUD.

Is Mirena removable?

Yes, a doctor or qualified healthcare professional can remove the device at any time.

Does Mirena cause weight gain?

Weight gain is a possibility, but this is not a common side effect of Mirena.

Can a person still use tampons?

Yes, individuals can still use tampons alongside Mirena. There will be no interaction between the two as the IUD placement is in the uterus, and tampons sit inside the vagina.

Can a sexual partner feel Mirena during sex?

Sexual partners should not feel the device during sex as the IUD is in the uterus. A sexual partner may feel the threads. However, if they can also feel the Mirena IUD, a person should contact their doctor as the fitting may be incorrect.

What is the difference between the Mirena IUD and the copper IUD?

There is very little difference between the two IUDs. Both claim to be highly effective, but doctors also prescribe the copper IUD as emergency contraception. However, a 2017 study found that those using copper IUDs were more likely to experience expulsion and pregnancy.

The insertion of the Mirena IUD into a person’s uterus can prevent pregnancy or help with heavy menstrual bleeding. A doctor or healthcare professional can remove the device at any time.

The Mirena IUD is usually available through an individual’s healthcare insurance. In other cases, a person can consider using a financial help scheme.

As many varieties of birth control are available, a person may find it helpful to get advice from a doctor on which type best meets their needs.