Frequently asked
questions about Mirena
About IUDs and birth control
An IUD (intrauterine device) is a small, T-shaped device that’s placed in your uterus by your healthcare provider to prevent pregnancy. Getting an IUD does not involve surgery, but instead, can be placed during an in-office visit or immediately after giving birth. Once in place, it provides continuous, highly effective birth control.
You may experience pain, bleeding, or dizziness during and after placement. If your symptoms do not pass within 30 minutes after placement, Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced.
Getting Mirena
You may experience pain, bleeding, or dizziness during and after placement. If your symptoms do not pass within 30 minutes after placement, Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced.
If you are concerned about pain, ask your healthcare provider about taking over-the-counter pain medication before the procedure.
No. Mirena can be removed at any time by your healthcare provider. You could become pregnant as soon as Mirena is removed, so you should use another method of birth control if you do not want to become pregnant.
Safety considerations and side effects
Mirena is not right for everyone. Do not use Mirena if you:
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are or might be pregnant; Mirena cannot be used as an emergency contraceptive
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have had a serious pelvic infection called pelvic inflammatory disease (PID), unless you have had a normal pregnancy after the infection went away
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have an untreated genital infection now
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have had a serious pelvic infection in the past 3 months after a pregnancy
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can get infections easily. For example, if you:
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have multiple sexual partners or your partner has multiple sexual partners
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have problems with your immune system
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use or abuse intravenous drugs
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have or suspect you might have cancer of the uterus or cervix
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have bleeding from the vagina that has not been explained
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have liver disease or a liver tumor
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have breast cancer or any other cancer that is sensitive to progestin (a female hormone), now or in the past
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have an intrauterine device in your uterus already
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have a condition of the uterus that changes the shape of the uterine cavity, such as large fibroid tumors
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are allergic to levonorgestrel, silicone, polyethylene, silica, barium sulfate or iron oxide
Mirena can cause serious side effects, including:
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Ectopic pregnancy and intrauterine pregnancy risks. There are risks if you become pregnant while using Mirena (see “What if I become pregnant while using Mirena?”).
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Life‐threatening infection. Life‐threatening infection can occur within the first few days after Mirena is placed. Call your healthcare provider immediately if you develop severe pain or fever shortly after Mirena is placed.
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Pelvic inflammatory disease (PID). Some IUD users get a serious pelvic infection called pelvic inflammatory disease. PID is usually sexually transmitted. You have a higher chance of getting PID if you or your partner has sex with other partners. PID can cause serious problems such as infertility, ectopic pregnancy or pelvic pain that does not go away. PID is usually treated with antibiotics. More serious cases of PID may require surgery including removal of the uterus (hysterectomy). In rare cases, infections that start as PID can even cause death. Tell your healthcare provider right away if you have any of these signs of PID: long-lasting or heavy bleeding, unusual vaginal discharge, low abdominal (stomach area) pain, painful sex, chills, fever, genital lesions or sores.
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Perforation. Mirena may go into the wall of the uterus (become embedded) or go through the wall of the uterus. This is called perforation. If this occurs, Mirena may no longer prevent pregnancy. If perforation occurs, Mirena may move outside the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed. Excessive pain or vaginal bleeding during placement of Mirena, pain or bleeding that gets worse after placement, or not being able to feel the threads may happen with perforation. The risk of perforation is increased if Mirena is inserted while you are breastfeeding, or if you have recently given birth.
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Expulsion. Mirena may come out by itself. This is called expulsion. Excessive pain or vaginal bleeding during placement of Mirena, pain or bleeding that gets worse after placement, or not being able to feel the threads may happen with expulsion. You may become pregnant if Mirena comes out. If you think that Mirena has come out, avoid intercourse or use a non-hormonal back-up birth control (such as condoms or spermicide) and call your healthcare provider. The risk of expulsion is increased with insertion right after delivery or second-trimester abortion.
Common side effects of Mirena include:
Pain, bleeding, or dizziness during and after placement. If these symptoms do not stop 30 minutes after placement, Mirena may not have been placed correctly. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced.
Changes in bleeding. You may have bleeding and spotting between menstrual periods, especially during the first 3 to 6 months. Sometimes the bleeding is heavier than usual at first. However, the bleeding usually becomes lighter than usual and may be irregular. Call your healthcare provider if the bleeding remains heavier than usual or increases after it has been light for a while.
Missed menstrual periods. About 2 out of 10 women stop having periods after 1 year of Mirena use. If you have any concerns that you may be pregnant while using Mirena, do a urine pregnancy test and call your healthcare provider. If you do not have a period for 6 weeks during Mirena use, call your healthcare provider. When Mirena is removed, your menstrual periods should return.
Cysts on the ovary. Some women using Mirena develop a painful cyst on the ovary. These cysts usually disappear on their own in 2 to 3 months. However, cysts can cause pain and sometimes cysts will need surgery.
Other common side effects include:
abdominal or pelvic pain
inflammation or infection of the outer part of your vagina (vulvovaginitis)
headache or migraine
vaginal discharge
These are not all of the possible side effects with Mirena. For more information, ask your healthcare provider. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. You may also report side effects to Bayer Healthcare Pharmaceuticals at 1-888-842-2937.
For the first 3 to 6 months, your period may become irregular and the number of bleeding days may increase. You may also have frequent spotting or light bleeding, and some women have heavy bleeding during this time. You may also have cramping during the first few weeks. After you have used Mirena for a while, the number of bleeding and spotting days is likely to lessen. For some women, periods will stop altogether. When Mirena is removed, your menstrual periods should return.
In some women with heavy bleeding, the total blood loss per cycle progressively decreases with continued use. The number of spotting and bleeding days may initially increase but then typically decreases in the months that follow.
Mirena does not protect against HIV infection (AIDS) and other sexually transmitted infections (STIs).
After getting Mirena
Yes, tampons or menstrual cups may be used with Mirena. Change tampons or menstrual cups with care to avoid pulling the threads of Mirena. If you think you may have pulled Mirena out of place, avoid intercourse or use a non-hormonal back-up birth control (such as condoms or spermicide), and contact your healthcare provider.
You and your partner should not feel Mirena during intercourse. Mirena is placed in the uterus, not in the vagina. Sometimes your partner may feel the threads. If this occurs, or if you or your partner experience pain during sex, talk with your healthcare provider.
It depends on whether you were using hormonal birth control prior to getting Mirena and also when Mirena is placed during your menstrual cycle. Your healthcare provider will confirm if you need to use back-up birth control after Mirena is placed.
Yes, you should check that Mirena is in the proper position by feeling the removal threads. Your healthcare provider should teach you how. It is a good habit to do this once a month.
- First, wash your hands with soap and water.
- Then, check for the threads by reaching up to the top of your vagina with clean fingers to feel the removal threads. Do not pull on the threads.
- If you feel more than just the threads or if you cannot feel the threads, Mirena may not be in the right position and may not prevent pregnancy. Avoid intercourse or use non-hormonal back-up birth control (such as condoms or spermicide) and ask your healthcare provider to check that Mirena is still in the right place.
Call your healthcare provider if you have any questions or concerns (see “When should I call my healthcare provider?” ). Otherwise, you should return to your healthcare provider for a follow-up visit 4 to 6 weeks after Mirena is placed to make sure that Mirena is in the right position.
Mirena must be removed after 8 years. However, your healthcare provider can place a new Mirena during the same office visit if you choose to continue using Mirena.
Yes. The Mirena IUD that you have is the same IUD that is now approved to prevent pregnancy for up to 8 years. However, it is important to be sure of your timeline. Reach out to your HCP and confirm the date of placement to ensure that you are using Mirena for an appropriate amount of time.
Getting pregnant and new moms
Your healthcare provider can remove Mirena at any time. You may become pregnant as soon as Mirena is removed. About 8 out of 10 women who want to become pregnant will become pregnant sometime in the first year after Mirena is removed.
Call your healthcare provider right away if you think you may be pregnant. If possible, also do a urine pregnancy test. If you get pregnant while using Mirena, you may have an ectopic pregnancy. This means that the pregnancy is not in the uterus. Unusual vaginal bleeding or abdominal pain especially with missed periods may be a sign of ectopic pregnancy.
Ectopic pregnancy is a medical emergency that often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility, and even death.
There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy and possible effects of the hormone on your unborn baby.
If you continue your pregnancy, see your healthcare provider regularly. Call your healthcare provider right away if you get flu-like symptoms, fever, chills, cramping, pain, bleeding, vaginal discharge, or fluid leaking from your vagina. These may be signs of infection.
You may use Mirena when you are breastfeeding. Mirena is not likely to affect the quality or amount of your breast milk or the health of your nursing baby. However, isolated cases of decreased milk production have been reported. The risk of Mirena going into the wall of the uterus (becoming embedded) or going through the wall of the uterus is increased if Mirena is inserted while you are breastfeeding.
Mirena and Heavy Periods
According to its definition, women with HMB may lose ⅓ cup of blood or more during their period. Symptoms of HMB may include:
Needing to wear more than one pad at a time or having to use both a tampon and a pad
Needing to change pads or tampons during the night
Having menstrual periods lasting more than 7 days
Having a menstrual flow with blood clots the size of a quarter or larger
Having a menstrual flow that soaks through one or more pads or tampons every hour for several hours in a row
For continued treatment of heavy menstrual bleeding after 5 years, your healthcare provider can remove Mirena and place a new Mirena during the same office visit.
Cost and insurance coverage
Follow these steps to check if Mirena is covered by your insurance. If Mirena isn’t covered or if you don’t have insurance, Bayer may be able to help.
If you do not have health insurance, or if Mirena® is not covered by your insurance, the cost of Mirena is $1,156.79. Learn more about how to pay for Mirena.
INDICATIONS FOR MIRENA
Mirena® (levonorgestrel-releasing intrauterine system) is a hormone-releasing IUD that prevents pregnancy for up to 8 years. Mirena also treats heavy periods for up to 5 years in women who choose intrauterine contraception.
IMPORTANT SAFETY INFORMATION
- If you have a pelvic or genital infection, get infections easily, or have certain cancers, don't use Mirena. Less than 1% of users get a serious pelvic infection called pelvic inflammatory disease (PID).
- If you have persistent pelvic or stomach pain, or excessive bleeding after placement, tell your healthcare provider (HCP). If Mirena comes out, call your HCP and avoid intercourse or use non-hormonal back-up birth control (such as condoms or spermicide). Mirena may go into or through the wall of the uterus and cause other problems.
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Pregnancy while using Mirena is uncommon but can be life threatening and may result in loss of pregnancy or fertility.
- Ovarian cysts may occur but usually disappear.
- Bleeding and spotting may increase in the first 3 to 6 months and remain irregular. Periods over time usually become shorter, lighter, or may stop.
Mirena does not protect against HIV or STIs.
Only you and your HCP can decide if Mirena is right for you. Mirena is available by prescription only.
For important risk and use information about Mirena, please see Full Prescribing Information.
