Mirena

What is Mirena?

Mirena is a plastic device containing the female hormone levonorgestrel. This hormone causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. The Mirena intrauterine device is placed in the uterus where it slowly releases the hormone to prevent pregnancy for up to 5 years. Mirena is meant for use in a woman who has had at least one child and is in a stable sexual relationship with someone who has no other sexual partners.

Mirena is also used in women who have heavy menstrual bleeding and choose to use an intrauterine form of birth control.

Mirena releases levonorgestrel into the uterus, but only small amounts of the hormone reach your blood stream.

Important information about Mirena

You should not use Mirena if you have abnormal vaginal bleeding, an uncontrolled pelvic infection, a condition that affects the shape of the uterus, past or present breast cancer, a liver problem, cervical or uterine cancer, a weak immune system, if you have recently had a serious pelvic infection following a pregnancy or abortion, or if you already have an intrauterine device (IUD)in place.

You also should not use Mirena if you have a history of pelvic inflammatory disease (unless you have had a normal pregnancy after the infection was treated and cleared), a recent abnormal Pap smear that has not yet been diagnosed or treated, or if you do not have an exclusive sexual partner.

Before using the Mirena intrauterine device, tell your doctor if you have diabetes, a bleeding or blood-clotting disorder, a vaginal infection, pelvic infection, or sexually transmitted disease, high blood pressure, heart disease, or a heart valve disorder. Mirena may be inserted immediately after a first trimester abortion.

Serious side effects of Mirena include severe cramps or pelvic pain, heavy or ongoing vaginal bleeding, unusual vaginal discharge, pale skin, easy bruising or bleeding, fever, chills, sudden numbness or weakness, severe headaches, or jaundice (yellowing of the skin or eyes). Only your doctor should remove the Mirena intrauterine system. Do not attempt to remove the device yourself.

Before taking Mirena

An intrauterine device can increase your risk of developing a serious pelvic infection, which may threaten your life or your future ability to have children. Ask your doctor about your personal risk and about ways to help prevent a pelvic infection.

You should not use Mirena if you are allergic to levonorgestrel, silicone, or polyethylene, or if you have:

  • abnormal vaginal bleeding;
  • an untreated or uncontrolled pelvic infection (vaginal, uterine, or bladder);
  • a serious pelvic infection following a pregnancy or abortion within the past 3 months;
  • a history of pelvic inflammatory disease (PID), unless you have had a normal pregnancy after the infection was treated and cleared;
  • uterine fibroid tumors or other conditions that affect the shape of the uterus;
  • past or present breast cancer;
  • liver disease or liver tumor (benign or malignant);
  • known or suspected cervical or uterine cancer;
  • a recent abnormal Pap smear that has not yet been diagnosed or treated;
  • a disease or condition that weakens your immune system, such as AIDS, leukemia, or IV drug abuse;
  • if you have another intrauterine device (IUD) in place; or
  • if you do not have an exclusive sexual partner.

You may need special tests to safely use the Mirena intrauterine device if you have:

  • diabetes;
  • a bleeding or blood-clotting disorder;
  • a vaginal infection, pelvic infection, or sexually transmitted disease; or
  • high blood pressure, heart disease or a heart valve disorder.

Mirena may be inserted immediately after a first trimester abortion.

Your doctor may ask about your partner's medical and sexual history before prescribing Mirena for you.

Mirena should not be used during pregnancy. This device can cause severe infection, miscarriage, premature birth, or death of the mother if it is left in place during pregnancy. Tell your doctor right away if you become pregnant while using Mirena.

If you choose to continue a pregnancy that occurs while using Mirena, watch for signs of infection such as fever, chills, flu symptoms, cramps, vaginal bleeding or discharge. Contact your doctor at once if you have any of these symptoms.

If you have recently had a baby and are breast-feeding, wait until your baby is at least 6 weeks old before you start using Mirena.

How is Mirena used?

Mirena is a T-shaped plastic device that is inserted through the vagina and placed into the uterus. You will receive the device in a clinic setting. Your doctor will place the device into your uterus using a thin plastic tube. The device is usually inserted within 7 days after the start of a menstrual period.

You may feel pain or dizziness during insertion of the Mirena intrauterine device. You may also have some vaginal bleeding. These symptoms should last only 30 minutes or less after the device is inserted, especially if you stay in a sitting or lying position during that time. Tell your doctor if you still have these symptoms after 30 minutes have passed.

A pair of strings is attached to the device for removal when you decide to discontinue using it. Your doctor will cut these strings short enough so they do not protrude from your vagina. Do not pull on the strings or attempt to remove the Mirena intrauterine device.

After each menstrual period you should check to make sure you can still feel the removal strings. Wash your hands with soap and water, and insert your clean fingers into the vagina. You should be able to feel the strings deep inside the vagina, at the opening of your cervix. Call your doctor at once if you cannot feel the strings, or if you think the device has slipped lower in your uterus or out of your uterus. A sudden increase in menstrual flow may be a sign that the device has slipped out of place.

If you think the device is not properly in place, use a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy until your doctor is able to replace the Mirena device.

Your doctor will need to see you within 4 and 12 weeks after insertion of the device to make sure it is still in place correctly. Be sure to also have regular annual pelvic exams and Pap smears while you are using Mirena.

The Mirena intrauterine system should not interfere with sexual intercourse, wearing tampons, or using other vaginal medications recommended by your doctor.

You may have irregular periods during the first 3 to 6 months of using Mirena. Your flow may be lighter or heavier, and you may eventually stop having periods after several months. Contact your doctor if you think you might be pregnant, or if you do not have a menstrual period for 6 weeks in a row.

Mirena must be removed at the end of the 5-year wearing time. Your doctor can insert a new device at that time if you wish to continue using this form of contraception. Only your doctor should remove the Mirena intrauterine system. Do not attempt to remove the device yourself.

Following removal of the Mirena intrauterine device, you may become pregnant right away. Most women who choose to discontinue using the device in order to have a baby will become pregnant within the first year after removal.

What happens if I miss a dose?

Since the intrauterine device continuously releases a low dose of levonorgestrel, missing a dose does not occur when using this form of levonorgestrel.

What happens if I overdose?

An overdose of levonorgestrel released from the Mirena intrauterine system is very unlikely to occur.

What should I avoid while using Mirena?

Avoid having sexual intercourse with more than one partner. Also avoid having sexual intercourse with a partner who has other sexual partners besides you. The intrauterine device can increase your risk of developing a serious pelvic infection, which is often caused by sexually transmitted disease.

Mirena will not protect you from sexually transmitted diseases--including HIV and AIDS. Using a condom is the only way to help protect yourself from these diseases.

Contact your doctor if your sexual partner develops HIV or a sexually transmitted disease, or if you have any change in sexual relationships.

Mirena side effects

Get emergency medical help if you have severe pain in your lower stomach or side. This could be a sign of a tubal pregnancy (a pregnancy that implants in the fallopian tube instead of the uterus). A tubal pregnancy is a medical emergency.

Mirena may become embedded into the wall of the uterus, or may perforate (form a hole) in the uterus. If this occurs, the device may no longer prevent pregnancy, or it may move outside the uterus and cause scarring, infection, or damage to other organs. If the device embeds in or perforates the uterine wall, your doctor may need to surgically remove the device.

Call your doctor at once if you have a serious side effect such as:

  • severe cramps or pelvic pain;
  • extreme dizziness, feeling like you might pass out;
  • heavy or ongoing vaginal bleeding, vaginal sores, vaginal discharge that is watery, foul-smelling discharge, or otherwise unusual;
  • severe pain in your side or lower stomach;
  • pale skin, weakness, easy bruising or bleeding;
  • fever, chills, or other signs of infection;
  • pain during sexual intercourse;
  • sudden numbness or weakness, especially on one side of the body;
  • sudden or severe headache, confusion, problems with vision, sensitivity to light;
  • jaundice (yellowing of the skin or eyes); or
  • signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side Mirena effects may include:

  • irregular menstrual periods, changes in bleeding patterns or flow;
  • breakthrough bleeding, or heavier menstrual bleeding during the first few weeks after device insertion;
  • back pain;
  • headache, nervousness, mild dizziness;
  • nausea, vomiting, bloating;
  • breast tenderness or pain;
  • weight gain, acne, changes in hair growth;
  • mood changes, loss of interest in sex;
  • mild itching, skin rash; or
  • puffiness in your face, hands, ankles, or feet.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Mirena?

Tell your doctor about all other medications you use, especially:

  • insulin;
  • a blood thinner such as warfarin (Coumadin); or
  • steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex), dexamethasone (Decadron, Hexadrol) and others.

This list is not complete and there may be other drugs that can interact with Mirena. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.