Just the Facts
Commonly Asked Questions
Will my periods change? How long does it last? Will my partner feel it? Does it hurt when it's placed? These are examples of some common questions about Mirena. We hope that we can answer all of the questions you may have right here, but always remember that your healthcare provider is your best resource for any and all questions regarding Mirena and birth control in general.
Get the conversation started at your next appointment with the Doctor Discussion Guide.
Understanding Mirena
- What is Mirena?
- Is Mirena FDA-approved?
- What is Mirena made of?
- How does Mirena work to prevent pregnancy?
- What about hormones and Mirena?
- Are there any placement-related complications?
Is Mirena Right for Me?
- Who is Mirena right for?
- Not sure if Mirena is right for you?
- Who should not use Mirena?
- What should I tell my healthcare provider when deciding if Mirena is right for me?
Mirena & My Body
- When should Mirena be placed?
- How is Mirena placed?
- Will placement hurt?
- How long does it take to place Mirena?
- What can I expect right after Mirena is placed?
- Can I get Mirena if I have a vaginal infection?
- Will my periods change with Mirena?
- How often should I see my healthcare provider once Mirena is placed?
- How can I be sure Mirena is properly in place?
- Can Mirena protect me from HIV or STDs (sexually transmitted diseases)?
- What about cysts, bleeding or spotting?
- How soon after I give birth can I get Mirena?
- What if I decide I want to try to get pregnant?
- What if I need birth control for more than 5 years?
- Why would I consider Mirena?
- Can I still use tampons?
- Why may my periods become lighter?
- Are there any potential serious complications with Mirena?
- What are the more common side effects of Mirena?
- What if I become pregnant while using Mirena?
- Will my partner be able to feel Mirena during intercourse?
- Does Mirena contain any metal?
Understanding Mirena
What is Mirena?
Mirena is an intrauterine contraceptive that releases small amounts of the hormone levonorgestrel locally into your uterus. Made of soft, flexible plastic, Mirena is placed by your healthcare provider during an office visit. Plus:
- Mirena offers contraception that's over 99% effective; in fact, it is one of the most effective methods of birth control
- Mirena prevents pregnancy for as long as you want, for up to 5 years
- You can try to become pregnant as soon as Mirena is removed by your healthcare provider
Is Mirena FDA-approved?
Mirena was approved by the FDA for use in the United States in 2000 for intrauterine contraception and in 2009 to treat heavy periods for women who choose intrauterine contraception. Discuss all safety considerations with your healthcare provider and use Mirena according to the Prescribing Information. No birth control is right for everyone and there are risks associated with Mirena that you should know about. Have a conversation with your healthcare provider to find out if Mirena is right for you.
What is Mirena made of?
Mirena is made of soft, flexible plastic and contains the hormone levonorgestrel.
How does Mirena work to prevent pregnancy?
Mirena releases small amounts of the hormone levonorgestrel directly into your uterus.
There is no single explanation for how Mirena works. Mirena may:
- Thicken cervical mucus to prevent sperm from entering your uterus
- Inhibit sperm from reaching or fertilizing your egg
- Make the lining of your uterus thin
Mirena may stop the release of your egg from your ovary, but this is not the way it works in most cases. Most likely the above actions work together to prevent pregnancy. Like other forms of birth control, Mirena is not 100% effective.
What about hormones and Mirena?
Mirena contains a progestin hormone called levonorgestrel that is often used in birth control pills. Mirena does not contain estrogen. Mirena releases the hormone into your uterus. Only small amounts of the hormone enter your blood.
Are there any placement-related complications?
Mirena may attach to or go through the wall of the uterus and cause other problems. If Mirena comes out, use back-up birth control and call your healthcare provider.
Some women may experience cramping or pain, bleeding and/or dizziness during and right after Mirena is placed. Tell your healthcare provider if your cramps are severe. If these symptoms last for more than 30 minutes, let your healthcare provider know. Mirena may not have been properly placed and your healthcare provider should examine you.
How well does Mirena work?
Mirena is one of the most effective forms of birth control. Once Mirena is placed by your healthcare provider, it is over 99% effective and works consistently to prevent pregnancy. So you don't have to think about taking birth control every day or even every year. Check the threads of Mirena once a month. Your healthcare provider can show you how. If you have trouble finding the threads, call your healthcare provider. And in the meantime, be sure to use a back-up form of birth control.
It is important to think about your daily, weekly and monthly routine and how that may affect which birth control method is best for you. The chart to the right shows the chance of getting pregnant for women who use different methods of birth control. The most effective methods, including intrauterine devices such as Mirena, are found at the top of the chart. If you have any questions about this information, please ask your healthcare provider.
No birth control is right for everyone and there are risks associated with Mirena that you should know about. For detailed information about possible side effects, some potentially serious, please see Mirena Safety Considerations and the Patient Information.
How can Mirena help with family planning decisions?
With Mirena, you get effective contraception and flexibility because you can have it removed by your healthcare provider whenever you want to try to have another baby. You can try to become pregnant as soon as Mirena is removed. In fact, within a year of having Mirena removed, approximately 8 out of 10 women succeed at becoming pregnant.
What if I haven't decided whether or not I want more children?
Then Mirena may be a good choice because it prevents pregnancy for as long as you want, for up to 5 years. As far as family planning goes, this can be especially appealing if you are undecided whether you want more children. Should you decide you do want to try to get pregnant, Mirena can be removed at any time by your healthcare provider. Or, if at the end of the 5-year period you're still undecided, you can have another Mirena placed.
What happens if I get pregnant while using Mirena?
In the uncommon event you get pregnant while using Mirena, seek emergency care because pregnancy with Mirena can be life threatening and may result in loss of pregnancy or fertility. Learn more about pregnancy and Mirena.
Is Mirena Right for Me?
Who is Mirena right for?
Mirena is recommended for women who have had at least one child. This is because most of the medical research conducted on Mirena for FDA approval was among women who had at least one child. Only you and your healthcare provider can decide if Mirena is right for you. Please see Who should not use Mirena.
Mirena offers a flexible option if:
- You want birth control you don't have to think about taking every day
- You had a baby and want to explore your birth control options
- You want to have more children
- You are happy with your family size the way it is
- You are unsure if you want more children
- You want birth control that is also approved to reduce heavy periods
Start a conversation to find out if Mirena may be right for you.
Not sure if Mirena is right for you?
Answer these questions and bring them with you to your healthcare provider.
Who should not use Mirena?
Only you and your healthcare provider can decide if Mirena is right for you. As the two of you discuss your options, there are a number of things you should share—like your general health, current or past health conditions, sexual history and whether you'd like to have more children in the future.
Mirena is not appropriate for women who:
- Might be pregnant
- Have had a serious pelvic infection called pelvic inflammatory disease (PID), unless you have had a normal pregnancy after the infection went away
- Have an untreated pelvic infection now
- Have had a serious pelvic infection in the past 3 months after a pregnancy
- Can get infections easily. For example, if you have
- More than one sexual partner or your partner has more than one partner
- Problems with your immune system
- Intravenous drugs abuse
- Have or suspect you might have cancer of the uterus or cervix
- Have bleeding from the vagina that has not been explained
- Have liver disease or a liver tumor
- Have breast cancer now or in the past or suspect you have breast cancer
- Have an intrauterine device in your uterus already
- Have a condition of the uterus that changes the shape of the uterine cavity, such as large fibroid tumors
- Are allergic to levonorgestrel, silicone or polyethylene
Additional information about Mirena is just a click away.
What should I tell my healthcare provider when deciding if Mirena is right for me?
You should share any current or past health conditions that you have with your healthcare provider to help you both decide if Mirena may be right for you.
Your healthcare provider needs to know if you:
- Have had a heart attack
- Have had a stroke
- Were born with heart disease or have problems with your heart valves
- Have problems with blood clotting or take medicine to reduce clotting
- Have high blood pressure
- Recently had a baby or if you are breastfeeding
- Have diabetes (high blood sugar)
- Use corticosteroid medications on a long-term basis
- Have severe migraine headaches
How do I get Mirena?
Have a conversation with your healthcare provider to understand if Mirena is a good option for you. If it is, then Mirena can usually be placed in your healthcare provider's office at your next visit.
Will Mirena be covered under my health plan?
Mirena may be covered by your health insurance. To find out if Mirena is covered under your plan, check your employee benefits, talk to your company's human resources department or call your healthcare insurance company directly.
When talking to your insurance company, be sure to:
- Have your insurance card on hand—you may be asked to supply information from it, such as your account and/or group number
- Provide the Healthcare Common Procedure Coding System (HCPCS) code for Mirena—often called the J-code—which is J7302
- Provide the Current Procedural Terminology (CPT) code for having Mirena placed, which is 58300
Go to Healthcare Plan Coverage for more information about HSAs (Health Savings Accounts) and to learn what financing options are available if Mirena is not covered by your health plan.
How does the price of Mirena compare with some other forms of birth control?
Approximately 3 out of 4 people with health insurance have coverage for Mirena. There are other options too, like flexible payment plans. Use the patient product cost calculator to compare the product costs of different options. Depending on your birth control needs and the help of your health plan, you may find that Mirena may be an affordable option for you. However, only you and your healthcare provider can decide if Mirena is right for you.
Mirena & My Body
When should Mirena be placed?
Mirena should be placed within 7 days of the start of your period. Once placed by your healthcare provider, Mirena prevents pregnancy for as long as you want, for up to 5 years.
How is Mirena placed?
Your healthcare provider will place Mirena into your uterus during an office visit. Placement typically takes only a few minutes.
He or she will:
- Apply an antiseptic solution to your vagina and cervix
- Pass a thin tube of soft, flexible plastic (the inserter) containing Mirena into your vagina and then into your uterus
- Check to make sure Mirena is positioned correctly
- Withdraw the plastic inserter, leaving Mirena in your uterus
- Ensure that the two threads attached to the stem of Mirena properly extend through the cervix, which help ensure that Mirena is properly placed. This will also help with the removal of Mirena by your healthcare provider when that time comes
- Trim the threads to the appropriate length
Once Mirena is placed, check your threads once a month—your healthcare provider can show you how. If you have trouble finding the threads, call your healthcare provider right away, and use a back-up method of birth control.
If you think you are pregnant and are considering Mirena, please tell your healthcare provider. Pregnant women should not use Mirena.
Will placement hurt?
Some women may experience some discomfort while Mirena is being placed. Side effects may include cramping or pain, bleeding and/or dizziness. This is common. To help minimize the cramps, ask your healthcare provider about medications that may be used before and after placement, such as over-the-counter pain medications. Let your healthcare provider know if the cramping is severe, or if these symptoms last for more than 30 minutes as Mirena may have not been properly placed and your healthcare provider should examine you.
How long does it take to place Mirena in the uterus?
Your healthcare provider can generally place or remove Mirena during an office visit. Placement of Mirena takes only a few minutes.
What can I expect right after Mirena is placed?
Some women may experience cramping or pain, bleeding and/or dizziness during and right after Mirena is placed. Tell your healthcare provider if your cramps are severe. If these symptoms last for more than 30 minutes, let your healthcare provider know. Mirena may not have been properly placed and your healthcare provider should examine you.
Can I get Mirena if I have a vaginal infection?
Don't use Mirena if you have a vaginal or pelvic infection or get infections easily. Less than 1% of users get a serious infection called pelvic inflammatory disease. If you have persistent pelvic or abdominal pain, see your healthcare provider.
Will my periods change with Mirena?
For the first 3 to 6 months, your monthly period may become irregular. You may also have frequent spotting or light bleeding. A few women have heavy bleeding during this time. Call your healthcare provider if the bleeding remains heavier than usual. After your body adjusts, the number of bleeding days is likely to decrease, but may remain irregular, and you may even find that your periods stop altogether for as long as Mirena is in place.
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. Call your healthcare provider if the bleeding becomes heavy after it has been light for a while.
By one year, about 1 out of 5 users may have no period at all. Your periods will return once Mirena is removed. If you do not have a period within 6 weeks of Mirena use, contact your healthcare provider to rule out pregnancy.
Track your periods right after you've had Mirena placed and share the results with your healthcare provider at your post-placement follow-up visit.
How often should I see my healthcare provider once Mirena is placed?
As a follow-up, you should visit your healthcare provider once in the first 4 to 12 weeks after Mirena is placed to make sure it is in the right position. After that, Mirena can be checked once a year as part of your routine exam. Call your healthcare provider if you have any questions or concerns.
How can I be sure Mirena is properly in place?
Once Mirena is placed, you should check the threads* once a month to make sure it is still positioned correctly. Your healthcare provider can show you how. If you have trouble finding the threads, call your healthcare provider. And in the meantime, be sure to use a back-up form of birth control.
*Two threads are attached to the stem of Mirena. These threads are the only part of Mirena you should be able to feel when Mirena is positioned correctly.
Can Mirena protect me from HIV or STDs (sexually transmitted diseases)?
No. Mirena does not protect against HIV or STDs. So, if while using Mirena you think you or your partner might be at risk of getting an STD, use a condom and call your healthcare provider.
What are my chances of getting an enlarged follicle, also known as an ovarian cyst?
About 12 out of 100 women using Mirena develop a cyst on the ovary, sometimes known as an enlarged follicle. These cysts usually disappear on their own in a month or two. However, cysts can cause pain and sometimes need surgery.
How soon after I give birth can I get Mirena?
Mirena should not be placed earlier than 6 weeks after you give birth or as directed by your healthcare provider. When you ask your healthcare provider about Mirena, be sure to tell him or her if you are breastfeeding and plan to continue breastfeeding after getting Mirena placed.
What if I decide I want to try to get pregnant?
When you decide you want to try to have another child, Mirena can be removed by your healthcare provider at any time. It typically takes just a few minutes during an office visit. In fact, you can try to become pregnant as soon as Mirena is removed. Within a year of having Mirena removed, about 8 out of 10 women succeed at becoming pregnant.
What if I need birth control for more than 5 years?
Mirena must be removed after 5 years. If you want to continue using Mirena after those 5 years, you can choose to have another one placed. Talk with your healthcare provider about replacing your Mirena before your scheduled appointment to have your current Mirena removed. He or she can then place your new Mirena during the same office visit.
Why would I consider Mirena?
Mirena is one of the most effective forms of birth control. Because Mirena can be removed at any time by your healthcare provider, you're free to keep your family planning options open. You can try to become pregnant as soon as Mirena is removed.
When exploring your birth control options, you should also consider reversibility, and how important that might be to you. Some methods, such as tubal ligation (getting your tubes tied) or your partner getting a vasectomy, should be considered as permanent.
No birth control is right for everyone and there are risks associated with Mirena that you should know about. For detailed information about possible side effects, some potentially serious, please see Mirena Patient Information.
Start a conversation to find out if Mirena may be right for you.
Can I still use tampons?
Yes. However, if you use tampons you should change them with care so as not to pull the threads of Mirena when removing the tampon.
Why may my periods become lighter?
The reason many women may have lighter periods or stop having periods altogether with Mirena is related to the uterine lining.
Typically, this is how your period works:
- Every month, the lining of the uterus thickens during the first half of your menstrual cycle to prepare for ovulation
- If ovulation takes place and the egg is not fertilized, the thickened uterine lining is shed as menstrual flow
- On average, a woman's menstrual flow lasts 3 to 5 days. It may be shorter or longer, depending on the woman
Once Mirena is placed:
- The levonorgestrel in Mirena reduces the monthly thickening of the lining of your uterus
- Less thickening means less menstrual flow
- Eventually your menstrual flow may stop completely
- Once Mirena is removed, your menstrual cycle will return
If you have not gotten your period or have other symptoms of pregnancy during the first 6 weeks of Mirena use, contact your healthcare provider to rule out pregnancy.
Track your periods right after you've had Mirena placed and share the results with your healthcare provider at your post-placement follow-up visit.
Are there any potential serious complications with Mirena?
Some serious but uncommon side effects of Mirena include:
- Pelvic inflammatory disease (PID). Use of Mirena and other IUDs has been associated with an increased risk of PID. The percentage of women who develop PID while using Mirena is less than 1%. The risk is highest shortly after placement—especially within the first 20 days—and if you have a vaginal infection at the time of placement. After the first 20 days, the risk of PID is reduced.
PID is an infection of the uterus and other organs of the upper reproductive system. It is caused by bacterial infections that are usually sexually transmitted, such as gonorrhea or chlamydia, that travel beyond the vagina and cervix into the uterus and other organs in the reproductive system. The risk of PID is greater if you or your partner have sex with multiple partners. If not treated quickly and appropriately, PID can lead to serious problems, including infertility, ectopic pregnancy or constant pelvic pain. Serious cases of PID may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.1
Before placement of Mirena, be sure to tell your healthcare provider if you have signs of a vaginal infection or PID. Signs of PID include long-lasting or heavy bleeding, unusual vaginal discharge, abdominal or pelvic pain or tenderness, or painful sex, chills or fever.
After placement, contact your healthcare provider if any of these symptoms listed above occur and persist. - A rare life-threatening infection called sepsis may occur within the first few days after Mirena is placed. As of September 2006, 9 sepsis cases out of an estimated 9.9 million Mirena users had been reported. Call your healthcare provider immediately if you experience severe pain or unexplained fever after Mirena is placed.
- Embedment is when Mirena attaches to the uterine wall. If embedment occurs, Mirena may no longer prevent pregnancy and you may need surgery to have it removed.
- Perforation. Mirena may go through (perforate) the uterine wall. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside the uterus and can cause scarring, infection or damage to other organs. Surgery may be needed to have Mirena removed.
Reference:
1.Pelvic inflammatory disease—CDC fact sheet. Centers for Disease Control and Prevention Web site. http://cdc.gov/STD/PID/stdfact-pid.htm. Accessed May 13, 2011.
What are the more common side effects of Mirena?
Possible common side effects of Mirena include:
Discomfort during placement. Pain, dizziness, bleeding or cramping may occur during placement. This is common. Let your healthcare provider know if the cramping is severe. 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 replaced or removed.
Expulsion. Mirena may come out by itself and no longer prevent pregnancy. Symptoms of partial or complete expulsion may include bleeding, pain and an increase in menstrual flow. If this occurs, Mirena may be replaced within 7 days of a menstrual period after pregnancy has been ruled out. If you notice Mirena has come out, use a back-up form of birth control like condoms and call your healthcare provider.
More than 10% of Mirena users may experience:
- Missed menstrual periods. About 2 out of 10 women stop having periods after 1 year of Mirena use. Your periods come back when Mirena is removed. If you do not have a period for 6 weeks during Mirena use, contact your healthcare provider to rule out pregnancy.
- Changes in bleeding. Your period may become irregular and you may have bleeding and spotting between menstrual periods, especially during the first 3 to 6 months. A few women have heavy bleeding during this time. After your body adjusts, periods usually get lighter and the number of bleeding days is likely to decrease, but may remain irregular. Or you may even find that your periods stop altogether—in which case, you should contact your healthcare provider to rule out pregnancy.
Call your healthcare provider if the bleeding remains heavier than usual or if the bleeding becomes heavy after it has been light for a while. - Pelvic and/or abdominal pain may occur. Talk to your healthcare provider if the pain is persistent.
- Cyst on the ovary. About 12 out of 100 women using Mirena develop a cyst on the ovary. These cysts usually disappear on their own in a month or two. However, cysts can cause pain and may sometimes require surgery.
Between 5% and 10% of Mirena users may experience:
- Headache/Migraine
- Acne
- Depressed mood
- Heavy or prolonged menstrual bleeding
Less than 5% of Mirena users may experience:
- Vaginal discharge
- Breast pain or tenderness
- Nausea
- Nervousness
- Inflammation of cervix, vulva or vagina
- Pelvic pain during your period
- Back pain
- Weight increase
- Decreased sex drive
- High blood pressure
- Pain during intercourse
- Anemia
- Unusual hair growth or loss
- Skin irritations (such as hives, rash, eczema or itching)
- Feeling bloated
- Swelling of hands and/or feet
- Expulsion
Every individual responds differently to medication, so talk to your healthcare provider about your individual risk factors and to see if Mirena is right for you.
What if I become pregnant while using Mirena?
Unfortunately, no birth control method, including Mirena or tubal ligation (getting your tubes tied), is 100% perfect. If you do get pregnant while using a birth control method, there may be risks to you and your baby. Here we talk about the risks of getting pregnant while Mirena is still in place.
Over the course of 5 years, fewer than 8 in 1,000 women become pregnant while using Mirena. One risk of getting pregnant while using Mirena is called ectopic pregnancy, when the pregnancy is not in the uterus. It may occur in the fallopian tubes. Signs of ectopic pregnancy may include unusual bleeding or abdominal pain. Ectopic pregnancy is an emergency that requires immediate medical attention and often surgery. Ectopic pregnancy can cause internal bleeding, infertility and even death. Call your healthcare provider right away if you think that you're pregnant.
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.
Will my partner be able to feel Mirena during intercourse?
You and your partner shouldn't feel Mirena during intercourse, because Mirena is placed in the uterus, not the vagina. Sometimes male partners feel the threads.
Does Mirena contain any metal?
No, Mirena does not contain any metal. It is made of soft, flexible plastic.
