Mirena trademark (levonorgestrel-releasing intrauterine system) 52 mg

Important Safety Information

If you have a pelvic 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 if Mirena comes out, tell your healthcare provider (HCP)... Continue below

Questions and answers about Mirena

Choose a topic below to learn more about Mirena, but always remember that your healthcare provider is your best resource for any and all questions regarding Mirena and birth control in general.

Understanding Mirena

What is Mirena?

Mirena is an intrauterine device (also known as an IUD) 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. Mirena is recommended for women who have had a child.
  • Mirena offers contraception that's over 99% effective; in fact, it is one of the most effective methods of reversible 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. In fact, about 8 out of 10 women succeed at becoming pregnant within 1 year of having Mirena removed.
Size of Mirena®

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.

See what Mirena looks like

How does Mirena work to prevent pregnancy?

Mirena prevents pregnancy, most likely in several ways:
  • Thickening cervical mucus to prevent sperm from entering your uterus
  • Inhibiting sperm from reaching or fertilizing your egg
  • Thinning the lining of your uterus
 
Mirena® IUD in uterus




While there's no single explanation for how Mirena works, most likely these actions work together to prevent pregnancy for up to 5 years.
 
 

What about hormones and Mirena?

Mirena contains a progestin hormone called levonorgestrel that is often used in birth control pills. Because Mirena releases levonorgestrel into your uterus, only small amounts of the hormone enter your blood. Mirena does not contain estrogen.

 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 backup birth control and call your healthcare provider.

Some women may experience cramping or pain, bleeding and/or dizziness during and after Mirena is placed. Tell your healthcare provider if your cramps are severe. If your 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 effective is Mirena at preventing pregnancy?

Mirena is one of the most effective forms of birth control. Unfortunately, no birth control method, including Mirena, is 100% perfect. Once Mirena is placed by your healthcare provider, it is over 99% effective and works continuously to prevent pregnancy. So you don't have to think about taking birth control every day or even every year. You just do a self-check of the threads of Mirena once a month to make sure it's in place. Be sure to ask your healthcare provider to explain how. If you have trouble finding the threads, or can't feel the threads, call your healthcare provider. And in the meantime, be sure to use a backup form of non-hormonal 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 below shows the chance of becoming 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 one method of 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.

Birth control effectiveness chart
 

How can Mirena help with family planning decisions?

With Mirena, you get effective contraception for up to 5 years and flexibility because you can have it removed by your healthcare provider whenever you want to try to have another child. 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 succeeded at becoming pregnant.

What if I haven't decided whether or not I want more children?

Mirena may be a good choice for you because it continuously prevents pregnancy for up to 5 years. But Mirena is reversible. Should you decide you do want to try to become pregnant, Mirena can be removed at any time by your healthcare provider. Or, if at the end of the 5 years you're still undecided, you can have another Mirena placed.

What happens if I become pregnant while using Mirena?

One risk of becoming pregnant while using Mirena is called ectopic pregnancy. This means that the pregnancy is not in the uterus. It may occur in the fallopian tubes. Signs of ectopic pregnancy may include unusual vaginal bleeding or abdominal pain. Ectopic pregnancy is an emergency that requires immediate medical attention and often requires surgery. Ectopic pregnancy can cause internal bleeding, infertility and even death, so it is important to call your healthcare provider right away if you think that you're pregnant.

There are also risks if you become 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.

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.

It is not known if Mirena can cause long-term effects on the fetus if it stays in place during a pregnancy.

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.

Does Mirena contain any metal?

No, Mirena does not contain any metal. It is made of soft, flexible plastic.

 
 

Is Mirena right for me?

Who is Mirena right for?

Mirena is a hormone-releasing IUD (intrauterine device) placed in your uterus to prevent pregnancy for as long as you want for up to 5 years. Mirena also treats heavy periods in women who choose intrauterine contraception.

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.

Mirena offers a flexible birth control 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 in the future
  • 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 treat heavy periods

Start a conversation with your healthcare provider to find out if Mirena may be right for you.

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:
  • Are or might be pregnant; Mirena cannot be used as an emergency contraceptive
  • 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:
    • Multiple sexual partners or your partner has multiple sexual partners
    • Problems with your immune system
    • Intravenous drug 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 or any other cancer that is sensitive to progestin (a female hormone), now or in the past
  • 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, polyethylene, silica, barium sulphate or iron oxide

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 (levonorgestrel-releasing intrauterine system) 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 severe migraine headaches

What else should you discuss with your healthcare provider?

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?

Check with your health insurance about coverage and cost. Costs may include insertion and removal. The majority of insurance plans are required to cover the cost of prescription birth control.

If Mirena is not covered by your health insurance provider, you may be able to get Mirena by using a Health Savings Account (HSA).

If you are having trouble getting Mirena at no cost, visit CoverHer.org or call the National Women's Law Center at 1-866-745-5487 1-866-745-5487 . A variety of resources are available to help you get coverage.

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.

Why would I consider Mirena?

Mirena is one of the most effective forms of birth control that lasts as long as you want, for up to 5 years. Because it can be removed at any time by your healthcare provider, it's reversible and you're free to keep your family planning options open. You can try to become pregnant as soon as Mirena is removed.

No one method of 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.

 
 

How to get Mirena

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 just a few minutes.

He or she will:
  • Apply an antiseptic solution to your vagina and cervix
  • Pass a slim tube of 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, do a self-check of your threads once a month. Be sure to ask your healthcare provider to explain how. If you have trouble finding the threads, call your healthcare provider right away, and use a backup method of birth control.

If you think you may be 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 your 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 is nonsurgical and typically takes just a few minutes.

Every woman is different, and some women may experience discomfort or spotting during or after placement. These symptoms should go away shortly. If they don't, contact your healthcare provider. Within 4 to 6 weeks you should return for a follow-up visit to make sure that everything is okay.

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 pelvic infection called pelvic inflammatory disease (PID). If you have persistent pelvic or abdominal pain, see your healthcare provider.

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 as there is an increased risk of perforation and of Mirena becoming attached to (embedded) or going through the wall of the uterus if Mirena is inserted while you are breastfeeding..

 
 

After Mirena placement

What can I expect right after Mirena is placed?

Some women may experience cramping or pain, bleeding and/or dizziness during and after Mirena is placed. Tell your healthcare provider if your cramps are severe. If your 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.

Will my periods change with Mirena?

For the first 3 to 6 months, your monthly period may become irregular and the number of bleeding days may increase. 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 and spotting 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 during 6 weeks of Mirena use, contact your healthcare provider to rule out pregnancy.

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 6 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 should I check that Mirena is in place?

You should check that Mirena is in proper position by feeling the removal threads.* It is a good habit to do this once a month. Your healthcare provider should tell you how to check that Mirena is in place. First, wash your hands with soap and water. You can check 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. Use non-hormonal back-up birth control (such as condoms and spermicide) and ask your healthcare provider to check that Mirena is still in the right place.

*Two thin 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.

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.

What if I decide I want to try to become 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.

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:

  • During the first 3 to 6 months, your monthly period may be heavier, irregular, your number of bleeding and spotting days may increase, and you may have frequent spotting or light bleeding
  • 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.

Are there any potential serious complications with Mirena?

Some serious but uncommon side effects of Mirena include:
  • 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 have 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. A hysterectomy (removal of the uterus) is sometimes needed. 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, or fever.
  • A life-threatening infection called sepsis, including Group A streptococcal sepsis (GAS), may occur within the first few days after Mirena is placed. Call your healthcare provider immediately if you experience severe pain or unexplained fever shortly after Mirena is placed.
  • Perforation. Mirena may become attached to (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. Surgery may be needed to have Mirena removed. The risk of perforation is increased if Mirena is inserted while you are breastfeeding.

What are the more common side effects of Mirena?

Possible common side effects of Mirena include:

Placement discomfort. Pain, bleeding or dizziness may occur during and after placement. This is common. Let your healthcare provider know if the cramping is severe. If your 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 think that Mirena has come out, use a back-up form of birth control such as condoms and spermicide and call your healthcare provider.

Missed menstrual periods. About 20% of women stop having periods after 1 year of Mirena use. Your periods will return once 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. 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.

Cysts 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.

This is not a complete list of 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 the manufacturer at 1-888-842-2937, or at 1-800-FDA-1088 or www.fda.gov/medwatch.

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 your partner feels the threads. If this occurs, talk to your healthcare provider.