What To Expect After Mirena Insertion

In last year’s post “Mirena and Menopause” we explained how Mirena (the levonorgestrel-containing IUD) is used at perimenopause and menopause. If you’ve decided to try Mirena you’ll also want to know what to expect after Mirena insertion…

What Is Mirena Used For?

Let’s take another quick look at the reasons why you might consider Mirena at perimenopause or menopause:

• It’s inexpensive, very reliable contraception.
• It’s suitable for women who can’t take oral estrogens due to a high risk of unwanted blood clots such as smokers, those with migraines with visual disturbances or high blood pressure;
• It’s has a lower circulating hormone dose than other hormonal contraceptives and can often be tolerated by women who have side effects on other types.
• It reduces heavy periods and may stop periods completely.
• It’s also a safe choice when used for hormonal replacement therapy with estrogen patches or gel, eg. for hot flushes).

Where Can I Get A Mirena insertion?

GP’s require special training to insert Mirena; check with your General Practice whether any of the doctors there do it. If not, search for a Family Planning or termination clinic in your area. As an added bonus many of these clinics offer light sedation for procedures, which is very helpful if you’re worried about pain.

Alternatively, ask your GP for referral to a gynaecologist. They can usually offer insertion with or without a local or general anaesthetic. Your local women’s health nurses or clinic should also be able to advise you of the different options available for IUD insertion in your region.

How To Prepare For Mirena Insertion Or Replacement

Your doctor will need to ensure that you’re not pregnant at the time of Mirena insertion. If you were, it is highly likely that the insertion procedure, or later removal of the device, would cause a miscarriage. If you still have periods, book the insertion appointment for a time when your period is expected, or continue contraception until the insertion.

If your periods are irregular you must not have unprotected intercourse for at least 3 weeks prior to the insertion and your doctor should perform a urine pregnancy test when you arrive. This is not required if you are postmenopausal by one year or more over the age of 50, two years or more under the age of 50, or have a reliable form of contraception in your system.

For replacement of an existing IUD you must not have unprotected intercourse in the week beforehand, as this may allow sperm enter the uterus during insertion. If your current IUD has expired however follow the advice above.

What To Expect During Mirena Insertion

The procedure can temporarily drop your heart rate and blood pressure. Make sure you’ve had plenty of food and fluids earlier in the day, especially if you faint easily.

The procedure can be quite uncomfortable, more so than a pap smear. It can help to take some period-pain tablets an hour or so beforehand and keep some handy to take regularly afterwards. I recommend two paracetamol tablets and two ibuprofen, naproxen or similar, taken with food 1-2 hours before the procedure.

Some women feel a bit sick or faint either during or after the procedure, so make a plan for getting home that doesn’t involve you driving. Try not to have any strenuous activities planned for the rest of the day. Your doctor can provide a medical certificate for the rest of the day off if needed.

What To Expect After Mirena Insertion: Short Term

For a few days afterwards you may have cramps and bleeding like a heavy period. You may even have the occasional cramp or odd sensation during the first few weeks while the IUD “settles in”.

Do not put anything in the vagina for three days after insertion, to minimise the risk of uterine infection. This means no intercourse, tampons, string-checks, baths or swimming until three days after your procedure.

It’s recommended that you feel for the IUD strings (in the upper vagina, near the cervix) once a week during the first month or so. This will allow you to detect any complications early if the device is no longer in the uterus.

If you can’t feel the strings, don’t panic; many women find it difficult to locate their cervix and feel the strings. Get your doctor to do an early review to confirm that the strings are there, and ask them for tips about how to find them yourself in future.

What To Expect After Mirena Insertion: Long Term

You may experience frequent bleeding in the first few months but this usually settles down over time. If you notice frequent bleeding keep track of it with a spotting diary. You should see the inserting doctor for an IUD check about 4-6 weeks afterwards, which is a good time to discuss any bleeding issues you’re having.

It could take some time before your final long-term bleeding pattern is apparent. Most women find that over 6-12 months their periods become much lighter or stop altogether. However occasionally women still have heavy periods and may need a different method of contraception. This is more common if you have things like fibroids causing heavy bleeding.

Check regularly that the strings are present in the upper vagina, perhaps about once a month. If you suddenly can’t feel the strings anymore get your GP to check with a speculum exam. If they can’t see any strings they can send you for an ultrasound or xray to confirm that it is definitely still in the uterus.

When To Remove Or Replace Mirena

For contraception: The contraceptive effect of Mirena lasts five years. If you are under 50 and your Mirena is expiring you should have it replaced to ensure ongoing contraception or use another contraceptive.

If you’re over 50 when it expires then you have a decision to make. Before having it removed your doctor should check that you’re definitely post-menopausal; if not you may be at risk of an unplanned pregnancy (rare, but not impossible).  If you’re not menopausal your periods will also return, possibly heavier and more frequent or prolonged than before.

Your GP can check whether you’re menopausal with a hormone blood test (follicle stimulating hormone, or FSH). Two tests 6 weeks apart that are both in the menopausal range confirms that you are menopausal. You should still leave the old IUD in place for another 12 months to be sure though. If your Mirena was inserted after age 45 it can be left in for contraception well past age 50, not just the usual five years.

For Hormonal Therapy: Mirena is validated for five years of endometrial protection. This means that it can be used to ‘balance’ the effects of estrogen in the uterus, to stop the lining from becoming thickened and bleeding.

If you are using Mirena with estrogen for combined HRT/ MHT you must have it replaced after five years, even if you’re not relying on it for contraception.

For more information about Mirena checkout this handout from Family Planning NSW, or speak to your local women’s health doctor, nurse or clinic.

Dr Teagle does not receive any gratuities or inducements related to Mirena. This article is intended to be informative only; women should consult with a doctor for individualised medical advice.

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