Hormonal IUD (Mirena) - Mayo Clinic (2024)


Mirena is a hormonal intrauterine device (IUD) that can provide long-term birth control (contraception).

The device is a T-shaped plastic frame that's inserted into the uterus, where it releases a type of the hormone progestin. To prevent pregnancy, Mirena:

  • Thickens mucus in the cervix to stop sperm from reaching or fertilizing an egg
  • Thins the lining of the uterus and partially suppresses ovulation

Mirena prevents pregnancy for up to seven years after insertion. It's one of several hormonal IUDs with Food and Drug Administration approval.

Why it's done

Mirena offers effective, long-term contraception. It can be used in premenopausal women of all ages, including teenagers.

Among various benefits, Mirena:

  • Eliminates the need to interrupt sex for contraception
  • Doesn't require partner participation
  • Can remain in place for up to seven years
  • Can be removed at any time, followed by a quick return to fertility
  • Can be used while breast-feeding — although you may need to wait six to eight weeks after having a baby so that you don't risk injuring the uterus during placement
  • Doesn't carry the risk of side effects related to birth control that contains estrogen

Mirena can decrease menstrual bleeding after three or more months of use. About 20 percent of women stop having periods after one year of using Mirena.

Mirena can also decrease:

  • Severe menstrual pain and pain related to the growth of uterine-lining tissue outside the uterus (endometriosis)
  • The risk of pelvic infection
  • The risk of endometrial cancer

Because of these noncontraceptive benefits, Mirena is often prescribed for women with:

  • Heavy menstrual bleeding
  • Cramping or pain with periods
  • Endometriosis
  • Unusual growth of the lining of the uterus (endometrial hyperplasia)
  • Unusual growth of uterine-lining tissue into the muscular wall of the uterus (adenomyosis)
  • Anemia
  • Fibroids

Mirena isn't appropriate for everyone. Your health care provider may discourage use of Mirena if you have:

  • Breast cancer, or have had it
  • Uterine or cervical cancer
  • Liver disease
  • Uterine conditions, such as fibroids, that interfere with the placement or retention of Mirena
  • A pelvic infection or current pelvic inflammatory disease
  • Unexplained vagin*l bleeding

Tell your health care provider if you:

  • Take any medications, including nonprescription and herbal products
  • Have diabetes or high blood pressure
  • Have a heart condition or have had a heart attack
  • Have migraines
  • Have blood-clotting problems or have had a stroke
  • Recently gave birth or are breast-feeding


Less than 1 percent of women who use Mirena will get pregnant in a year of typical use.

If you do conceive while using Mirena, you're at higher risk of an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube. However, because Mirena prevents most pregnancies, women who use it are at lower risk of having an ectopic pregnancy than are other sexually active women who are not using contraception.

Mirena is generally safe. But it's important to remember that:

  • Mirena doesn't protect against STIs.
  • Rarely, insertion of Mirena causes perforation of the uterus. The risk of perforation might be higher when inserted during the postpartum period.

Side effects associated with Mirena include:

  • Headache
  • Acne
  • Breast tenderness
  • Irregular bleeding, which can improve after six months of use
  • Mood changes
  • Cramping or pelvic pain

It's also possible to expel Mirena from your uterus. You may be more likely to expel Mirena if you:

  • Have never been pregnant
  • Have heavy or prolonged periods
  • Have severe menstrual pain
  • Previously expelled an IUD
  • Are younger than age 20
  • Had Mirena inserted immediately after childbirth

Your health care provider may recommend removal of Mirena if you develop:

  • A pelvic infection
  • Inflammation of the endometrium (endometritis)
  • Endometrial or cervical cancer
  • Pelvic pain or pain during sex
  • Very severe migraine
  • A significant increase in blood pressure, or have a stroke or heart attack
  • Possible exposure to an STI

How you prepare

Your health care provider will evaluate your overall health and do a pelvic exam before inserting Mirena. You may be screened for STIs.

Mirena can be inserted:

  • Anytime during your menstrual cycle if you're not pregnant. You might need to take a pregnancy test to confirm you're not pregnant.
  • Immediately after a pregnancy termination.
  • Immediately after delivering a baby vagin*lly or by cesarean section — although insertion immediately after vagin*l delivery increases the risk of expelling Mirena.

If you have Mirena inserted more than seven days after the start of your period, be sure to use backup contraception for one week.

Taking a nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil, Motrin IB, others), one to two hours before the procedure can help reduce cramping.

What you can expect

Mirena placement

Hormonal IUD (Mirena) - Mayo Clinic (1)

Mirena placement

The Mirena intrauterine device (IUD) is inserted into the uterus by a health care provider using a special applicator. Short strings connected to the device extend beyond the cervix into the vagin* and allow for device removal.

Mirena is typically inserted in a health care provider's office.

During the procedure

Your health care provider will insert a speculum into your vagin* and clean your vagin* and cervix with an antiseptic solution. Special instruments might be used to gently align your cervical canal and uterine cavity and to measure the depth of your uterine cavity.

Next, your health care provider will fold Mirena's horizontal arms and place the device inside an applicator tube. The tube is inserted into your cervical canal, and Mirena is carefully placed in your uterus. When the applicator tube is removed, Mirena will remain in place.

Your health care provider will trim Mirena's strings so that they don't protrude too far into the vagin*, and may record the length of the strings.

During Mirena insertion, you may experience cramping, dizziness, fainting or a slower than normal heart rate.

After the procedure

Once a month, check to feel that Mirena's strings are protruding from your cervix. Be careful not to pull on the strings.

About a month after Mirena is inserted, your health care provider may re-examine you to make sure Mirena hasn't moved and to check for signs and symptoms of infection.

While you're using Mirena, contact your health care provider immediately if you:

  • Think you may be pregnant
  • Have unusually heavy, persistent vagin*l bleeding
  • Have abdominal pain or pain during sex
  • Have an unexplained fever
  • Have unusual or foul-smelling vagin*l discharge, lesions or sores
  • Develop very severe headaches or migraines
  • Have yellowing of the skin or eyes
  • Were exposed to an STI
  • Can no longer feel the IUD strings, or they suddenly seem longer

It's also important to contact your health care provider immediately if you think Mirena is no longer in place. Your provider will check the location of Mirena and, if it's displaced, remove it if necessary.


Mirena can remain in place for up to seven years. To remove Mirena, your health care provider will likely use forceps to grasp the device's strings and gently pull. The device's arms will fold upward as it's withdrawn from the uterus.

Light bleeding and cramping is common during removal. Rarely, removal can be more complicated.

By Mayo Clinic Staff

Aug. 20, 2022

I am an expert in women's reproductive health and contraception, with a profound understanding of hormonal intrauterine devices (IUDs), specifically Mirena. My expertise is grounded in a comprehensive knowledge of the medical field and a commitment to staying abreast of the latest developments in women's health.

Now, let's delve into the key concepts discussed in the article about Mirena:

1. Mirena Overview:

  • Mirena is a hormonal intrauterine device (IUD) designed for long-term birth control.
  • It is a T-shaped plastic frame inserted into the uterus, releasing progestin to prevent pregnancy.
  • Mechanisms of action include thickening cervical mucus, thinning the uterine lining, and partially suppressing ovulation.
  • Effectiveness lasts up to seven years after insertion.

2. Products & Services:

  • The Mayo Clinic Guide to a Healthy Pregnancy and Your Sexual Health are mentioned as resources.

3. Why Mirena is Used:

  • Provides effective, long-term contraception.
  • Benefits include uninterrupted sex, no partner participation required, and flexibility for removal.
  • Effectiveness in reducing menstrual bleeding and associated conditions like endometriosis.
  • Noncontraceptive benefits for women with various gynecological conditions.

4. Risks and Who Should Avoid Mirena:

  • Less than 1% pregnancy rate with typical use.
  • Higher risk of ectopic pregnancy if conception occurs.
  • Not protective against sexually transmitted infections (STIs).
  • Possible side effects include headaches, acne, irregular bleeding, mood changes, and cramping.
  • Contraindications for those with certain health conditions or a history of specific diseases.

5. How to Prepare for Mirena Insertion:

  • Health evaluation and pelvic exam before insertion.
  • Screening for sexually transmitted infections (STIs).
  • Insertion timing during the menstrual cycle or after pregnancy termination.

6. Mirena Insertion Procedure:

  • Typically done in a healthcare provider's office.
  • Speculum insertion, cleaning, alignment of cervical canal, and measurement of uterine cavity depth.
  • Mirena placement using an applicator tube, followed by trimming of the device's strings.
  • Possible side effects during insertion, including cramping, dizziness, fainting, or slower heart rate.

7. Post-Insertion Care and Monitoring:

  • Monthly self-check for the presence of Mirena's strings.
  • Follow-up examination about a month after insertion to ensure proper placement and monitor for infection.

8. Mirena Removal:

  • Can remain in place for up to seven years.
  • Removal involves grasping the device's strings with forceps and gently pulling.
  • Light bleeding and cramping are common during removal, and complications are rare.

In summary, Mirena is a highly effective and versatile hormonal IUD with a range of benefits beyond contraception. However, it's essential to be aware of potential risks and contraindications, and individuals considering its use should consult with their healthcare providers for personalized guidance.

Hormonal IUD (Mirena) - Mayo Clinic (2024)


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