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Contraception- Intrauterine System ("Mirena", IUS, Hormonal IUD)

How is a Mirena intrauterine contraceptive system (IUS) inserted?

A vaginal speculum is inserted and the cervix is visualized. The cervix is cleansed using an aqueous antiseptic solution. Local anaesthetic (e.g. lidocaine 1%) can be injected into the anterior lip of the cervix, prior to application of a tenaculum, and it can also be used to establish a para-cervical block, particularly in nulliparous women. The tenaculum on the anterior lip of the cervix though not mandatory is often extremely helpful in straightening and aligning the cervical canal with the uterine cavity (thus decreasing the risk of perforation). The uterus is usually sounded. The IUS is then loaded into the barrel of the inserter, using sterile technique and following the manufacturer's recommended method and making sure that the arms are perpendicular to the barrel. The strings are held in place in the groove found at the end of the barrel. The flange on the outside of the barrel is adjusted to the depth of the uterine cavity (as measured by the sound). The tip of the inserter barrel is directed into the cervical canal and passed gently into the uterine cavity. The barrel should be inserted until the flange is approximately 1.5 centimeters away from the cervix. The device is then expelled from the barrel by pulling back on the green button to the marked line. While holding the green button in place the flange is advanced until it abuts the cervix. The green button is then slid to the end of the barrel, leaving the IUCD in the uterine cavity and releasing the strings from the groove. The strings are clipped at a distance of approximately 2.5cm from the external os, in order to facilitate removal of the device. It is important that all users receive instruction on the correct insertion of Mirena.

I had a Mirena IUD inserted a few months ago. I have had small amounts of bleeding almost every day. Is this normal?

Yes, it is. This IUD is made of two components, plastic and levonorgestrel (a progestin hormone). The levonorgestrel is released slowly from the IUD and causes the lining of the uterus to become very thin. When the Mirena is first inserted, before the lining becomes completely thinned out, women may have unpredictable spotting. Eventually, the lining becomes so thin that many women stop having their periods altogether. It should get better over the next few months. If that is not happening, see your health care provider to make sure there is not another cause for the bleeding.

I had a Mirena® inserted over 2 months ago. I am really happy with it and I haven't had any major side effects aside from a little irritability and unpredictable periods. The problem is that since I've had the IUD, I have had almost no sexual appetite at all! I have never heard of this as a side effect. Is this common?

Although this is not a common side-effect, it has been reported in less than 1% of women who use the Mirena®. Some of the progestin from the device enters your system and can cause the ovary to produce less testosterone. This is likely to lessen after the device has been in place for several months and less progestin is absorbed into your body.

I just had an IUD put in. How long before it is good for contraception?

An IUD (such as Nova T, Flexi T 300, or the Mirena® IUS) is actually effective immediately, however most health-care professionals recommend waiting a week (use either condoms or abstinence) before relying on it to protect against pregnancy.

Is ibuprofen helpful in reducing the pain of IUD insertion?

A recent study examined the pain associated with the insertion of a copper-T intra-uterine device (IUD) and whether a 400 mg dose of ibuprofen would improve the pain scores.

A total of 2019 women participated, 1011 used ibuprofen 45 minutes before IUD insertion, and 1008 used a placebo (sugar) pill.

Using a visual analog scale (a line labeled from 0 to 10, with 0 being no pain, and 10 being the worst pain imaginable), participants marked an X on the line that measured the amount of pain they felt with the IUD insertion. There was no significant difference in pain scores between the two groups. Forty-eight percent of women marked a pain score of 1 or less, while only 4.4 % marked a score of 7 or higher. Women who were older, had never had a baby, or whose last pregnancy had ended more than six months ago had higher pain scores. The 400 mg dose of ibuprofen did not improve the pain score in any group.

What is reassuring is that the overall pain scores were quite low. Women who are afraid of discomfort associated with an IUD insertion can be reassured that, in general, the pain experienced with this procedure is very low.

What are frequent side effects of the progestin releasing intrauterine system (Mirena)?

An altered menstrual bleeding pattern is common after Mirena is inserted This change in the menstrual bleeding pattern is due to the direct action of Levonorgestrel on the endometrium. The duration and volume of menstrual bleeding gradually decreases after the first three to six months. With continued use of Mirena bleeding patterns vary from scanty menstruation in some women to, oligomenorrhea or amenorrhea in others. Hormonal side effects are also common particularly in the first three to six months. The most common side effects reported include headache, breast tenderness, acne, weight change and depression. These side effects do subside over time.

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