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Mirena Insertion & Removal

Like other available intrauterine devices (IUDs), Mirena is becoming a popular option for women who want an effective, reliable, reversible contraceptive. And like other intrauterine devices, Mirena can be inserted during a regular doctor’s visit.


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For some women, the experience of getting an IUD is quite painful, while others report a sensation similar to mild menstrual cramping. Women also may feel dizzy, nauseous or have a slower heartrate.

It’s important that a doctor uses sterile procedures for inserting Mirena to lower the chance that the patient will develop infections.

Insertion is recommended during the first seven days of a menstrual cycle and at least six weeks after giving birth. The doctor may recommend you avoid intercourse for two weeks before your appointment.

It’s also recommended that patients eat something light before the doctor’s visit. The woman may need to give a urine sample for a pregnancy test, so she shouldn’t urinate just before the appointment.

Doctors suggest taking pain medication, either ibuprofen or acetaminophen, 30 minutes before the appointment to help manage pain during the procedure.

Inflamed Pelvis
Pelvic inflammatory disease can happen if someone with an undiagnosed STI gets an IUD

Prior to inserting the device, the doctor should test the patient to make sure she doesn’t have a sexually transmitted infection (STI). This is to protect her from getting pelvic inflammatory disease, which can happen if someone with an undiagnosed STI gets an IUD.

The procedure should take about five minutes.

Before inserting the device, the doctor should do an exam to determine the size, shape and position of the uterus and ensure it’s safe to implant the device.

The doctor then will insert a speculum to get a clear look at the cervix. After that, the doctor will use an antiseptic solution to clean the cervix and vagina.

Next, the doctor will use an instrument called a tenaculum to manipulate the uterus so it can be measured with a rod called a sound. After getting a measurement, the doctor will use the sterile insertion tube that comes with the Mirena to place the device in the desired location in the uterus, and release it there.

The doctor will cut the threads dangling from the device to a length of about 3 centimeters outside the cervix. The doctor should show you how to check your threads periodically.

After Insertion

The patient should plan to rest in the doctor’s office for about 15 minutes following the procedure. It might also be best to try to avoid returning to work or doing any physical labor right after the procedure.

Mirena doesn’t become effective until seven days after insertion.

Mirena becomes effective seven days after insertion, so you will need backup birth control for a week after the procedure. Take over-the-counter medicine for any pain. A hot water bottle or a heating pad can be used for cramping.

The patient shouldn’t insert anything into her vagina for 24 hours after the procedure. So there should be no use of tampons or douching or sexual intercourse in that time frame.

Patients may experience sporadic, light bleeding for up to three months after as their bodies get used to the Mirena. After about six months, half of women have just light spotting for about three days a month. About a fifth of women stop having periods completely after a year with a Mirena.

Mirena recommends that patients see a doctor four to six weeks after having a Mirena inserted.


Women are instructed to check their Mirena threads monthly. If the threads are not in place or have significantly shortened, they may have broken or retracted into the cervical canal or uterus.

If the woman loses consciousness or has a sudden severe abdominal pain, she should seek emergency care.

She should call the doctor or seek urgent care if she:
  • Develops a fever higher than 100.4 degrees or chills
  • Has discharge with a bad odor, lesions or sores
  • Has new abdominal pain or tenderness that gets more intense and can’t be relieved with over-the-counter medicine
  • Experiences very heavy bleeding
  • Feels like she may faint
  • Think she may be pregnant
  • Develops very severe headaches
  • Has yellowing skin or eyes
  • Is exposed to a sexually transmitted infection

When Mirena perforates the uterus, it most commonly is during insertion. Sometimes, however, this isn’t noticed until later. The risk of perforation increases if Mirena is inserted into a patient who is breastfeeding. This happens up to 2.6 times per 1,000 insertions, according to medical literature. When this occurs, the device must be removed, sometimes surgically.

If the patient thinks her Mirena is no longer in place, she should call her doctor immediately.

Signs of a displaced device include:
  • She or her partner experience pain during sex
  • She can’t find the Mirena’s strings, or they feel longer
  • Her normal periods come back
  • She can feel the device at her cervix or in her vagina


Sometimes the Mirena migrates outside the uterus. One theory for how this happens is that the device perforates the uterus and then the involuntary constriction and relaxation of the muscles of the intestines cause the device to move around inside the abdomen.

Doctors performing laparoscopic surgery
If the Mirena device migrated outside the uterus, doctors typically remove the IUD laparoscopically

If the Mirena migrated outside the uterus, it likely needs to be removed surgically. This migration can occur about eight times for every 1,000 device insertions. Doctors typically perform this removal laparoscopically through a small incision in the abdomen. It is usually an out-patient procedure. First, they will use an ultrasound and possibly an x-ray to try to locate the device.

Absent complications such as perforation or migration, there are other reasons to remove Mirena, including the end of its five-year period of effectiveness. Sometimes women will have the Mirena taken out earlier because they want to become pregnant. In other instances, the side effects, such as continuing pain or discomfort, will prompt its removal.

The routine removal involves pulling the Mirena out with forceps used to tug on the strings. This is the procedure used the majority of the time.

Did You Know
The majority of the time, Mirena is removed using forceps to tug on the strings.

If the strings are not visible, a brush that looks similar to a mascara brush or a bottle brush, can be inserted into the cervical canal and twisted and withdrawn to try to pull the strings into view. If that doesn’t work, an instrument called an IUD hook may be used next to try to find the strings in the cervical canal or uterus and pull them into the vagina. The hook can also be used to attempt to remove the Mirena from the uterus.

It may be necessary to use ultrasound to locate the Mirena.

If the strings are not in place, narrow forceps may be used to reach the Mirena in the uterus. In this case, the doctor may need to dilate the cervical canal. The procedure of looking for the Mirena in this event in the uterus may be painful, and the doctor may administer pain medication to minimize this.

The standard removal procedure also may involve some pain or bleeding.

If Mirena is removed in the middle of the woman’s menstrual cycle, and she has had intercourse within a week before, she is at risk of pregnancy unless a new Mirena is immediately inserted.

If the Mirena is removed after the seventh day of the menstrual cycle, and the patient wants to start using a different form of contraception, it is recommended that the contraception start at least a week before the removal of the Mirena.

Please seek the advice of a medical professional before making health care decisions.

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9 Cited Research Articles

  1. Erian, M., McLaren, G., and Baartz, D. (2011, January-March). The Wandering Mirena: Laparoscopic Retrieval. Retrieved
  2. Mirena. (n.d.). Mirena. Retrieved
  3. Mirena. (n.d.). Mirena Videos. Animated Insertion Video. Retrieved
  4. Mirena. (n.d.) Important Safety Information About Mirena. Retrieved
  5. Mayo Clinic. (n.d.). Mirena (hormonal IUD). Retrieved
  6. Chatel, A. (2015, April 13). Want To Get An IUD But Don’t Know How to Prepare? Here Are 6 Steps To Take Before The Procedure. Retrieved
  7. Women’s Wellness Center. (n.d.). IUD Patient Information. Retrieved
  8. University of Michigan. (n.d.). How to Prepare for Your IUD or Implant Insertion. Retrieved
  9. Milton, S.H., and Isaacs, C. (2015, April 16) Intrauterine Device Extraction Technique. Retrieved
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