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Mirena Insertion

Like other intrauterine devices (IUDs), women must go to a doctor to have Mirena inserted. The procedure takes about five minutes and is non-surgical. Most of the time, women don’t have any problems after insertion. But, sometimes Mirena IUD insertion can have complications. These include perforation of the uterus, nausea, bleeding or cramping.

Last Modified: April 27, 2022
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For some women, the Mirena intrauterine device (IUD) is an effective, long-term option for birth control. IUD insertion takes a few minutes in a doctor’s office.

Because the procedure is not surgical, it doesn’t require anesthesia or incisions. After IUD insertion, women can continue daily activities. But, in some instances, complications can occur during Mirena insertion or shortly after.

For some women, the Mirena insertion is painful. Others report a sensation similar to mild menstrual cramping. Women also may feel dizzy or nauseous.

Some complications, such as uterine perforation, led women to file Mirena lawsuits against Bayer.

What to Expect Before Mirena IUD Insertion

Menstrual Calendar
It's best to have Mirena inserted during the first seven days of your period.

Before scheduling Mirena IUD insertion, women should know their menstrual cycles. Bayer recommends women have Mirena inserted during the first seven days of a menstrual cycle.

Before inserting the IUD, the doctor will also check for sexually transmitted diseases (STDs), infection and pregnancy. If any of these tests are positive, a woman cannot get an IUD. The doctor may recommend women avoid intercourse for two weeks before the insertion appointment.

Mirena, New Moms and Breastfeeding

New moms may receive Mirena at least six weeks after giving birth. Breastfeeding women should know that Mirena is unlikely to affect breastfeeding performance, but “isolated post-marketing cases of decreased milk production have been reported,” according to the Mirena insert.

Small amounts of progestins pass into the breast milk of nursing mothers. This has resulted in detectable steroid levels in infant plasma, the insert says.

What Is Mirena Insertion Like?

The entire Mirena insertion procedure takes less than five minutes, according to Planned Parenthood.

“Each step happens in rapid succession, so it’s all done within a couple of minutes.”

On the day of the appointment, the doctor or nurse will ask a few questions before inserting the IUD. He or she will also check the vagina, uterus and cervix.

The doctor 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.

During Mirena placement, some doctors will use a local anesthetic to help numb the cervix. Then, the IUD enters the opening of the cervix and goes into the uterus in a thin, plastic tube.

Mirena Insertion Procedure Illustration

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.

Is Mirena Insertion Painful?

Mirena insertion is painful for some women. The pain usually goes away in minutes. Taking pain medication — either ibuprofen or acetaminophen — 30 minutes before the appointment may help manage pain during the procedure.

What to Expect After Mirena Insertion

The patient should plan to rest in the doctor’s office for about 15 minutes following the procedure. There may be temporary cramping and backaches after insertion.

Some women feel dizzy and may even faint after. A family member or friend should come along to the appointment just in case.

The patient shouldn’t insert anything into her vagina for 24 hours after the procedure. This includes tampon use, douching or sexual intercourse.

Women should 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.

How Long Does It Take for Mirena to Work?

Mirena works seven days after insertion, according to an article in Time magazine. Until then, women should use another form of birth control or not have sex.

Bleeding After Mirena Insertion

Patients may experience sporadic, light bleeding for up to three months after insertion.
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 Cramping After Insertion

Some women say they felt cramping after Mirena insertion. They described it as similar to mild menstrual cramping.

A hot water bottle or a heating pad may help with cramping. Women can take over-the-counter medicine for pain.

IUD Insertion Side Effects

The majority of women don’t have serious problems with Mirena insertion. Major Mirena side effects usually occur after the device is already in the body for a while.

Uterine perforation, infection and device migration are the most serious Mirena insertion side effects.

Perforation of the Uterus

Uterine perforation happens when the IUD or the equipment used to insert Mirena makes a hole in the uterus. Sometimes women or their doctors might not notice this until later.

The risk of perforation increases if a patient is breastfeeding when she receives Mirena. This happens up to 2.6 times per 1,000 insertions, according to a study in the American Family Physician.

If this occurs, a doctor must remove Mirena. Sometimes, this requires surgery.

Symptoms of perforation include abdominal pain and uterine bleeding.

Device Migration

Device migration occurs if Mirena moves from its place in the uterus. If a patient thinks her Mirena is no longer in place, she should call her doctor immediately.

Signs of a displaced device include:
  • Pain during sex
  • Missing Mirena strings or strings feel longer
  • Normal periods come back
  • Feeling the device in the cervix or the vagina


If bacteria cling to the IUD and enter the uterus during insertion, it can cause an infection. This is more likely to happen if a woman has an STD when she gets Mirena. Symptoms may develop within a few days.

See a doctor or seek urgent care with the following symptoms:

  • A fever higher than 100.4 degrees or chills
  • Discharge with a bad odor
  • Lesions or sores
  • Very heavy bleeding
  • Feeling faint
  • Very severe headaches
  • Yellowing skin or eyes
  • Exposure to a sexually transmitted infection
  • New abdominal pain or tenderness that gets more intense and can’t be relieved with over-the-counter medicine

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