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Mirena Insertion

Your health care provider must insert the Mirena intrauterine device (IUD) into your cervix. It's a nonsurgical procedure that takes about five minutes. Short strings on the device extend into the vagina and allow for device removal. Although very rare, Mirena insertion may have complications.

Last Modified: September 5, 2023
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Preparing for Mirena Insertion

Although you can have Mirena inserted at any time, some doctors may recommend scheduling your procedure during the first seven days of your period while the cervix is more open. New moms may have Mirena inserted at least six weeks after giving birth.

Mirena is not likely to affect the quality or amount of your breast milk or your baby’s health. This is because Mirena is designed so that its active hormone, a synthetic form of progesterone, has a limited impact on other areas of the body. Still, according to Mirena, isolated cases of decreased milk production have been reported. Discuss any concerns with your doctor before your insertion procedure.

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

Before your appointment, it’s advised that you eat and take 800 mg of ibuprofen (Advil or Motrin) to ease any cramping from the procedure.

Bring any relevant test results with you that your doctor has requested to review prior to insertion, for example, tests for sexually transmitted diseases. They will also test for pregnancy. Your doctor may recommend you avoid sexual intercourse for two weeks before having Mirena inserted.

What Is Mirena Insertion Like?

On the day of insertion, the doctor will ask you some questions and insert a speculum to open the vagina to look at your cervix. Next, they will gently clean your vagina, uterus and cervix with an antiseptic solution.

Some doctors use a local anesthetic to numb the cervix before inserting Mirena, a thin, plastic tube about 1.25 inches long. The doctor will cut the threads dangling from the device to a length of around 3 centimeters and show you how to check them from time to time.

Mirena Insertion Procedure Illustration

Mirena insertion can be painful for some women, which is why taking pain medication in advance helps. This pain is primarily caused by cramping in the uterus that results from minor irritation during the insertion process. Some women also experience bleeding or dizziness.

Any symptoms should pass within 30 minutes after placement of the Mirena device, but it’s best if you have a family member or friend along to the appointment just in case.

What to Expect After Mirena Insertion

You may experience mild cramping and spotting (light bleeding) for a couple of days. Bleeding after Mirena insertion is relatively common.

Try a hot water bottle or heating pad for lower abdomen pain. In addition, you may take over-the-counter pain medicines such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin) or naproxen (Aleve), which may help you recover after Mirena insertion.

As your body adjusts to Mirena, your period may be irregular for the first three to six months. For some women, bleeding may increase. Call your doctor if your period continues to be heavier than usual.

A 2022 clinical study of 80 participants studied the effects of the Mirena IUD on endometrial thickness and curative effect in patients with perimenopausal abnormal uterine bleeding. The endometrial thickness and menstrual volume scores following three months of treatment were remarkably lower than those before treatment and were considerably lower than those of the control group.

After your body has adjusted to Mirena, your period may be shorter and lighter than before, or it may stop altogether. About 20% of women report no longer having their period one year after insertion.

You can check the string of your IUD by inserting a clean finger into your vagina and feeling for the cervix, which is at the top of your vagina. You should be able to feel the plastic threads coming out of the cervix opening. If you cannot feel them, make an appointment with your doctor.

Common Questions About Mirena Insertion

How long does it take for Mirena to work?

The Mirena IUD is effective immediately if inserted within seven days after the start of your period. If you have Mirena inserted at any other time in your menstrual cycle, it will not be effective for at least seven days.

Will I bleed after Mirena insertion?

Spotting and bleeding are common immediately after Mirena insertion, and irregular bleeding and spotting are typical for the first few months after Mirena is inserted. It should become lighter fairly quickly.

Is cramping common after Mirena insertion?

Uterine cramping is common after Mirena insertion. If over-the-counter pain medications do not relieve your cramping, see your doctor.

When is it safe to have sex after Mirena placement?

When it is safe to have sex after Mirena placement depends on whether you were using hormonal birth control before getting Mirena. It also depends on when Mirena was placed in your menstrual cycle. Ask your doctor if you should be using a backup birth control method.

Mirena IUD Side Effects

Mirena isn’t suitable for every woman. Check with your doctor to see if Mirena is a good birth control option for you. Most side effects are mild to moderate. While serious side effects are rare, some adverse reactions and complications have been reported.

Mirena can cause serious side effects, including:
  • Perforation of the Uterus. The device may go into or through the uterus wall and lead to scarring, infection or internal damage. Excessive pain or bleeding, or an inability to feel the threads, may be a sign of perforation.
  • Device Migration or Expulsion. This occurs rarely and means the device has moved out of the uterus and into the pelvis. You may become pregnant if Mirena comes out. If you can't feel the strings or your partner or you feel the IUD itself, it has migrated.
  • Infection. Pelvic inflammatory disease is a slight risk during the first 20 days after the IUD is inserted.

Contact your doctor if you experience severe abdominal pain or cramping, unusual bleeding, fever or chills, foul-smelling vaginal discharge, painful intercourse or a positive pregnancy test. Some people who have experienced adverse reactions have been advised to schedule Mirena removal with their doctor.

Some women who have experienced serious complications have filed Mirena lawsuits seeking compensation for their injuries and medical expenses.

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