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So you've decided to go with a Mirena IUD—great choice! Whether you are tired of your unexpected menstrual cycles, want effective birth control that you don't have to remember every day, have painful periods or you are dealing with heavy period flow, Mirena just may be the option you're looking for.
That being said, let's face it—no matter how clear the decision is, you're anxious about the experience that's about to occur. Is it going to hurt? How is my body going to react to it?
Well, don't you worry! We've got your back! This article will be your best guide in figuring out the ins and outs of what to expect after Mirena insertion. From what your body may initially do to the changes you can expect over the next months, we are here to walk with you through every step.
The Basics About The Mirena IUD
Mirena IUD (Intrauterine Device) is a soft, flexible plastic T-shaped device that is placed in the uterus for long-term birth control. It is a hormonal IUD that contains a progestogen called levonorgestrel that is released into the endometrium.
It is considered a long acting reversible contraception (LARC), that can provide birth control for up to five years (it is registered to be used up to 8 years in the USA and UK to prevent pregnancy).
But Mirena is good for more than just getting around those two little lines on the pregnancy test. It also releases a hormone called levonorgestrel to thin out the uterine lining and increase the cervical mucus, making it harder for sperm to get through. For many women, this means lighter periods. While for others, it means no periods at all.
Therefore, aside from being a contraceptive, Mirena intrauterine device is prescribed to lessen heavy menstrual bleeding that can be common during perimenopause or PCOS, and is included in the medication regimen for certain disease processes such as endometriosis.
When used for the treatment of heavy menstrual bleeding or as the progestogen component of hormone therapy in perimenopause or menopause it is typically used for 5 years.
Preparing For Your Mirena Insertion
Now, before diving into what to expect after Mirena's insertion, let's quickly run through the prep.
First, you'll have a detailed discussion with your health provider about the procedure, what to expect, and how to prepare for it. Ask every question you have, no matter how silly it sounds. After all, it's about your health.
You should be able to sign a consent form that documents the risks and benefits and potential side effects that you have discussed and that you are happy to undergo the procedure with the information you have been given.
Your insertion may be planned for the last few days of your period as often the cervix is more open, but it can be planned for any day of your cycle.
On the day of the procedure, you will most likely be advised to take an over-the-counter pain reliever, such as ibuprofen, about an hour before having the IUD inserted. This helps to ease potential discomfort if it ever comes to that.
Some providers may also give you medication to soften the cervix and make insertion easier.
If medical procedures can be stressful, it may also be helpful to bring a friend/partner along for support, or bring your earbuds and favourite music to listen to.
It may also be good to have a driver to take you home in case you don't feel up to this afterwards.
What Happens During the Procedure?
During the actual procedure, you will be asked to lie on you back or your side. Your clinician may do a pelvic exam to determine the tilt of your uterus and they may insert topical anaesthetic. They will insert a speculum to gently open your vagina (think of it like getting a Pap smear).
Once the length of your uterus has been measured, the IUD is inserted through your cervix and into your uterus. After this the strings are cut to a length where they can be felt and seen for when your mirena needs to be removed/changed.
The whole procedure takes just minutes, and once you have had a few minutes rest, had a blood pressure check and your clinician is happy with how you are feeling, you are good to go.
What to Expect Immediately After Mirena Insertion
Dizziness
You can experience dizziness shortly after the IUD insertion. This generally occurs as the cervix is a sensitive body part and some women have dizziness as an automatic response when the insertion takes place. It often passes relatively quickly. If you feel that you will faint or the dizziness does not seem to go away, let your healthcare provider know.
Cramping Or Abdominal Discomfort
Most women experience some degree of cramping and even discomfort immediately during and after the insertion, much like period cramps.
They can last a few hours to a few days and are typically manageable with over-the-counter pain relievers such as ibuprofen. A hot water bottle on your lower abdomen can also serve the purpose. But you already know that, right?
Bleeding or Spotting
It's entirely normal to expect a little spotting or light bleeding like a light period right after the procedure.
Ongoing spotting lasts a few days to weeks.
If you have had very heavy and long periods, the spotting can take months to settle. The spotting usually starts tapering after your body acclimates to the device.
Mood Swings
As discussed before, Mirena also releases a hormone called levonorgestrel. So, it's normal for you to feel some emotional ups and downs in the days following your Mirena insertion.
Your body is adjusting to a new hormonal balance, and it sometimes causes mood swings, but as your body adjusts to a consistent level of levonorgestrel, any mood swings should settle.
Aftercare Following Your Mirena Insertion
Cramps
After your insertion, if you feel sore and crampy for the first few days, you can take regular anti-inflammatories to settle down the prostaglandins that contribute to cramps.
Vagina Care
It's important not to put anything in the vagina after an IUD insertion to reduce the risk of introducing infection and to give the cervix and uterus time to heal.
Avoid penetrative sex, tampon use, douching and any other thing that could be inserted in the vagina for 7 days after your mirena insertion.
It is also recommended that you avoid swimming and baths for 7 days after insertion to minimise infection risk.
Exercise
You should avoid strenuous exercise for 48 hours after, while the bleeding is settling.
Follow-up
You may have a 6 week follow-up to check your IUD strings are visible, or you may check your own IUD strings.
Adjusting to Life with a Mirena IUD
Now that we have covered the immediate results of your IUD insertion, let's discuss what happens after Mirena's insertion over the next few weeks to months. This is the adjustment period, during which your body adjusts to its new hormonal set-up and learns how to live with your IUD.
During the first few months, you might find you have some irregular bleeding or spotting. Your periods can be much lighter and more frequent. It's all just part of your body modulating itself in response to the hormones. Some women find that after a year or more, they don't get periods at all, and some find that the periods do happen but are very light.
When it comes to most day-to-day things, you'll be pleased to know that Mirena doesn't interfere with your daily activities. You can still exercise, have sex, use tampons—just generally go about your life without having to worry that your IUD will work its way out or move out of place.
You will likely still experience your regular hormonal menstrual cycle so the mirena is unlikely to reduce premenstrual symptoms. It may seem weird to still have these symptoms monthly without the period that usually accompanies them.
If you use a menstrual cup, make sure to release the suction before removing the cup to avoid disrupting the IUD position/pulling it out.
Potential IUD Complications and How to Handle Them?
While most women have a smooth experience following Mirena insertion, it's always good to know about potential complications. It's not about being paranoid; it's about being prepared.
After the insertion, you can experience mild cramping and discomfort, which is quite common.
You may develop a headache, tender breasts, and mood swings, symptoms that sound much like PMS. These complaints generally subside in a few weeks, by which time your body is expected to adjust to the changed hormonal level.
In rare cases, infection, pelvic inflammatory disease, expulsion of the device, or perforation of the uterine wall can happen. The following should not be ignored:
severe pain,
heavy bleeding or prolonged bleeding,
fever, or
foul-smelling vaginal discharge.
If you experience any of these symptoms you should seek urgent medical help.
Also it is important to note that although pregnancy is uncommon with a correctly inserted mirena IUD, it may be more likely to cause an ectopic pregnancy if you did become pregnant.
Mirena IUD Side Effects
Most women tolerate mirena IUD well, due to the lower hormonal exposure compared to other hormonal birth control methods and it has been a game changer in terms of preventing surgeries for heavy bleeding.
However, some women do not respond well to levonorgestrel, and some women are sensitive to most progestogens.
If women have used an oral contraceptive containing levonorgestrel previously and have had mood disturbance this could be an indication that a mirena IUD could have similar effects.
Low Mood
Low mood or depression seems to affect 6% of women who are sensitive to this type of progestin.
Facial Hair/Hair Loss
Additionally as levonorgestrel has androgenic effects, fewer than 5 percent of women may experience hair loss and/or facial hair growth.
Weight Gain
Less weight gain occurs with mirena IUD compared with progestin injectable contraceptives such as depo injection. The average weight gain after 5 years of use with mirena IUD is 1.5kg compared with 0.9kg gained by women who used copper IUD (Weight Gain Associated With LARC 2020).
Related: Progesterone sensitivity/intolerance
Mirena Removal
Mirena removal is a comparatively simple procedure compared to insertion. It can be done at any time during your cycle, but you may want to plan it for the days following your period or during your period itself.
You might experience some cramping and spotting while your doctor removes Mirena, so you may want to take ibuprofen before the appointment. The strings are located and then the IUD is gently removed in the time it takes for you to give a cough.
And that's it! You're no longer using Mirena as contraception once it's removed! Most women ovulate within 2 months of having their Mirena IUD removed, unless of course you were using it as HRT and are now postmenopausal.
The Bottom Line
So, there you have it—the most comprehensive guide on what to expect after Mirena insertion! Hopefully, it answers all your questions and quells your fears about the next steps. Everyone's body is different, so your Mirena experience will be unique.
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Feel free to contact us for professional advice about your unique concerns and needs.
As a menopause specialist and women's health doctor, Dr Deb Brunt @ Ōtepoti Integrative Health would love to support you at each stage of life, supporting all aspects of your health and wellbeing.
Dr Deb Brunt | Ōtepoti Integrative Health | Book Appointment
References
Hattiangadi, Rohan MD. Weight Gain Associated With LARC Within a Racially Diverse Patient Population [38I]. Obstetrics & Gynecology 135():p 102S, May 2020.
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