Frequently Asked Questions

Mirena is an intrauterine contraceptive that delivers small amounts of hormone directly into the uterus. Made of soft, flexible plastic, it is put in place by your healthcare provider during an office visit. Plus:

• Mirena offers contraception that's over 99% effective; in fact, it is one of the most effective methods of birth control
• Mirena prevents pregnancy for as long as you want, for up to 5 years
• You can try to get pregnant immediately once it's removed by your healthcare provider. A woman's chances of getting pregnant within 12 months of having Mirena removed are approximately 80%

Mirena is safe if you have discussed all of the safety considerations with your healthcare provider and Mirena is used according to the Patient Prescribing Information. Mirena was approved by the FDA for use in the United States in 2001. No birth control is right for everyone and there are certain risks associated with Mirena that you should know about. For detailed information about possible side effects, some potentially serious, please see Safety with Mirena. Talk with your healthcare provider to find out if Mirena is right for you.

Mirena is T-shaped and made of soft, flexible plastic that is placed in the uterus by your healthcare provider during an office visit. It's designed to be small and comfortable, so that you and your partner most likely won't even feel like it's there.

Mirena slowly releases very small amounts of the hormone levonorgestrel directly into your uterus.

There is no single explanation for how Mirena works. Mirena may:

• Thicken cervical mucus to prevent sperm from entering your uterus
• Inhibit sperm from reaching or fertilizing your egg
• Make the lining of your uterus thin

Mirena may stop the release of your egg from your ovary, but this is not the way it works in most cases. Most likely the above actions work together to prevent pregnancy. Like other forms of birth control, Mirena is not 100% effective.

Mirena contains levonorgestrel, a progestin hormone commonly used in birth control pills. The low level of progestin in Mirena is safe and effective. Mirena is the only form of birth control that releases very small doses of progestin over time, directly into your uterus. Mirena does not contain estrogen.

Mirena may attach to or go through the wall of the uterus and cause other problems. If Mirena comes out, use backup birth control and call your healthcare provider.

Mirena is one of the most effective forms of birth control. Once Mirena is properly placed by your healthcare provider, it is over 99% effective and works consistently to prevent pregnancy. So you don't have to think about taking birth control every day, every week or even every year. All you have to do is check the threads once a month. Your healthcare provider will show you how. If you have trouble finding the threads, call your healthcare provider right away. And in the meantime, use a backup form of birth control.

It is important to think about your daily, weekly and monthly routine and how that may affect which birth control method is best for you. The chart below shows the chance of getting pregnant for women who use different methods of birth control. The most effective methods, including intrauterine devices such as Mirena, are found at the top of the chart. If you have any questions about this information, please ask your healthcare provider.

Fewer Pregnancies

Fewer than 1 pregnancy
per 100 women in 1 year

• Implants
• Injections
• Intrauterine devices
• Sterilization

• Birth control pills
• Skin patch
• Vaginal ring with hormones

10-20 pregnancies
per 100 women in 1 year

• Condoms
• Diaphrams

• No sex during the most fertile days of the monthly cycle
• Spermicide
• Withdrawal

85 or more pregnancies
per 100 women in 1 year

• No birth control

More Pregnancies

No birth control is right for everyone and there are certain risks associated with Mirena that you should know about. For detailed information about possible side effects, some potentially serious, please see Safety with Mirena or click on Patient Prescribing Information.

With Mirena, you get effective protection and flexibility. Especially since you can have it removed as soon as you want to try to have another baby. A woman's chances of getting pregnant within 12 months of having Mirena removed are approximately 80%. Any way you look at it, you're in control.

Then Mirena is a good choice because it prevents pregnancy for as long as you want, for up to 5 years. As far as family planning goes, this can be especially appealing if you are undecided whether you want more children. Should you decide you do want to try to get pregnant, Mirena can be removed at any time by your healthcare provider. If at the end of the 5-year period, you're still undecided, you can have another Mirena placed.

In the uncommon event you get pregnant while using Mirena, seek emergency care because pregnancy with an intrauterine device can be life threatening and may result in loss of pregnancy or fertility.

Mirena is recommended for women who have had at least one child. This is because most of the medical research conducted on Mirena for FDA approval was among women who had at least one child. Only you and your healthcare provider can decide if Mirena is right for you. Please see Who should not use Mirena section below.

Whatever stage of reproductive life you're in, Mirena offers a flexible option if you:

• Had a baby and want to explore your birth control options
• Want to have more children
• Are unsure if you want more children
• Are happy with your family size the way it is
• Want birth control you don't have to think about taking every day

Answer these questions and bring them with you to your healthcare provider.

Only you and your healthcare provider can decide if Mirena is right for you. As the two of you discuss your options, there are a number of things you should share—like your general health, current or past health conditions, sexual history and the possibility that you'd like to have more children in the future. Mirena is not appropriate for women who:

• Are pregnant or might be pregnant
• Have had a serious pelvic infection called pelvic inflammatory disease (PID) unless they have since had a normal pregnancy
• Currently have an untreated pelvic infection
• Have had a serious pelvic infection in the past 3 months after a pregnancy
• Can get infections easily. For example, if they have
• More than one sexual partner or their partner has more than one partner
• Problems with their immune system
• Intravenous drug abuse
• Have or suspect they might have cancer of the uterus or cervix
• Have bleeding from the vagina that has not been explained
• Have liver disease or a liver tumor
• Have breast cancer now or in the past, or suspect they have breast cancer
• Have an intrauterine device in the uterus already
• Have a condition that changes the shape of the uterus, such as large fibroids
• Are allergic to levonorgestrel, silicone or polyethylene

You should share any current or past health conditions that you have with your healthcare provider to help you both decide if Mirena may be right for you. Your healthcare provider needs to know if you:

• Recently had a baby or if you are breastfeeding
• Have ever had pelvic inflammatory disease (PID)
• Have ever had an ectopic pregnancy
• Have diabetes (high blood sugar)
• Have heart disease or a congenital heart condition
• Have problems with blood clotting or have taken medicine to reduce clotting
• Have high blood pressure

For a more complete list of considerations to discuss with your healthcare provider click here.

You and your healthcare provider can determine if Mirena is the right birth control option for you. Want help keeping life simple? Just follow these steps:

• Know your choices. View a helpful chart about your birth control options, including Mirena intrauterine contraceptive
• Ask the right questions. Print a questionnaire of important considerations to discuss with your healthcare provider
• Talk to your healthcare provider. Find out if Mirena is right for you. If your healthcare provider is trained in placing Mirena, he or she can generally place it during an office visit

To speak to a specialist who will help answer your questions about Mirena, call 1-888-84-BAYER (1-888-842-2937).

Mirena may be covered by your health insurance. To find out, call your insurance provider, talk with your company's human resources manager or check your employee handbook.

When calling your insurance provider to confirm that Mirena is covered by your health plan, be sure to provide them with the Healthcare Common Procedure Coding System (HCPCS) code (often called "the J code") for Mirena, which is J7302, and the Current Procedural Terminology (CPT) code for having Mirena placed, which is 58300.

To learn more, visit our healthcare plan coverage section for more information about what financing options are available if Mirena is not covered by your health plan.

To many, affordable birth control is important. Compared with the cost of using some other birth control methods, Mirena essentially pays for itself after just 1 or 2 years. Over time, you could save hundreds of dollars or more on the cost of refills and co-pays, with the help of your health plan.

To learn more, visit our healthcare plan coverage section.

Mirena should be placed within 7 days of the start of your period. When properly placed, Mirena prevents pregnancy for as long as you want, for up to 5 years.

Your healthcare provider will place Mirena into your uterus during an office visit. You may feel some discomfort during the procedure. Placement typically takes only a few minutes. He or she will:

• Apply an antiseptic solution to your vagina and cervix
• Pass a thin tube of flexible plastic (the inserter) containing Mirena into your vagina and then into your uterus
• Check to make sure Mirena is positioned correctly
• Withdraw the plastic inserter, leaving Mirena in your uterus
• Ensure that the two threads attached to the stem of Mirena properly extend through the cervix, which help ensure that Mirena is properly placed. This will also help with the removal of Mirena by your healthcare provider when that time comes
• Trim the threads to the appropriate length

Once Mirena is properly placed, all you have to do is check the threads once a month. Your healthcare provider can show you how. If you have trouble finding the threads, call your healthcare provider right away. And in the meantime, be sure to use a backup form of birth control.

If you think you may be pregnant and are considering Mirena, please tell your healthcare provider. Pregnant women should not use Mirena.

Some women may experience some discomfort while Mirena is being placed. Side effects may include cramping or pain, bleeding and/or dizziness. This is common. Let your healthcare provider know if the cramping is severe.

Your healthcare provider can generally place or remove Mirena during an office visit. He or she will check for proper placement, because if not properly placed, removal can be difficult.

Some women may experience cramping or pain, bleeding, and/or dizziness during and right after Mirena is placed. Tell your healthcare provider if your cramps are severe. To help minimize the cramps, ask your healthcare provider about medications that may be used before placement. If these symptoms last for more than 30 minutes, let your healthcare provider know. Mirena may not have been properly placed and your healthcare provider should examine you.

Do not use Mirena if you have a vaginal or pelvic infection, get infections easily or have certain cancers. If you do have a vaginal or pelvic infection, seek treatment from your healthcare provider. Once treated, speak with your healthcare provider to see if Mirena is right for you.

For the first 3 to 6 months, your monthly period may become irregular. You may also have frequent spotting or light bleeding. A few women have heavy bleeding during this time. Call your healthcare provider if the bleeding remains heavier than usual. After your body adjusts, the number of bleeding days is likely to decrease, but may remain irregular, and you may even find that your periods stop altogether for as long as Mirena is in place.

Around the end of the third month of use, you may see up to a 75% reduction in the amount of menstrual bleeding.¹ Call your healthcare provider if the bleeding becomes heavy after it has been light for a while.

By one year, about 1 out of 5 users may have no period at all. Your periods will return once Mirena is removed. If, after the start of your last period, you go 6 weeks without another period, contact your healthcare provider to rule out pregnancy.

As a follow-up, you should visit your healthcare provider once in the first 4 to 12 weeks after Mirena is placed to make sure it is in the right position. After that, Mirena can be checked once a year as part of your routine exam.

Once Mirena is placed, you should check the threads once a month to make sure it is still positioned correctly. Your healthcare provider can show you how. If you have trouble finding the threads, call your healthcare provider. And in the meantime, be sure to use a backup form of birth control.

No. Mirena does not protect against HIV or STDs. So, if while using Mirena you think you or your partner might be at risk of getting an STD, use a condom and call your healthcare provider.

Ovarian cysts may occur and usually disappear. Bleeding and spotting may increase in the first few months and continue to be irregular. Periods over time may become shorter, lighter or even stop.

Mirena should not be placed earlier than 6 weeks after you give birth or as directed by your healthcare provider. When you ask your healthcare provider about Mirena, be sure to tell him or her if you are breastfeeding and plan to continue breastfeeding after getting Mirena placed.

Mirena prevents pregnancy for as long as you want, for up to 5 years. When you decide you want to try to have another child, Mirena can be removed by your healthcare provider at any time. It typically takes just a few minutes during an office visit. After that, you can begin trying to get pregnant right away. A woman's chances of getting pregnant within 12 months of having Mirena removed are approximately 80%.

Mirena must be removed after 5 years. If you want to continue using Mirena after those 5 years, you can choose to have another one placed. Talk with your healthcare provider about replacing your Mirena before your scheduled appointment to have your current Mirena removed. He or she can then place your new Mirena during the same office visit.

In the uncommon event you get pregnant while using Mirena, seek emergency care because pregnancy with an intrauterine device can be life threatening and may result in loss of pregnancy or fertility.

Mirena is one of the most effective forms of birth control. Because Mirena can be removed, you're free to keep your family planning options open. Among women who have decided they want to try to become pregnant again, 80% became pregnant within 12 months of having Mirena removed.

When exploring your birth control options, you should also consider reversibility, and how important that might be to you. Some methods, such as getting your tubes tied or your partner getting a vasectomy, should be considered permanent.

No birth control is right for everyone and there are certain risks associated with Mirena that you should know about. For detailed information about possible side effects, some potentially serious, please see Important Patient Information.

Yes. However, if you use tampons you should change them with care so as not to pull the threads of Mirena when removing the tampon.

The reason many women may have lighter periods or stop having periods altogether with Mirena centers on the uterine lining.

Typically, this is how your period works:

• Every month, the lining of the uterus thickens during the first half of your menstrual cycle
• The lining is shed as menstrual flow
• On average, a woman's menstrual flow lasts 3 to 4 days. It may be shorter or longer, depending on the woman

Once Mirena is placed:

• The levonorgestrel in Mirena reduces the monthly thickening of the lining of your uterus
• Less thickening means less menstrual flow
• Eventually your menstrual flow may stop completely
• Once Mirena is removed, your menstrual cycle will come back

If you have not gotten your period or have other symptoms of pregnancy during the first 6 weeks of use, contact your healthcare provider to rule out pregnancy.

Mirena may be associated with uncommon but serious side effects:

• Pelvic inflammatory disease (PID). Use of Mirena and other IUDs has been associated with an increased risk of PID. The percentage of women who develop PID while using Mirena is less than 1%. The risk is highest shortly after placement—especially within the first 20 days—and if you have a vaginal infection at the time of placement. After the first 20 days, the risk of PID is reduced.

• PID is an infection of the uterus and other organs of the upper reproductive system. It is caused by bacterial infections that are usually sexually transmitted, such as gonorrhea or chlamydia, that travel beyond the vagina and cervix into the uterus and other organs in the reproductive system. The risk of PID is greater if you or your partner have sex with multiple partners. If not treated quickly and appropriately, PID can lead to serious problems, including infertility, ectopic pregnancy or constant pelvic pain. Serious cases of PID may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.²

• Before placement of Mirena, be sure to tell your healthcare provider if you have signs of a vaginal infection or PID. Signs of PID include long-lasting or heavy bleeding, unusual vaginal discharge, abdominal or pelvic pain or tenderness, or painful sex, chills or fever.

• After placement, contact your healthcare provider if any of these symptoms listed above occur and persist.

• A rare life-threatening infection called sepsis may occur within the first few days after Mirena is placed. As of September 2006, 9 sepsis cases out of an estimated 9.9 million Mirena users had been reported. Call your healthcare provider immediately if you experience severe pain or unexplained fever after Mirena is placed.

• Embedment is when Mirena attaches to the uterine wall. If embedment occurs, Mirena may no longer prevent pregnancy and you may need surgery to have it removed.

• Perforation. Mirena may go through (perforate) the uterine wall. If your uterus is perforated, Mirena may no longer prevent pregnancy. It may move outside the uterus and can cause scarring, infection or damage to other organs. Surgery may be needed to have Mirena removed.

Possible side effects of Mirena may include:

• Discomfort during placement. Dizziness, bleeding or cramping may occur during placement. This is common. Let your healthcare provider know if the cramping is severe or if the symptoms don't stop 30 minutes after placement.

• Expulsion. Mirena may come out by itself and no longer prevent pregnancy. Symptoms of partial or complete expulsion may include bleeding, pain and an increase in menstrual flow. If this occurs, Mirena may be replaced within 7 days of a menstrual period after pregnancy has been ruled out. If you notice Mirena has come out, use a backup form of birth control like condoms and call your healthcare provider.

More than 10% of Mirena users may experience:

• Missed menstrual periods. About 2 out of 10 women stop having periods after 1 year of Mirena use. Your periods come back when Mirena is removed. If you do not have a period for 6 weeks during Mirena use, contact your healthcare provider to rule out pregnancy.

• Changes in bleeding. Your period may become irregular and you may have bleeding and spotting between menstrual periods, especially during the first 3 to 6 months. A few women have heavy bleeding during this time. After your body adjusts, periods usually get lighter and the number of bleeding days is likely to decrease, but may remain irregular. Or you may even find that your periods stop altogether—in which case, you should contact your healthcare provider to rule out pregnancy.

• Call your healthcare provider if the bleeding remains heavier than usual or if the bleeding becomes heavy after it has been light for a while.

• Pelvic and/or abdominal pain may occur. Talk to your healthcare provider if the pain is persistent.

• Cyst on the ovary. These cysts may develop as long Mirena is in place. They are generally harmless and usually disappear in a month or two. However, cysts can cause pain and may sometimes require surgery.

Between 5% and 10% of Mirena users may experience:

• Headache/Migraine
• Acne
• Depressed mood
• Heavy or prolonged menstrual bleeding

Less than 5% of Mirena users may experience:

• Vaginal discharge
• Breast pain or tenderness
• Nausea
• Nervousness
• Inflammation of cervix, vulva or vagina
• Pelvic pain during your period
• Back pain
• Weight increase
• Decreased sex drive
• High blood pressure
• Pain during intercourse
• Anemia
• Unusual hair growth or loss
• Skin irritations (such as hives, rash, eczema or itching)
• Feeling bloated
• Swelling of hands and feet
• Expulsion

Every individual responds differently to medication, so talk to your healthcare provider about your individual risk factors and to see if Mirena is right for you.

Use of Mirena and other IUDs has been associated with an increased risk of pelvic inflammatory disease (PID). The percentage of women who develop PID while using Mirena is less than 1%. The risk is highest shortly after placement—especially within the first 20 days—and if you have a vaginal infection at the time of placement. After the first 20 days, the risk of PID is reduced.

PID is an infection of the uterus and other organs of the upper reproductive system. It is caused by bacterial infections that are usually sexually transmitted, such as gonorrhea or chlamydia, that travel beyond the vagina and cervix into the uterus and other organs in the reproductive system. The risk of PID is greater if you or your partner have sex with multiple partners. If not treated quickly and appropriately, PID can lead to serious problems, including infertility, ectopic pregnancy or constant pelvic pain. Serious cases of PID may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.²

Before placement of Mirena, be sure to tell your healthcare provider if you have signs of a vaginal infection or PID. Signs of PID include long-lasting or heavy bleeding, unusual vaginal discharge, abdominal or pelvic pain or tenderness, or painful sex, chills or fever.

After placement, contact your healthcare provider if any of these symptoms listed above occur and persist.

Unfortunately, no birth control method, including Mirena or even getting your tubes tied, is 100% perfect. If you do get pregnant while using a birth control method, there can be risks to you and your baby.

Less than 8 in 1,000 women become pregnant over the course of the five years using Mirena. One risk of getting pregnant using Mirena is called ectopic pregnancy, when the pregnancy is not in the uterus. It may occur in the fallopian tubes. Signs of ectopic pregnancy may include unusual bleeding or abdominal pain. Ectopic pregnancy is an emergency that requires immediate medical attention and often surgery. Ectopic pregnancy can cause internal bleeding, infertility and even death. Call your healthcare provider right away if you think that you're pregnant.

There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. Severe infection, miscarriage, premature delivery and even death can occur with pregnancies that continue with an intrauterine device (IUD). Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage. If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy.

For more information about birth control options, visit:

American Academy of Family Physicians
www.familydoctor.org

National Women's Health Information Center
www.womenshealth.gov

National Women's Health Resource Center
www.healthywomen.org

ReproLine: Reproductive Health Online
www.reproline.jhu.edu/index.htm

For more information about Mirena, continue to explore our website or call 1-888-84-BAYER.