06.09.2014

Getting pregnant using mirena

If you have a pelvic infection, get infections easily or have certain cancers, don’t use Mirena.
Mirena is an intrauterine device (IUD) that prevents pregnancy and lasts for as long as you want, for up to 5 years. Mirena may be right for you if you’re looking for reversible birth control you can count on for up to 5 years. If you and your doctor decide that Mirena is the right birth control for you, review your health insurance plan and make an appointment to have it placed. Follow these easy steps when calling your health insurance provider to find out if Mirena is covered.
After Mirena is placed, your body may experience some changes that you should pay attention to and discuss with your healthcare provider.
Find answers to frequently asked questions about Mirena, such as, how Mirena works, who Mirena is right for, how to get Mirena, and what to expect after Mirena placement. Choose a topic below to learn more about Mirena, but always remember that your healthcare provider is your best resource for any and all questions regarding Mirena and birth control in general. Mirena (levonorgestrel-releasing intrauterine system) is an intrauterine device (also known as an IUD) that releases small amounts of the hormone levonorgestrel locally into your uterus. Mirena (levonorgestrel-releasing intrauterine system) was approved by the FDA for use in the United States in 2000 for intrauterine contraception and in 2009 to treat heavy periods for women who choose intrauterine contraception. Mirena (levonorgestrel-releasing intrauterine system) is made of soft, flexible plastic and contains the hormone levonorgestrel. While there’s no single explanation for how Mirena works, most likely the above actions work together to prevent pregnancy for up to 5 years.
Mirena (levonorgestrel-releasing intrauterine system) contains a progestin hormone called levonorgestrel that is often used in birth control pills. Mirena (levonorgestrel-releasing intrauterine system) may attach to or go through the wall of the uterus and cause other problems.
Mirena (levonorgestrel-releasing intrauterine system) is one of the most effective forms of birth control. No birth control is right for everyone and there are risks associated with Mirena that you should know about.
With Mirena (levonorgestrel-releasing intrauterine system), you get effective contraception for up to 5 years and flexibility because you can have it removed by your healthcare provider whenever you want to try to have another child. Then Mirena (levonorgestrel-releasing intrauterine system) may be a good choice because it prevents pregnancy for as long as you want, for up to 5 years. There are also risks if you become pregnant while using Mirena and the pregnancy is in the uterus. Mirena (levonorgestrel-releasing intrauterine system) is a hormone-releasing IUD (intrauterine device) placed in your uterus to prevent pregnancy for as long as you want for up to 5 years. Start a conversation with your healthcare provider to find out if Mirena may be right for you. Only you and your healthcare provider can decide if Mirena (levonorgestrel-releasing intrauterine system) is right for you. You should share any current or past health conditions that you have with your healthcare provider to help you both decide if Mirena (levonorgestrel-releasing intrauterine system) may be right for you.
Have a conversation with your healthcare provider to understand if Mirena (levonorgestrel-releasing intrauterine system) is a good option for you.
Check with your health insurance to see if you can get Mirena (levonorgestrel-releasing intrauterine system) at no cost, including product cost and your placement and removal appointments. Go to Insurance Coverage for more information about changes to healthcare and a list of insurance providers that may cover the cost of Mirena, including product cost and your placement and removal appointments. If you are having trouble getting Mirena at no cost, visit CoverHer.org or call the National Women’s Law Center at 1-866-745-5487. Depending on your birth control needs and the help of your health plan, you may find that Mirena may be an affordable option for you. Mirena is one of the most effective forms of birth control that lasts as long as you want, for up to 5 years. Mirena (levonorgestrel-releasing intrauterine system) should be placed within 7 days of the start of your period. Your healthcare provider will place Mirena (levonorgestrel-releasing intrauterine system) into your uterus during an office visit. If you think you may be pregnant and are considering Mirena, please tell your healthcare provider. Some women may experience some discomfort while Mirena (levonorgestrel-releasing intrauterine system) is being placed. Your healthcare provider can generally place or remove Mirena (levonorgestrel-releasing intrauterine system) during an office visit.
Don’t use Mirena (levonorgestrel-releasing intrauterine system) if you have a vaginal or pelvic infection or get infections easily. Mirena (levonorgestrel-releasing intrauterine system) should not be placed earlier than 6 weeks after you give birth or as directed by your healthcare provider. As a follow-up, you should visit your healthcare provider once in the first 4 to 6 weeks after Mirena (levonorgestrel-releasing intrauterine system) is placed to make sure it is in the right position.
Once Mirena (levonorgestrel-releasing intrauterine system) is placed, you should do a self-check of the threads* once a month to make sure it is still positioned correctly. About 12 out of 100 women using Mirena (levonorgestrel-releasing intrauterine system) develop a cyst on the ovary, sometimes known as an enlarged follicle. When you decide you want to try to have another child, Mirena (levonorgestrel-releasing intrauterine system) can be removed by your healthcare provider at any time.
The reason many women may have lighter periods or stop having periods altogether with Mirena (levonorgestrel-releasing intrauterine system) is related to the uterine lining. If you have not gotten your period or have other symptoms of pregnancy during the first 6 weeks of Mirena use, contact your healthcare provider to rule out pregnancy. 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.
You and your partner shouldn’t feel Mirena (levonorgestrel-releasing intrauterine system) during intercourse, because Mirena is placed in the uterus, not the vagina. Mirena (levonorgestrel-releasing intrauterine system) is a hormone-releasing system placed in your uterus to prevent pregnancy for as long as you want for up to 5 years.
Don't use Mirena if you have a pelvic infection, get infections easily or have certain cancers. Although uncommon, pregnancy while using Mirena can be life threatening and may result in loss of pregnancy or fertility. Skyla (levonorgestrel-releasing intrauterine system) is a hormone-releasing IUD that prevents pregnancy for up to 3 years. Pregnancy while using Skyla is uncommon but can be life threatening and may result in loss of pregnancy or fertility. Essure® is permanent birth control that works with your body to create a natural barrier against pregnancy. Essure is not right for you if you are uncertain about ending your fertility, can have only one insert placed, suspect you are pregnant or have been pregnant within the past 6 weeks, have had your tubes tied, have an active or recent pelvic infection, or have a known allergy to contrast dye. BAYER, the Bayer Cross and Mirena, Skyla, Mirena and Essure are registered trademarks of Bayer.
Many women around the world are attempting to prevent pregnancy and therefore rely on some sort of contraceptive or birth control.
Mirena is a small device that is placed into the uterus that releases levonorgestrel slowly into the blood stream in order to prevent pregnancy for between three and five years.
Although there are women who have issues getting pregnant and may experience some side effects from using Mirena, it is safe to use. Many women take some sort of contraceptive in order to avoid pregnancy and many have been taking one for many years. Mirena is no different from any other type of birth control and you should follow the general guidelines for becoming pregnant. However, most of these women become pregnant within the first year with 90% of couples conceiving within 18 months.
You doctor will need to make sure that everything is fine and may decide to prescribe a medication to help you increase your chances of becoming pregnant.
Some women have experienced difficulties in becoming pregnant after they have had Mirena removed.
Having a miscarriage is a stressful experience whether you were trying to become pregnant or not. If pregnancy should occur with Mirena in place, remove Mirena because leaving it in place may increase the risk of spontaneous abortion and preterm labor. For the proper insertion and removal instructions, choose which MirenaA® product you are using.
Mirena is also indicated for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. Mirena must be removed by the end of the fifth year and can be replaced at the time of removal with a new Mirena if continued contraceptive protection is desired.
Mirena is supplied within an inserter in a sterile package (see Figure 1Figure 1) that must not be opened until required for insertion [see Description (11.2)]. Follow the insertion instructions exactly as described in order to ensure proper placement and avoid premature release of Mirena from the inserter.
Insert Mirena into the uterine cavity during the first seven days of the menstrual cycle or immediately after a first trimester abortion. Exclude pregnancy and confirm that there are no other contraindications to the use of Mirena.
Proceed with insertion only after completing the above steps and ascertaining that the patient is appropriate for Mirena.
Using sterile gloves lift the handle of the sterile inserter and remove from the sterile package. Push the slider forward as far as possible in the direction of the arrow thereby moving the insertion tube over the Mirena T-body to load Mirena into the insertion tube (Figure 2Figure 2).
While holding the inserter steady, move the slider down to the mark to release the arms of Mirena (Figure 5Figure 5). Holding the entire inserter firmly in place, release Mirena by moving the slider all the way down (Figure 7Figure 7).
Using a sharp, curved scissor, cut the threads perpendicular, leaving about 3 cm visible outside of the cervix [cutting threads at an angle may leave sharp ends (Figure 8Figure 8)]. If you suspect that Mirena is not in the correct position, check placement (for example, using transvaginal ultrasound).
If pregnancy is not desired, the removal should be carried out during menstruation, provided the woman is still experiencing regular menses. If the threads are not visible, determine location of Mirena by ultrasound [see Warnings and Precautions (5.10)]. If Mirena is found to be in the uterine cavity on ultrasound exam, it may be removed using a narrow forceps, such as an alligator forceps. If pregnancy is not desired and if a woman wishes to continue using Mirena, a new system can be inserted immediately after removal any time during the cycle. Mirena is a LNG-releasing IUS consisting of a T-shaped polyethylene frame with a steroid reservoir containing a total of 52 mg LNG.
Evaluate women for ectopic pregnancy if they become pregnant with Mirena in place because the likelihood of a pregnancy being ectopic is increased with Mirena.


The incidence of ectopic pregnancy in clinical trials with Mirena, which excluded women with a history of ectopic pregnancy, was approximately 0.1% per year. If pregnancy occurs while using Mirena, remove Mirena because leaving it in place may increase the risk of spontaneous abortion and preterm labor. In patients becoming pregnant with an IUD in place, septic abortion - with septicemia, septic shock, and death - may occur.
If a woman becomes pregnant with Mirena in place and if Mirena cannot be removed or the woman chooses not to have it removed, warn her that failure to remove Mirena increases the risk of miscarriage, sepsis, premature labor and premature delivery.
When pregnancy continues with Mirena in place, long-term effects on the offspring are unknown.
Severe infection or sepsis, including Group A streptococcal sepsis (GAS), have been reported following insertion of Mirena. Mirena is contraindicated in the presence of known or suspected PID or in women with a history of PID unless there has been a subsequent intrauterine pregnancy [see Contraindications (4)]. PID is often associated with a sexually transmitted infection, and Mirena does not protect against sexually transmitted infection. Mirena can alter the bleeding pattern and result in spotting, irregular bleeding, heavy bleeding, oligomenorrhea and amenorrhea.
Partial or complete expulsion of Mirena may occur resulting in the loss of contraceptive protection. Delay Mirena insertion a minimum of six weeks or until uterine involution is complete following a delivery or a second trimester abortion.
Because the contraceptive effect of Mirena is mainly due to its local effects within the uterus, ovulatory cycles with follicular rupture usually occur in women of fertile age using Mirena. Spontaneous reports of breast cancer have been received during postmarketing experience with Mirena. The data provided reflect the experience with the use of Mirena in the adequate and well-controlled studies as well as in the supportive and uncontrolled studies for contraception and heavy menstrual bleeding (n=5,091). Consult the labeling of all concurrently used drugs to obtain further information about interactions with Mirena or the potential for enzyme alterations. Mirena has not been studied in women over age 65 and is not approved for use in this population.
No studies were conducted to evaluate the effect of hepatic disease on the disposition of LNG released from Mirena [see Contraindications (4)]. No studies were conducted to evaluate the effect of renal disease on the disposition of LNG released from Mirena.
Mirena consists of a T-shaped polyethylene frame (T-body) with a steroid reservoir (hormone elastomer core) around the vertical stem. The components of Mirena, including its packaging, are not manufactured using natural rubber latex.
The local mechanism by which continuously released LNG enhances contraceptive effectiveness of Mirena has not been conclusively demonstrated.
Low doses of LNG are administered into the uterine cavity with the Mirena intrauterine delivery system. Pediatric: Safety and efficacy of Mirena have been established in women of reproductive age.
Geriatric: Mirena has not been studied in women over age 65 and is not currently approved for use in this population. Hepatic Impairment: No studies were conducted to evaluate the effect of hepatic disease on the disposition of Mirena. Renal Impairment: No formal studies were conducted to evaluate the effect of renal disease on the disposition of Mirena. Mirena has been studied for safety and efficacy in two large clinical trials in Finland and Sweden.
About 80% of women wishing to become pregnant conceived within 12 months after removal of Mirena. The efficacy of Mirena in the treatment of heavy menstrual bleeding was studied in a randomized, open-label, active-control, parallel-group trial comparing Mirena (n=79) to an approved therapy, medroxyprogesterone acetate (MPA) (n=81), over 6 cycles. Mirena (levonorgestrel-releasing intrauterine system), containing a total of 52 mg LNG, is available in a carton of one sterile unit NDC# 50419-423-01.
Inform the patient about the possibility of pelvic inflammatory disease (PID) and that PID can cause tubal damage leading to ectopic pregnancy or infertility, or infrequently can necessitate hysterectomy, or cause death.
Counsel the patient on how she can check that the threads still protrude from the cervix and caution her not to pull on the threads and displace Mirena. Mirena does not protect against HIV infection (AIDS) and other sexually transmitted infections (STIs). Mirena is a hormone-releasing system placed in your uterus by your healthcare provider to prevent pregnancy for up to 5 years.
Mirena can also lessen menstrual blood loss in women who have heavy menstrual flow and who also want to use a birth control method that is placed in the uterus to prevent pregnancy.
Mirena is a small flexible plastic T-shaped system that slowly releases a progestin hormone called levonorgestrel that is often used in birth control pills.
Mirena is intended for long-term use but you can stop using Mirena at any time by asking your healthcare provider to remove it.
Mirena may work in several ways including thickening cervical mucus, inhibiting sperm movement, reducing sperm survival, and thinning the lining of your uterus.
The following chart shows the chance of getting pregnant for women who use different methods of birth control. In the clinical trial performed in women with heavy menstrual bleeding and treated with Mirena, almost 9 out of 10 were treated successfully and their blood loss was reduced by more than half. There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus. It is not known if Mirena can cause long-term effects on the fetus if it stays in place during a pregnancy. You may use Mirena when you are breastfeeding if more than six weeks have passed since you had your baby. Made of soft, flexible plastic, Mirena is placed by your healthcare provider during an office visit. Discuss all safety considerations with your healthcare provider and use Mirena according to the Prescribing Information.
Because Mirena releases levonorgestrel into your uterus, only small amounts of the hormone enter your blood. Unfortunately, no birth control method, including Mirena or tubal ligation (getting tubes tied), is 100% perfect. The chart below shows the chance of becoming pregnant for women who use different methods of birth control.
For detailed information about possible side effects, some potentially serious, please see Mirena Safety Considerations and the Patient Information.
However, over the course of 5 years, fewer than 8 in 1,000 women become pregnant while using Mirena. Severe infection, miscarriage, premature delivery and even death can occur with pregnancies that continue with an intrauterine device (IUD).
Mirena (levonorgestrel-releasing intrauterine system) does not protect against HIV or STDs. This is because most of the medical research conducted on Mirena for FDA approval was among women who had at least one child.
If it is, then Mirena can usually be placed in your healthcare provider’s office at your next visit.
If your health insurance provider does not cover the cost of Mirena, you may be able to get Mirena by using a Health Savings Account (HSA) or by contacting your Specialty Pharmacy. For detailed information about possible side effects, some potentially serious, please see Mirena Patient Information. Once placed by your healthcare provider, Mirena prevents pregnancy for as long as you want, for up to 5 years. 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 as there is an increased risk of perforation in women who are breastfeeding. These threads are the only part of Mirena you should be able to feel when Mirena is positioned correctly. If you want to continue using Mirena after those 5 years, you can choose to have another one placed. However, if you use tampons you should change them with care so as not to pull the threads of Mirena (levonorgestrel-releasing intrauterine system) when removing the tampon. Call your healthcare provider immediately if you experience severe pain or unexplained fever shortly after Mirena is placed. Most women never experience any issues in relation to using Mirena and are able to become pregnant quickly after it is removed.
Mirena is an option that gives these women long lasting results with little hassles when it comes maintaining it. Remember that even women who have never taken any form of birth control have only a one in four chance of becoming pregnant each month. You should also check into the natural things that you can do to increase your chances of becoming pregnant naturally.
However, if you do decide that you are ready to become pregnant, you can have it removed and begin trying immediately. However, it is difficult to say whether this is from the device itself or simply that they are one of the unfortunate women who have difficulties becoming pregnant.
Mirena is also indicated to treat heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception. Consider removing Mirena if these or the following arise during use: uterine or cervical malignancy or jaundice.
Inform women about the possibility of PID and that PID can cause tubal damage leading to ectopic pregnancy or infertility, or infrequently can necessitate hysterectomy, or cause death. Healthcare providers should become thoroughly familiar with the insertion instructions before attempting insertion of Mirena. Insertion of Mirena into a uterine cavity less than 6 cm by sounding may increase the incidence of expulsion, bleeding, pain, perforation, and possibly pregnancy. DO NOT move the slider downward at this time as this may prematurely release the threads of Mirena.
Either remove Mirena during the first 7 days of the menstrual cycle and start the new method immediately thereafter or start the new method at least 7 days prior to removing Mirena if removal is to occur at other times during the cycle. The risk of ectopic pregnancy, in women who have a history of ectopic pregnancy and use Mirena is unknown. Follow her pregnancy closely and advise her to report immediately any symptom that suggests complications of the pregnancy.
Remove Mirena in cases of recurrent endometritis or PID, or if an acute pelvic infection is severe or does not respond to treatment. During the first three to six months of Mirena use, the number of bleeding and spotting days may be increased and bleeding patterns may be irregular. The possibility of pregnancy should be considered if menstruation does not occur within six weeks of the onset of previous menstruation. The risk of perforation may be increased if Mirena is inserted when the uterus is fixed retroverted or not completely involuted during the postpartum period. The inserter (Figure 11Figure ), which is used for insertion of Mirena into the uterine cavity, consists of a symmetric two-sided body and slider that are integrated with flange, lock, pre-bent insertion tube and plunger.


Studies of Mirena and similar LNG IUS prototypes have suggested several mechanisms that prevent pregnancy: thickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium. In study sites having verifiable data and informed consent, 1,169 women 18 to 35 years of age at enrollment used Mirena for up to 5 years, for a total of 45,000 women-months of exposure. The subjects included reproductive-aged women in good health, with no contraindications to the drug products and with confirmed heavy menstrual bleeding (≥ 80 mL menstrual blood loss [MBL]) determined using the alkaline hematin method.
Provide the Patient Information Booklet and give her the opportunity to read the information and discuss fully any questions she may have concerning Mirena as well as other methods of contraception and therapies for heavy menstrual bleeding. Teach her to recognize and report to her healthcare provider promptly any symptoms of ectopic pregnancy.
The threads are the only part of Mirena you can feel when Mirena is in your uterus; however, unlike a tampon string, the threads do not extend outside your body.
Your healthcare provider can place a new Mirena during the same office visit if you choose to continue using Mirena. You could become pregnant as soon as Mirena is removed, so you should use another method of birth control if you do not want to become pregnant. Your healthcare provider will then clean your vagina and cervix with an antiseptic solution, and slide a slim plastic tube containing Mirena into your uterus. If your symptoms do not pass within 30 minutes after placement, Mirena may not have been placed correctly. Otherwise, you should return to your healthcare provider for a follow-up visit 4 to 6 weeks after Mirena is placed to make sure that Mirena is in the right position.
Severe infection, miscarriage, premature delivery, and even death can occur with pregnancies that continue with an intrauterine device (IUD).
If you are breastfeeding, Mirena is not likely to affect the quality or amount of your breast milk or the health of your nursing baby. If these symptoms do not stop 30 minutes after placement, Mirena may not have been placed correctly. Once Mirena is placed by your healthcare provider, it is over 99% effective and works consistently to prevent pregnancy. The most effective methods, including intrauterine devices such as Mirena, are found at the top of the chart. In fact, within a year of having Mirena removed, approximately 8 out of 10 women succeed at becoming pregnant. Should you decide you do want to try to become pregnant, Mirena can be removed at any time by your healthcare provider. Because of this, your healthcare provider may try to remove Mirena, even though removing it may cause a miscarriage.
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. If you do not have a period during 6 weeks of Mirena use, contact your healthcare provider to rule out pregnancy. Talk with your healthcare provider about replacing your Mirena before your scheduled appointment to have your current Mirena removed.
It is best that you wait until you have a menstrual cycle before you being actively trying to become pregnant, but this is not necessary. There has been no research that has shown that Mirena makes it harder or easier to become pregnant after stopping taking it over other birth control methods.
Evaluate women for ectopic pregnancy because the likelihood of a pregnancy being ectopic is increased with Mirena. PID is often associated with sexually transmitted infections (STIs); Mirena does not protect against STIs, including HIV. If removal occurs at other times during the cycle and the woman has had intercourse in the week prior to removal, she is at risk of pregnancy. Also consider the possibility of ectopic pregnancy in the case of lower abdominal pain, especially in association with missed periods or if an amenorrheic woman starts bleeding.
Women with a previous history of ectopic pregnancy, tubal surgery or pelvic infection carry a higher risk of ectopic pregnancy.
In clinical trials, total combined upper genital infections were reported in 3.5% of Mirena users.
The significance of actinomyces-like organisms on Pap smear in an asymptomatic IUD user is unknown, and so this finding alone does not always require Mirena removal and treatment.
Once pregnancy has been excluded, repeated pregnancy tests are generally not necessary in amenorrheic women unless indicated, for example, by other signs of pregnancy or by pelvic pain [see Clinical Studies (14.1)]. Delayed detection or removal of Mirena in case of perforation may result in migration outside the uterine cavity, adhesions, peritonitis, intestinal perforations, intestinal obstruction, abscesses and erosion of adjacent viscera. Delay Mirena insertion a minimum of six weeks or until involution is complete following a delivery or a second trimester abortion. Mirena typically decreases menstrual bleeding over time; therefore, an increase of menstrual bleeding may be indicative of an expulsion. If expulsion has occurred, Mirena may be replaced within 7 days after the onset of a menstrual period after pregnancy has been ruled out. Exclude pregnancy and verify the location of Mirena, for example, by sonography, X-ray, or by gentle exploration of the cervical canal with a suitable instrument.
Small amounts of progestins were observed to pass into the breast milk of nursing mothers who used Mirena, resulting in detectable steroid levels in infant serum. Subjects had previously been pregnant, had no history of ectopic pregnancy, had no history of pelvic inflammatory disease over the preceding 12 months, were predominantly Caucasian, and over 70% of the participants had previously used IUDs (intrauterine devices). About 8 out of 10 women who want to become pregnant will become pregnant sometime in the first year after Mirena is removed. Your healthcare provider will then remove the plastic tube, and leave Mirena in your uterus. Your healthcare provider will examine you to see if Mirena needs to be removed or replaced. However, isolated cases of decreased milk production have been reported among women using progestin-only birth control pills. Call your healthcare provider immediately if you develop severe pain or fever shortly after Mirena is placed. Or, if at the end of the 5-year period you’re still undecided, you can have another Mirena placed.
If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy. Some methods, such as tubal ligation (getting your tubes tied) or your partner getting a vasectomy, should be considered as permanent. Within a year of having Mirena removed, about 8 out of 10 women succeed at becoming pregnant. You have a higher chance of getting PID if you or your partner have sex with other partners.
If this occurs, Mirena may be replaced within 7 days of a menstrual period after pregnancy has been ruled out. If you do not have a period for 6 weeks during Mirena use, contact your healthcare provider to rule out pregnancy. Women who have Essure are more likely to have an ectopic pregnancy (pregnancy outside the uterus) if they get pregnant. However, most couples who attempt to become pregnant after removing Mirena do so within the first year.
Tell women about the signs of ectopic pregnancy and associated risks, including loss of fertility.
Consider pregnancy if menstruation does not occur within 6 weeks of the onset of previous menstruation. Because of the local exposure of the fetus to LNG, the possibility of teratogenicity following exposure to Mirena cannot be completely excluded. Aseptic technique during insertion of Mirena is essential in order to minimize serious infections such as GAS.
Metabolic clearance rates may differ among individuals by several-fold, and this may account in part for wide individual variations in LNG concentrations seen in individuals using LNG–containing contraceptive products. Treatment with Mirena showed a statistically significantly greater reduction in MBL (see Figure 12) and a statistically significantly greater number of subjects with successful treatment (see Figure 13).
The box on the bottom of the chart shows the chance of getting pregnant for women who do not use birth control and are trying to get pregnant. After you have used Mirena for a while, the number of bleeding and spotting days is likely to lessen. You can ask your healthcare provider for information about Mirena that is written for health providers. Let your healthcare provider know if the cramping is severe, or if your symptoms last for more than 30 minutes as Mirena may have not been properly placed and your healthcare provider should examine you. After your body adjusts, the number of bleeding and spotting days is likely to decrease, but may remain irregular, and you may even find that your periods stop altogether for as long as Mirena (levonorgestrel-releasing intrauterine system) is in place. PID can cause serious problems such as infertility, ectopic pregnancy or pelvic pain that does not go away. If perforation occurs, Mirena may move outside the uterus and can cause internal scarring, infection or damage to other organs. If your symptoms do not stop 30 minutes after placement, Mirena may not have been placed correctly.
If you think that Mirena has come out, use a back-up form of birth control such as condoms and spermicide and call your healthcare provider. Or you may even find that your periods stop altogether—in which case, you should contact your healthcare provider to rule out pregnancy. If you rely on Essure for birth control before receiving confirmation from your doctor, you are at risk of getting pregnant.
Women with a history of ectopic pregnancy, tubal surgery, or pelvic infection carry a higher risk of ectopic pregnancy.
A new Mirena may be inserted at that time or during the next menses if it is certain that conception has not occurred. If perforation occurs, Mirena may move outside the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed. If you think that Mirena has come out, use a backup birth control method like condoms and spermicide and call your healthcare provider. Your healthcare provider will examine you to see if Mirena needs to be replaced or removed. In a clinical trial with other IUDs1 and a clinical trial with an IUD similar to Mirena, the highest rate occurred within the first month after insertion.
Ectopic pregnancy is an emergency that requires immediate medical attention and often requires surgery. If you feel more than just the threads or if you cannot feel the threads, Mirena may not be in the right position and may not prevent pregnancy. Ectopic pregnancy can cause internal bleeding, infertility and even death, so it is important to call your healthcare provider right away if you think that you’re pregnant.
Use non-hormonal back-up birth control (such as condoms and spermicide) and ask your healthcare provider to check that Mirena is still in the right place.



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