14.08.2015

What are my chances of getting pregnant on mirena

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. Ovarian cysts may occur and are generally asymptomatic, but may be accompanied by pelvic pain or dyspareunia. You are encouraged to report negative side effects or quality complaints of prescription drugs to the FDA.
For the proper insertion and removal instructions, choose which MirenaA® product you are using. Once a month, see what our medical experts have to say about birth control, health, sex, science, and more.
Women under 30 years old are incredibly fertile—their ability to get pregnant is at its peak.
All reversible birth control methods will help prevent pregnancy while you’re using them, but none have long-lasting effects on your ability to get pregnant when you stop. Let’s look, for example, at how long it takes for women to get pregnant when they quit the Pill compared to when they quit non-hormonal fertility awareness methods (FAM, sometimes called natural family planning). If you had sex with a new partner and didn’t use a condom, you can still protect yourself by getting tested. Mirena has been studied for safety and efficacy in two large clinical trials in Finland and Sweden.
Acute pelvic inflammatory disease or a history of pelvic inflammatory disease unless there has been a subsequent intrauterine pregnancy. Tell women who choose Mirena about the risks of ectopic pregnancy, including the loss of fertility. The risk of ectopic pregnancy in women who have a history of ectopic pregnancy and use Mirena is unknown. When pregnancy continues with Mirena in place, long-term effects on the offspring are unknown.
As of September 2006, 9 cases of Group A streptococcal sepsis (GAS) out of an estimated 9.9 million Mirena users had been reported. 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. PID is often associated with a sexually transmitted disease, and Mirena does not protect against sexually transmitted disease. All women who choose Mirena must be informed prior to insertion about the possibility of PID and that PID can cause tubal damage leading to ectopic pregnancy or infertility, or in infrequent cases can necessitate hysterectomy, or can cause death. Mirena can alter the bleeding pattern and result in spotting, irregular bleeding, heavy bleeding, oligomenorrhea and amenorrhea. It is recommended that postpartum Mirena insertion be delayed until uterine involution is complete to decrease perforation risk. Since the contraceptive effect of Mirena is mainly due to its local effect, 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 uterus should be carefully sounded prior to Mirena insertion to determine the degree of patency of the endocervical canal and the internal os, and the direction and depth of the uterine cavity. Syncope, bradycardia, or other neurovascular episodes may occur during insertion or removal of Mirena, especially in patients with a predisposition to these conditions or cervical stenosis. Inform patient of the risks of leaving Mirena in place or removing it during pregnancy and of the lack of data on long-term effects on the offspring of women who have had Mirena in place during conception or gestation (see WARNINGS). If possible Mirena should be removed after the patient has been warned of the risks of removal.
Levonorgestrel may affect glucose tolerance, and the blood glucose concentration should be monitored in diabetic users of Mirena. Mirena has not been studied in women over age 65 and is not currently approved for use in this population. About 80% of women wishing to become pregnant conceived within 12 months after removal of Mirena.
The most serious adverse reactions associated with the use of Mirena are discussed above in the WARNINGS and PRECAUTIONS sections.
The following adverse reactions have been identified during post approval use of Mirena: device breakage and angioedema.
Mirena (levonorgestrel-releasing intrauterine system), containing a total of 52 mg levonorgestrel, is available in a carton of one sterile unit NDC# 50419-421-01. NOTE: Health care providers are advised to become thoroughly familiar with the insertion instructions before attempting insertion of Mirena. Mirena is inserted with the provided inserter ( figure 1) into the uterine cavity within seven days of the onset of menstruation or immediately after first trimester abortion by carefully following the insertion instructions. Examine the patient to establish the size and position of the uterus, to detect cervicitis or other genital contraindications and to exclude pregnancy. Obtain cervical cultures, perform a pregnancy test and give antibiotic prophylaxis if indicated. Mirena is a hormone-releasing system placed in your uterus to prevent pregnancy for up to 5 years. You must have Mirena removed after 5 years, but your health care provider can insert a new Mirena during the same office visit if you choose to continue using Mirena. The following chart shows the chance of getting pregnant for women who use different methods of birth control. There are also risks if you get pregnant while using Mirena and the pregnancy is in the uterus.
We do not know 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.
Neither you nor your partner should feel Mirena during intercourse, as Mirena is placed in the uterus, not in the vagina.
Medicines are sometimes prescribed for conditions that are not mentioned in patient information leaflets. 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. Tell your healthcare provider right away if you have any of these signs of PID: long-lasting or heavy bleeding, unusual vaginal discharge, low abdominal (stomach area) pain, painful sex, chills, or fever.
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. Tell your doctor if you are taking immunosuppressants or think you may have a nickel allergy. Long-term Risks: There are reports of chronic pelvic pain in women possibly related to Essure.
BAYER, the Bayer Cross and Mirena, Skyla, Mirena and Essure are registered trademarks of Bayer. 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. That’s why women who use the Pill but accidentally forget to take it for a few days can get pregnant that month. A big study of over 2,000 women who quit the Pill after using it for an average of seven years found that 21% were pregnant in one month and 79% were pregnant in a year. Luckily, getting tested for Chlamydia or Gonorrhea is easy and painless: you just pee in a cup. The inserter, 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. Low doses of levonorgestrel can be administered into the uterine cavity with the Mirena intrauterine delivery system. Morphological changes of the endometrium are observed, including stromal pseudodecidualization, glandular atrophy, a leucocytic infiltration and a decrease in glandular and stromal mitoses. Studies of Mirena 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, 1169 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. Teach them to recognize and report to their physician promptly any symptoms of ectopic pregnancy.
As of September 2006, 390 live births out of an estimated 9.9 million Mirena users had been reported.
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. Because spontaneous reports are voluntary and from a population of uncertain size, it is not possible to use post-marketing data to reliably estimate the frequency or establish causal relationship to drug exposure.
These estimates include the combined risk of the contraceptive method plus the risk of pregnancy or abortion in the event of method failure.
The patient should be given the opportunity to read the information and discuss fully any questions she may have concerning Mirena as well as other methods of contraception. Mirena should not be inserted until 6 weeks postpartum or until involution of the uterus is complete in order to reduce the incidence of perforation and expulsion. Patients with certain types of valvular or congenital heart disease and surgically constructed systemic-pulmonary shunts are at increased risk of infective endocarditis. Mirena should be used with caution in patients who have a coagulopathy or are receiving anticoagulants.
Use of Mirena in patients with vaginitis or cervicitis should be postponed until proper treatment has eradicated the infection and until it has been shown that the cervicitis is not due to gonorrhea or chlamydia (see CONTRAINDICATIONS).
If decreased pulse, perspiration, or pallor are observed, the patient should remain supine until these signs have disappeared. Since Mirena may be displaced, patients should be reexamined and evaluated shortly after the first postinsertion menses, but definitely within 3 months after insertion. If removal is difficult, the patient should be counseled and offered pregnancy termination.
If the retrieval threads are not visible, they may have retracted into the uterus or have been broken, or Mirena may have been broken, perforated the uterus, or have been expelled. It is recommended that potential users be fully informed about the risks and benefits associated with the use of Mirena, with other forms of contraception, and with no contraception at all.
Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure. Each Mirena is packaged in a thermoformed blister package with a peelable lid, together with an insertion tube. Insertion of Mirena into a uterine cavity less than 6.0 cm by sounding may increase the incidence of expulsion, bleeding, pain, perforation, and possibly, pregnancy.
While holding the inserter steady release the arms of Mirena ( figure 7a) by pulling the slider back until the top of the slider reaches the mark (raised horizontal line on the handle) ( figure 7b). Holding the inserter firmly in position release Mirena by pulling the slider down all the way. Mirena does not protect against HIV infection (AIDS) and other sexually transmitted diseases (STDs). Each box on the chart contains a list of birth control methods that are similar in effectiveness. Your health care provider will then clean your vagina and cervix with an antiseptic solution, and slide a thin plastic tube containing Mirena into your uterus. Otherwise, you should return to your health care provider for a follow-up visit in the first 3 months 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. Your answers will help you and your health care provider decide if Mirena is a good choice for you.
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.
As far as family planning goes, this can be especially appealing if you are undecided whether you want more children. 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.
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 whether you’d like to have more children in the future.
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. A variety of resources are available to help you get the coverage you may be entitled to under the ACA. 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. 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.
The risk of perforation is higher if inserted in lactating women and may be higher if inserted in women who are postpartum or when the uterus is fixed retroverted. Women who stopped using FAM had very similar rates of pregnancy, with 20-25% pregnant in one month and 80% pregnant in a year. 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). The incidence of ectopic pregnancy in clinical trials that excluded women with risk factors for ectopic pregnancy was about 1 ectopic pregnancy per 1000 users per year. Women with a previous history of ectopic pregnancy, tubal surgery or pelvic infection carry a higher risk of ectopic pregnancy. Guidelines for PID treatment are available from the Center for Disease Control (CDC), Atlanta, Georgia.
Once pregnancy has been excluded, repeated pregnancy tests are generally not necessary in amenorrheic subjects unless indicated, for example, by other signs of pregnancy or by pelvic pain. Inserting Mirena immediately after first trimester abortion is not known to increase the risk of perforation, but insertion after second trimester abortion should be delayed until uterine involution is complete.
Two observational studies have not provided evidence of an increased risk of breast cancer during the use of Mirena.
She should also be given instructions on what other symptoms require her to call her health care provider. The possibility of insertion of Mirena in the presence of an existing undetermined pregnancy is reduced if insertion is performed within 7 days of the onset of a menstrual period. Location of Mirena may be determined by sonography, X-ray, or by gentle exploration of the uterine cavity with a probe. Levonorgestrel is a progestin hormone often used in birth control pills; however, unlike many birth control pills, Mirena does not contain an estrogen. About 8 out of 10 women who want to become pregnant will become pregnant some time in the first year after Mirena is removed. Your health care provider will then remove the plastic tube, and leave Mirena in your uterus. Because of this, your health care provider may try to remove Mirena, even though removing it may cause a miscarriage.
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. 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.
In other words, women who quit the Pill get pregnant just as fast as other women, even if they’ve used the Pill for years. There may be a delay of up to two months after stopping the implant and up to six months after stopping the shot, but this varies from person to person, and most women get pregnant soon after stopping these methods.
The plasma concentrations achieved by Mirena are lower than those seen with levonorgestrel contraceptive implants and with oral contraceptives.
The elimination half-life of levonorgestrel after daily oral doses is approximately 17 hours; both the parent drug and its metabolites are primarily excreted in the urine. Most of these follicles are asymptomatic, although some may be accompanied by pelvic pain or dyspareunia. She should be instructed on how to check after her menstrual period to make certain that the threads still protrude from the cervix and cautioned not to pull on the threads and displace Mirena. If the threads are not visible, location of the Mirena should be verified, for example with X-ray, ultrasound, or gentle probing of the uterine cavity.
Mirena may stop release of your egg from your ovary, but this is not the way it works in most cases.
If Mirena cannot be removed, talk with your health care provider about the benefits and risks of continuing the pregnancy. You have a higher chance of getting PID if you or your partner have sex with other partners. If you do not have a period for 6 weeks during Mirena use, contact your health care provider. You can ask your health care provider for information about Mirena that is written for health providers.
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. 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. Women with a history of ectopic pregnancy, tubal surgery, or pelvic infection carry a higher risk of ectopic pregnancy.
The longer a woman has an untreated STI like Chlamydia or Gonorrhea, the higher the chance that it will cause scarring in the tubes that connect her ovaries and uterus.
However, due to limitations of the available data a precise estimate of the pregnancy rate is not possible.
She should be informed that there is no contraceptive protection if Mirena is displaced or expelled.
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. PID can cause serious problems such as infertility, ectopic pregnancy or pelvic pain all the time. If you notice that Mirena has come out, use a backup birth control method like condoms and call your health care provider. 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. That scarring makes it difficult for an egg to travel the right direction, and hurts her chances of getting pregnant in the future.
If expulsion has occurred, it may be replaced within 7 days of a menstrual period after pregnancy has been ruled out. As menstrual flow usually decreases after the first 3 to 6 months of Mirena use, increase of menstrual flow may be indicative of an expulsion. Your healthcare provider will examine you to see if Mirena needs to be replaced or removed. Ectopic pregnancy is an emergency that requires immediate medical attention and often requires surgery.
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. If you cannot feel the threads at all, ask your healthcare provider to check that Mirena is still in the right place.
Tell your health care provider right away if you have any of these signs of PID: long-lasting or heavy bleeding, unusual vaginal discharge, low abdominal (stomach area) pain, painful sex, chills, or fever.



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