Should I use the Mirena coil during menopause?

The Mirena coil is a long-acting reversible contraceptive (sometimes referred to as a LARC method), that can be used for five years before needing to be changed. The Mirena coil is a device which is inserted into the uterus (womb). It consists of a T-shaped frame, about 3cm long and 3cm wide, which has a vertical tube containing the hormone levonorgestrel.

Levonorgestrel is a synthetic form of progesterone, which is found naturally in our bodies, and is released daily by the Mirena in small amounts. Progesterone hormones keep the lining of the uterus thin, making it more difficult for a fertilised egg to implant and result in a pregnancy.

They also thicken cervical mucus, making it more difficult for sperm to enter the uterus and fertilise an egg. In some people, the Mirena also stops ovulation (the release of an egg from the ovaries), but about 75% of people with wombs will continue to ovulate whilst using the Mirena.¹

Menopause and hormone replacement therapy (HRT)

To understand how the Mirena coil could impact menopause, it is important to understand how menopause affects our hormones.

The menopause is a natural part of ageing which usually occurs between the ages of 45 and 55, when people with a uterus stop having periods due to a reduction in levels of various hormones including oestrogen, progesterone, and testosterone.

This reduction in hormone levels can cause menopausal symptoms such as hot flushes, mood swings, and vaginal dryness. Technically, menopause occurs when periods stop entirely for 12 months, but people may experience menopausal symptoms several years before their officially cease; this is called the perimenopause.

To help manage menopausal symptoms, some people choose to take hormone replacement therapy (HRT).²

It can be taken in a “combined” form (with both oestrogen and progestogen) or in an oestrogen-only form. People who still have a uterus (i.e. who have not had a hysterectomy) need to take a combined form of HRT, with both oestrogen and progestogen. This is because oestrogen taken “unopposed” (without progestogen) thickens the lining of the uterus (also known as the endometrium). This can lead to a condition called endometrial hyperplasia, where the lining of the uterus is abnormally thick, and this can in some cases progress to uterine (endometrial) cancer.³

Although the Mirena coil is most often used as a contraceptive, it is also licensed in the UK as the progestogen component of hormone replacement therapy

Whether used for HRT or for contraception, progesterone hormones keep the lining of the uterus thin, which protects against endometrial hyperplasia.

HRT comes in many different forms, including skin patches, gels, vaginal creams, and vaginal pessaries.⁴ If you need to take combined HRT, you can take tablets or use patches that contain both oestrogen and progestogen, or you can use different medicine preparations to take each hormone: for example, a patch containing oestrogen, and a tablet containing progestogen.

Using the Mirena coil as part of HRT

Although the Mirena coil is most often used as a contraceptive, it is also licensed in the UK as the progestogen component of hormone replacement therapy (HRT). This means that oestrogen-only HRT (such as oestrogen patches) can be used by somebody who has a Mirena coil inserted, because the Mirena coil acts as endometrial protection.

Whilst there are other types of hormonal coils (such as Jaydess and Kyleena), only Mirena is licensed for endometrial protection as part of HRT; this is because Mirena contains a higher level of progestogen than other hormonal coils.⁵

Guidelines state that someone who has the Mirena coil inserted after the age of 45 may continue to use the same Mirena until periods stop; however, people using Mirena for endometrial protection as part of HRT must change their Mirena every 5 years – regardless of their age when it was inserted – to ensure progesterone levels remain high enough to protect the uterus lining.⁶

However, since most of the effect of HRT comes from the replacement of oestrogen, if you’re using the Mirena as the progestogen component you must still remember to take whatever form of oestrogen-only HRT you are prescribed (e.g. oestrogen patches, or oestrogen tablets).

Other advantages of using the Mirena as part of HRT

The Mirena coil also tends to make periods lighter. This is because the synthetic progesterone released by the Mirena works to keep the lining of the uterus thin, which means that there is less to shed during your menstrual bleed. This can be particularly helpful in the perimenopause, when periods often become heavier, longer or more painful.⁷

It should be noted that some people experience irregular bleeding in the first 3-6 months following Mirena insertion, but this tends to improve over time.⁸

The Mirena and menopausal symptoms

The symptoms of perimenopause can be extensive, including breast tenderness, acne, mood disturbances, weight gain, joint discomfort, and insomnia. Some of these symptoms are also side effects of the Mirena.

If you are using the Mirena coil, it may be difficult to decipher whether your symptoms are due to you entering perimenopause or side effects of the coil. These symptoms could also be due to pregnancy (although this is unlikely, as the Mirena is a very effective contraceptive) so it is worth doing a pregnancy test.

A Mirena coil can be inserted at some GP practices, or at a sexual health clinic, but you should check with a doctor first to ensure that oestrogen HRT is appropriate for you

Hormonal blood tests are sometimes used to try and identify whether you’re approaching menopause. These tests look at levels of the hormones follicle-stimulating hormone (FSH) and lutenising hormone (LH), which are produced in the brain and provide a signal to the ovaries to produce oestrogen. As you approach menopause, levels of these hormones tend to be raised.

However, these blood tests can be difficult to interpret if you are using the Mirena, as synthetic hormones affect the levels of natural hormones made by the body. Your doctor can advise on appropriate steps.

I want to use a Mirena coil as part of HRT, who should I speak to?

If you already have a Mirena coil inserted, are over 35, and are experiencing what you think might be symptoms of perimenopause, speak to a doctor about further investigations and the possibility of starting HRT.

If you are already using or considering using HRT, and you are interested in using a Mirena coil as the progesterone component of it, discuss with your doctor. A Mirena coil can be inserted at some GP practices, or at a sexual health clinic, but you should check with a doctor first to ensure that oestrogen HRT is appropriate for you and that it is safe for you to have a Mirena coil.

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Last updated February 2023
Next update due 2026