Should I get my Mirena coil removed?

Woman lying on the grass

If you are currently wondering whether to remove your Mirena coil, it means you have already had one fitted and have likely been told a bit about it by your doctor. To brush over the basics, the Mirena is a levonorgestrel-releasing intrauterine system (referred to as ‘LNG-IUS’), or in simpler terms, it’s a small T-shaped device which is inserted into one’s uterus to provide long-term contraception.

It does so by constantly releasing small amounts of the hormone levonorgestrel (a synthetic progestogen) into the uterine cavity which mainly acts by making changes to the inner lining of the womb, and thereby preventing implantation of a fertilised egg.1 It also thickens the cervical mucus, making it difficult for sperm to get through and in a minority of women it prevents ovulation as well.2 With an effectiveness of more than 99%3 and a low side-effect profile, owing to less absorption of hormones into the bloodstream, the Mirena is becoming popular among methods of long-acting reversible contraception (LARC) available.

When is the Mirena coil usually removed?

The amount of hormone released from the IUS drops significantly after a certain period of time, hence the Mirena is licensed for use only for a duration of five years. Although some contraceptive effect may still persist after that time, it is recommended to remove the Mirena and replace it after five years, as this is the period when it is most effective. That being said, you don’t necessarily have to wait until the due date to remove the coil; you can get it removed at any time earlier if you wish to do so.

Why would you take out your Mirena coil early?

One reason is pretty obvious: you insert the Mirena to avoid pregnancy, and if you wish to get pregnant the coil can be removed right away. Evidence suggests that fertility can be regained without a delay after the removal of the Mirena.4 Also, if you decide that a different method of contraception would be more suitable for you, the Mirena can be removed at any time to make the switch. Pain and change of bleeding pattern are some of the other common reasons of earlier removal of the coil.

Period changes after Mirena insertion

You might be concerned about changes to your period after insertion of the Mirena. It is normal to experience irregular, frequent bleeding during the initial months after insertion, but this often settles and by 6 months’ time, most users get lighter or no periods at all. This is due to the long-term progestogen action on the endometrium, causing thinning of the lining which is not harmful and is not a reason to remove the Mirena. However, if the bleeding pattern suddenly changes sometime after insertion or if you continue to get heavy menstrual bleeding beyond 6 months it’s advisable to meet a doctor to exclude any other pathology like fibroid, malignancy, or infection.

Pain, infection, and the Mirena

It is normal to experience some cramping pain in the lower abdomen during insertion of the coil. It may persist for a few hours or even a few days in some women. You can get painkillers to alleviate the pain and it should eventually settle with time. But if it doesn’t settle or if it’s a very severe pain, you need to get yourself checked by a doctor to investigate what could be causing it. For example, infection, perforation, expulsion (when the Mirena coil comes out), or an ectopic pregnancy (when the fertilised egg implants itself outside of the womb). Even in the absence of these concerns, you can get the coil removed if the pain is too much.

Although the Mirena increases the risk of PID, the risk is still low: this infection is not common in Mirena users

The Mirena is associated with a slightly higher risk of infection of female reproductive organs, called pelvic inflammatory disease (PID). This is often caused by sexually transmitted infections (STI) like chlamydia which was in the vagina but ascended to upper organs during the coil insertion procedure. Some are screened for these asymptomatic infections prior to insertion. However, the risk is mainly during the first 20 days following insertion and it is best to be on the lookout for any symptoms or signs of infections in these initial days. You need to meet your doctor if you experience fever, severe lower abdominal pain or pain during intercourse, or bad-smelling vaginal discharge.

If an infection is detected, you will be treated with a course of antibiotics. The Mirena does not always need to be removed unless there’s poor response to treatment. However, it’s important to note that although the Mirena increases the risk of PID, the risk is still low: this infection is not common in Mirena users.5 Also, the Mirena itself does not cause STIs but doesn’t protect you from STIs either, hence using a barrier method like condoms is still recommended.

Hormonal side effects

Although systemic absorption of the progestogen is less than in other hormonal contraception methods, one might still experience some mild unpleasant hormonal side effects like headaches, acne, breast tenderness, and mood changes with the Mirena. These appear during the first few weeks to months following insertion and often settle with time. Rarely, if they persist and continue to bother you significantly, removal of the coil can be considered. And if you are worried about gaining some weight, be assured that there is no evidence to suggest that the Mirena causes weight gain.6

Mirena and sex

Some are worried that Mirena has a negative impact on sexual intercourse, but there’s no reason to be so. There’s no evidence to suggest it causes low libido, and in fact, some women claim it actually increases their sex drive.7 The Mirena does not usually cause pain or discomfort during intercourse. Rarely, if you have having sex with a partner who has a penis, they might feel some discomfort when the strings of the coil touch their penis. Your doctor will be able to cut the strings shorter for you if this is something you want.

What if you get pregnant while using the Mirena?

The chance that you will get pregnancy while using the Mirena is less than 1%, but if you do get pregnant, you will need to meet with your doctor immediately so that they can exclude an ectopic pregnancy. This does not in any way mean that the Mirena increases your overall risk of ectopic pregnancy. It does not: the overall risk is actually lower with the Mirena use.8 However, immediate removal of the IUS is recommended if you are pregnant, as there is a high risk of miscarriage with the coil in situ.9

What other complications can the Mirena cause?

Uterine perforation is a rare but serious complication that occurs in about 1 in 1000 women with IUS insertion.10 This may sometimes cause pain but may be completely asymptomatic as well. Hence, you are advised to check for the presence of the strings of the coil once a month and seek medical care soon if they cannot be felt. If you are unable to feel the strings, it could mean that the Mirena is malpositioned (this may or may not indicate perforation) or that it has been expelled from your body. If the coil has come out, you are no longer protected against pregnancy.

Using another form of contraception like condoms is recommended until you meet your doctor who will decide whether or not to remove the Mirena, depending on where it’s positioned. A surgical intervention may be necessary in case of perforation.

Should I be worried about the removal process?

Whatever your reasons may be, it is advisable to discuss your concerns with your doctor and they will help to decide whether the coil really needs removal or not. If you strongly believe that you need it out, no matter what the doctor says, they will still do it because what you want matters most.

The process of removal is quite simple and straightforward. You already know what it feels like to get the Mirena inserted and the removal is said to be even less discomforting than that. However, it is a procedure to be done by an experienced doctor or a nurse and not something to be attempted by yourself at home.

Featured image is of a woman lying on the grass, with her hand over her abdomen. She is wearing pale blue jeans and a yellow shirt. Only her legs, abdomen, lower torso, and right hand are in the frame

Last updated January 2020
Next update due 2022

Dr. Shehara Ariyaratne, MBBS

Shehara graduated from the University of Colombo, with degrees in Medicine and Surgery. She has research experience in various fields of medicine, having worked at the Epidemiology Unit of Sri Lanka and National Institute of Infectious Diseases. She is currently practising paediatrics and radiology at the Lady Ridgeway Hospital, Colombo, the main paediatric hospital in the country. Though a medical doctor in profession, writing has always been her passion and she hopes her articles will help empower women.

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References

  1. National Collaborating Centre for Women’s and Children’s Health, ‘Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception’, NICE Clinical Guidelines, October 2005
  2. Ibid
  3. NHS, ‘Intrauterine system (IUS)’, February 2018, [online], https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/ (accessed 01 January 2020)
  4. FSRH Clinical Effectiveness Unit, ‘Intrauterine Contraception’, Clinical Guidance, April 2015, (amended 2019) https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/, (accessed 17 January 2020)
  5. NICE, ‘Contraception – IUS/IUD’, Clinical Knowledge Summary, National Institute for Health and Care Excellence, May 2019, [online], https://cks.nice.org.uk/contraception-iusiud#!scenario (accessed 17 January 2020)
  6. Attia, A.M., et al., ‘Role of the levonorgestrel intrauterine system in effective contraception’, Patient preference and adherence, vol. 7, 2013, pp. 777-785
  7. Engle, Gigi, ‘Turns out, an IUD can seriously affect your sex drive (in a good way)’, Glamour magazine, 24 March 2019, [online], https://www.glamour.com/story/how-an-iud-can-affect-your-sex-drive-in-a-good-way (accessed 17 January 2020)
  8. FSRH Clinical Effectiveness Unit, ‘Intrauterine Contraception’, Clinical Guidance, April 2015, (amended 2019) https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/, (accessed 17 January 2020)
  9. Schiesser, M., et al., ‘Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases’, Ultrasound in Obstetrics and Gynaecology, vol. 23, 2004
  10. FSRH Clinical Effectiveness Unit, ‘Intrauterine Contraception’, Clinical Guidance, April 2015, (amended 2019) https://www.fsrh.org/standards-and-guidance/documents/ceuguidanceintrauterinecontraception/, (accessed 17 January 2020)