mirena IUD PROS + CONS
The Mirena is a tiny T-shaped IUD that is placed in the uterus for up to five years and is very, very effective at reducing your chances of getting pregnant—over 99%, according to the brand (1). It’s made of plastic and a synthetic hormone called levonorgestrel (a type of progestin), which is what prevents you from getting pregnant.
The hormone works in three ways: It thickens the cervical mucus to prevent sperm from reaching an egg, thins the lining of your uterus so that an egg won’t be able to implant there if it does happen to get fertilized, and also lowers your chances of monthly ovulation (2).
The Mirena is now in its nineteenth year in America (3), but the IUDs go all the way back to 1909. Since then there has been many iterations of the device, including one made of silkworm gut (!) and another made with pure silver, before we got to the plastic one that’s on the market today (4). While it had a rough introduction to market (hello pelvic inflammatory disorders) after being re-designed and tested over and over, the IUD is now one of the most effective and cost-efficient ways of not getting pregnant (5).
V. IMPORTANT NOTE: Mirena won’t protect you against STIs or STDs—it’s only used for pregnancy prevention. However, for STI/STD protection, you can use condoms in conjunction with an IUD.
WHY USE MIRENA?
There are a ton of reasons why ovulators opt for Mirena. Firstly, it’s a LARC (Long Acting Reversible Contraceptive) which means that there’s less upkeep needed for the IUD than, say, a vaginal ring or birth control pills, and it lasts for years, which can be very convenient. It’s also discreet—your partner(s) don’t need to know. If you don’t want to tell or can’t tell your partner(s) or parent(s) about your birth control, they will never see the Mirena. And it starts working quickly (from immediately to seven days after insertion, depending on where you are in your cycle when it’s inserted), which is great if you want pregnancy protection ASAP. (6) The Mirena can also reduce pain and heavy bleeding associated with endometriosis or other menstrual conditions (2).
Furthermore, unlike other birth control options, like the pill, IUDs only contain Progestin, no estrogen. This is a plus for those who are sensitive to estrogen, smokers and over 35, and/or have health conditions like a history of blood clots, breast cancer, or serious heart problems (7). And speaking of how the IUD reacts with other conditions, because it’s hormones are localized in the uterus rather than traveling through the whole blood stream, IUDs are “optimal” for users with who take multiple medications or have multiple chronic diseases (8).
MIRENA INSERTION- WHAT’S IT LIKE?
The insertion takes place at a health care provider’s office, and it should only take a few minutes. Do note, for those who have experienced sexual violence, it can be triggering, so bring support if you can! A tube is inserted into your vaginal canal and the Mirena is placed in your uterus—you might feel a pinch. The tube is then removed and the procedure is done. The insertion is different for everybody (for example, the process can be more difficult if you have a tilted uterus, or more uncomfortable if you’ve never had a vaginal birth, as your cervix will be more closed), and while some people feel light to heavy cramping, similar to a bad period, others may experience intense pain or fainting (9). Protip: During the bleeding phase of your cycle your cervix is slightly more open, so if you get your insertion done while you have your period, it may be a bit easier.
And the Mirena removal?
When you’re ready to have your IUD removed, go back to your healthcare provider, who will pull on the strings of the Mirena to take it out. If you had a tough time with the insertion, note that removal tends to be less painful. You can have one IUD taken out and another placed during the same appointment. But because you can still experience some heavy cramping, consider having a friend drive you home and some Advil ready.
DO NOT USE MIRENA IF…
You are allergic to levonorgestrel
Have or had cancer that is sensitive to progestin
Have liver disease or a liver tumor
Have unexplained vaginal bleeding
Get vaginal infections easily
Are currently pregnant
Have had PID (aka pelvic inflammatory disease)
Currently have an untreated pelvic infection
Have experienced sexual trauma, as the insertion and removal process can be triggering
Some users report headaches, nausea, breast tenderness, mood changes, weight gain, and/or acne (10), and IUDs have also been linked to Bacterial Vaginosis and UTIs (11, 12). Irregular bleeding, or “spotting” is also common for the first 3 - 6 months, after which time bleeding usually becomes light, with 1 out of 5 users no longer having a period after one year (according to Mirena’s website).
Each person will react differently and it may take your body several months to a year to adjust to a new type of birth control. For this reason, it’s important to always check in with yourself to see how you are feeling and to make sure that an IUD is still the right choice for you. You should also be periodically checking for the Mirena strings to make sure it is still in place. If you can’t feel them, call your health care provider.
While it’s great that you can’t lose or forget to take the Mirena, some people find it scary, yucky or weird to have a foreign object in their body. Which is totally fair—you weren’t born with plastic in you! It’s fine to feel weird about having something inside you, and if you don’t like that or any of the side effects, just head back to the doctor and have the Mirena removed.
Will the Mirena affect my fertility?
How the Mirena affects your fertility really depends on the person—we know we always say this, but it’s true! You can be fertile as soon as the IUD is removed, so if you don’t want to get pregnant, take precautions and use a different form of contraception ASAP. For those trying to get pregnant, know that it can also take time for the body to adjust to no longer being on hormones. In addition to your body needing to re-adjust, synthetic hormones can change the cervical crypts which create the cervical fluid necessary to conceive (15). For this reason, it’s important to try and be patient with yourself and your body if you can’t get pregnant right away.
Heads up: Some of these complications sound scary, but they are rare and pretty unlikely to happen. That said, if it happens to you, it doesn’t matter how rare it is! They’re important to know about just in case so you can take control of your health.
Ectopic Pregnancy: If you become pregnant while you have an IUD in place, you’re at a higher risk for an ectopic pregnancy (which means that the pregnancy occurs outside of the uterus). This is very rare, but it can be dangerous. If you think you’re pregnant while using an IUD, you need to visit a hospital.
Expulsion: There is also a small chance (2-10% in the first year) that the IUD could leave your body, meaning that you no longer have birth control (10). You might see your IUD in the toilet or your undies, or you might not. If you can’t feel your strings, there’s a chance it’s gone. Expulsion isn’t dangerous but it does mean you’re no longer protected. If you think it may be gone, check in with your provider.
Perforation: It’s possible that an IUD can go into the uterine wall, and if that happens you need to see a doctor right away. This is most likely to occur during insertion and, unlike expulsion, you’ll have lots of pain, a possible fever, and bleeding. It’s also less likely than expulsion, with only 1.4 of every 1,000 users experiencing it (10).
MIRENA AND WEIGHT GAIN…
In general, hormonal and non-hormonal IUDs show the same results with weight gain and very few users report weight gain while on an IUD (10)—but even though it’s a small percentage, it’s possible! Take note of your own body and if you feel like the IUD might be the cause of weight gain. If it doesn't feel good for you, remember that you have other options.
For more info about how medications and existing medical conditions might interact with the Mirena, check out their website here. Also a reminder: Have a convo with your healthcare provider about your health history and medications before starting any B.C method. A list of questions to ask your provider can be found here.
Depending on your insurance and where you get the procedure done, it will cost between $0-$1,300. But don’t let that higher end price tag scare you away if you think Mirena is the right choice for you. Many insurance providers, like Medicaid, will help cover the costs, and if you don’t have insurance or your’s won’t cover it the cost, many clinics, including Planned Parenthood health centers, offer IUDs at much lower fees.
PROS AND CONS
As with every form of birth control, there are benefits and drawbacks to the Mirena IUD. We’re listing out a few, but note that because every body is different, these pros and cons might be different for you.
It’s effective. An IUD is one of the most effective methods of birth control.
It lasts 5 years
There’s a good chance your period will be less bloody or stop altogether—according to Mirena’s site, after a year 1 in 5 users “may” have no period (1)
It’s private and no one needs to know you have one
For those with very painful periods, it can make your cycle a lot more bearable (though won’t address the root cause of what is causing the discomfort)
It’s safe while breast/chest feeding
Everybody’s body reacts differently to the hormones, as well as having a new foreign object inserted. This is why it's so important to take note of the changes you witness or feel!
Some people don’t like not bleeding anymore
You need to be able to get to a healthcare provider for insertion and removal
Insertion and removal can be triggering and very uncomfortable
WE KNOW YOU’VE GOT EM! HERE ARE SOME ANSWERS TO COMMON QS ABOUT IUDS:
Will going to the bathroom or having sex cause it to come out?
Nope, it’s sitting tight in your uterus.
Do I have to have given birth before in order to get a Mirena inserted?
Nope, uteruses pre- and post-baby will fit the Mirena. However, it used to be true that you could only get an IUD post-birth, and that was partly because it can be easier to insert an IUD into a uterus that has given birth (14).
Why have I heard some bad things about IUDs?
IUDs used to have a bad name, and rightfully so! In the 70s, an IUD called the Dalkon Shield was put on the market and prematurely advertised as highly effective. However, the design of one of the IUD’s strings funneled bacteria back into the uterus, which caused pelvic inflammatory disease, sepsis, and infertility, causing 20 women to die due to infection. There were so many infections caused by the device that over 300,000 lawsuits were filed against the makers of the Dalkon Shield. Since then, many regulations have been put in place and the current IUD products that are sold are much different and safer (4).
I’m still a virgin if there’s an IUD in me, right?
Yep! While IUDs (and tampons) involve insertion, they’re not a sexual act and don't mean that you’re going to be partaking in intercouse. That’s your choice!
Written by: Catherine Work, Business Developer/Analyst for Cycles+Sex and avid birth control advocate.
Medically Reviewed by: Danielle LeBlanc, RN
Disclaimer - the information on this site is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your practitioners.
5. Bethune, Britni. “Increasing IUD Use in the United States: A Cost Consequences Study.” Evans School Review, vol. 2, no. 1, 2012, doi:10.7152/esr.v2i1.13733
10. Espey, Eve, and Lisa Hofler. “Practice Bulletin No. 186 Summary: Long-Acting Reversible Contraception: Implants and Intrauterine Devices.” Obstetrics & Gynecology, vol. 130, no. 5, 2017, pp. 1173–1175., doi:10.1097/00006250-201711000-00047.
15. Hendrickson-Jack, Lisa. The Fifth Vital Sign. Fertility Friday Publishing, Inc. 2019