Insertion and Removal of Mirena Intrauterine Devices

Why Consider an IUD?

IUD is long-acting, reliable, safe and reversible contraception. IUDs can offer long-term contraception for up to 10 years after insertion.

Further, the IUD can be removed at any point of time ensuring an immediate return to fertility.

Other Benefits of IUDs?

It is also often used to treat heavy and painful periods (hormonal IUD). Benefits over the other contraceptive methods are

• Menstrual bleeding reduction (hormonal IUD)
• Menstrual pain decreases (hormonal IUD)
• Endometrial cancer risk is decreased (hormonal IUD)
• Elimination of adverse effects associated with oestrogen based contraceptive
• It is significantly cheaper than the pill over the long term
• You do not need to remember to take it, therefore, the contraceptive cover is much higher comparing to the oral contraceptive pill or condoms

IUDs do not offer protection against sexually transmitted diseases.

IUD Insertion Procedure

IUD insertion is a quite safe procedure and takes about 5 minutes. It is generally performed in the rooms.

The procedure is slightly more involved than a Cervical Screening Test/Pap smear and uses similar devices such as a speculum.

During the procedure we will:

• Insert a speculum into the vagina
• Clean the cervix with an antiseptic solution,
• Aligns the cervical canal and the uterine cavity using appropriate instruments
• Measures the depth of your uterine cavity with a tool
• Insert the IUD and
• Finally, the strings of the device are then trimmed.

You Should:

• Have a current and normal Cervical Screening Test (PAP smear).
• Swabs for Chlamydia and Gonorrhoea that are negative or be at very low risk of acquiring Pelvic Inflammatory Disease (these may be done on the day of your visit if not already done by your GP)
• Take two Nurofen or Panadol 1 hour before the appointment
• Be aware that very rarely the UID cannot be inserted in the rooms and you may require to undergo the procedure under a General Anaesthetic on at another visit.
• It is best to have the appointment made during or towards the end of your period as the insertion may be less uncomfortable
• Be aware that the actual process of the insertion takes a few minutes only and you should not be too concerned regarding the appointment
• Avoid swimming, baths, sexual intercourse, and tampons for 3 days after IUD insertion.
• Might be a good idea to have someone with you to drive you home.
• We will do our best to make your appointment quick and minimise the discomfort associated with the procedure. 

Complications

• Perforation of the womb occurs in less than 1:1000 patients. This may require a laparoscopy (keyhole surgery) to remove the IUD. The IUD is not effective once it is outside of the uterus and you will need alternative contraception
• Expulsion: The IUD can fall out if you are still having heavy periods or passing large clots. On rare occasions, young patients may have ongoing cramping resulting in expulsion.
• Missing strings: The stings can vanish into the uterine cavity which will make removal difficult. We can retrieve it in our rooms on most occasions with the help of a brush or a string finder but occasionally we have to do it in a theatre with the help of a hysteroscope
• Infection: It is possible to develop an infection of the uterus (endometritis) or Pelvic Inflammatory Disease. You need to contact us if you are unwell or have lower abdominal pain and offensive vaginal discharge. The IUD needs to be removed and the infection treated.
• Pregnancy is very rare but not impossible, if you are pregnant you need to contact your doctor to diagnose the location of the pregnancy or exclude ectopic pregnancy (pregnancy outside of the uterus)

Mirena IUD

• Mirena is an intrauterine device that contains the progesterone Levonorgestrel
• Mirena is used for contraception as well as Menorrhagia and/or Dysmenorrhea (heavy and/or painful periods)
• Once inserted Mirena will last for 5 years
• Fertility returns as soon as the Mirena is removed

Side Effects

• Irregular bleeding, daily spotting, or mild irregular spotting that usually resolves within three months. 15% of patients may have ongoing irregular bleeding that would require the removal of the Mirena.
• Some patients may not have periods or have very rare and light periods. This is not harmful. (Most patients enjoy this)
• Bloating, breast tenderness, mood changes, headaches, acne, or weight gain are possible but rare and usually resolve after two to three months.

Kyleena

Kyleena is a slightly smaller version of the Mirena. It also contains Levonorgestrel (a Progesterone) but at a lower dose. The idea behind this is that it is easier to insert and better tolerated by women who had no pregnancies/deliveries in the past. 

Less Progesterone means less suppression of the endometrium, therefore, it is unlikely to achieve “ no periods” or very light periods.

Less Progesterone should also mean fewer side effects like breast tenderness, headaches, bloating and mood changes. 

Periods are likely to be lighter than before and regular. 

Copper (Non-Hormonal) IUD

Copper IUD has no hormones so there are no side effects of hormonal nature such as breast tenderness, bloating, headache and irregular bleeding. However, Copper IUD can cause periods to be slightly heavier and more painful than usual.

There are different types of copper IUD, some last for 5 years, others for 10 years.

It is a very effective form of contraception.

More details about Implanon Insertion & Removal.