Levonorgestrel Intrauterine Device 52mg

What is this medication for?

Levonorgestrel Intrauterine Device 52mg (also known as Mirena®) is a long-acting contraceptive intrauterine device (IUD). It slowly releases the hormone levonorgestrel, which is a type of progestogen, into the body. This causes changes to the cervix, and lining of the uterus (womb), thus preventing pregnancy. Mirena® is effective for contraception up to 8 years, but can be removed earlier, if required. 

Mirena® can also be used for other indications, and its length of use depends on the indication:

• For reduction of heavy menstrual bleeding (menorrhagia), it is effective for 5 years but continued use for up to 8 years may be considered. 

• For prevention of abnormal thickening of the uterus lining (endometrial hyperplasia) in those on hormone replacement therapy, it is effective for 4 years.

How should I take or use this medication?

• Mirena® comes in the form of a small, “T-shaped” device, which is inserted into the uterus by a trained healthcare professional.

• Your healthcare professional will discuss with you on the most suitable time to insert Mirena®. The need for a back up contraception (e.g. condoms) (if applicable) for the first 7 days will depend on the timing of insertion or whether you are switching from another type of hormonal contraception.

What precautions should I take when taking or using this medication?

Inform your healthcare professional if: 

• You are allergic to this medication or any of the other ingredients of this medication.

• You are pregnant or planning to become pregnant.

• You have a history of ectopic pregnancy (pregnancy outside the uterus).

• You have a history of or current medical conditions such as cancer, unexplained vaginal bleeding, pelvic, uterus or vaginal infections, abnormal growth in the uterus (e.g. fibroids), liver problems, stroke, heart diseases or seizures (fits).

• You are taking any other medications, including supplements, traditional medications and herbal remedies.

What are some common side effects of this medication? ​

• Dizziness after insertion of Mirena® and pain (like menstrual cramps) in the first few weeks after insertion.

  • Your doctor will advise you to rest for a while after the procedure.

• Changes in menstrual bleeding patterns e.g. bleeding may become absent, irregular, infrequent, frequent, prolonged, or occasionally heavy. 

  • Spotting or frequent bleeding is common during the first 3 – 6 months. However over time, your bleeding may stop (this is normal).

• If you have not had your menses for six weeks and are concerned, then you may consider taking a pregnancy test. If this is negative, there is no need to carry out another test unless you have other signs of pregnancy e.g. nausea or vomiting, feeling tired or breast tenderness

• Inform your healthcare professional if you are having heavy and continuous bleeding as it may lead to a condition known as anaemia (a lack of healthy red blood cells in the body).

• Stomach or pelvic pain.

• Headache

  • You may take painkillers such as Paracetamol to manage headaches.

• Vaginal irritation or discomfort 

  • If you suspect that you may have a vaginal infection such as pain, thick white discharge, itch or burning of the vagina; please see your healthcare professional. 

• Changes in mood

Inform your healthcare professional if the side effects above become severe and bothersome.

What are some rare but serious side-effects that I need to seek medical advice immediately? 

The symptoms of a drug allergy include one or more of the following: 

• Swollen face/eyes/lips/tongue

• Difficulty in breathing

• Itchy skin rashes over your entire body

If you experience any of these side effects or symptoms, you should see your healthcare provider immediately.

Very rarely, Mirena® may cause:

• Increased risk of blood clot formation, though the risk is lower for Mirena® (progestogen-only contraceptive) compared to combined oral contraceptives:

  • Any unusual sudden cough, breathlessness or difficulty in breathing 

  • Severe pain in the chest which may spread to the left arm

  • Severe pain or swelling in either of your legs

  • Change in your speech, including slurring of words

  • Change in your senses of hearing, smell or taste

  • Vision changes such as loss of vision or blurred vision

  • Changes in your senses of hearing, smell or taste

  • Unusual, severe or long-lasting headache or worsening of migraine

• Severe abdominal pain or fever developing shortly after insertion, which could indicate an infection.

• Severe abdominal pain, abnormal, continuous bleeding or painful sex which could indicate damage or a tear in the wall of the uterus (perforation).

• Dark urine or light-coloured stools, nausea, vomiting, loss of appetite, stomach pain, yellowing of your eyes or skin

• New onset of migraine, severe or frequent headaches, blurred vision

• A lump in the breast, breast pain or soreness, or nipple discharge

  • It is important to regularly check your breasts. If you feel any lump in your breasts, you should contact your healthcare provider.

What food or medication should I avoid when I take or use this medication?

• Some medications might interact with Mirena®. Check with your healthcare professional if you want to take any other medicines, supplements or herbal products. 

• If you see any other healthcare professional, inform him/her that you are using this device before he/she prescribes any other medicines.

What else should I know about this medication? 

Checking that Mirena® is in place 

Mirena® has two thin threads attached to it. You can check if Mirena® is in place after your menses, by gently putting your finger high up inside your vagina and feeling for the threads near the opening of your uterus (cervix). 

• Do not pull the threads because you may accidentally pull the Mirena® device out. 

• If you cannot feel the threads, this may indicate that it has been *expelled out or perforation has occurred. In this case you should avoid intercourse or use a barrier contraceptive (such as condoms) and contact your doctor.

 *In some patients, muscular contractions of the womb during menstruation may sometimes push the Mirena® out of place or expel it. This is more likely to occur if you are overweight or have heavy periods. Some possible symptoms of an expulsion are pain and abnormal bleeding (e.g. heavier bleeding than usual), but Mirena® may also come out without you noticing. 

The use of sanitary pads is recommended (instead of tampons or menstrual cups) to reduce the likelihood of accidentally pulling the threads of Mirena®.

Pregnancy and Fertility 

Mirena® protects you against pregnancy as soon as it is inserted, but it is recommended to wait at least 24 hours after it is inserted to have sexual intercourse to allow your body to rest.  You should not feel the presence of Mirena® during sexual intercourse, but your partner may feel the removal threads.

As Mirena® does not affect your normal fertility, you may become pregnant once it is removed from your body.