Getting Started with the 5 year Levonorgestrel IUD (“Mirena”)

What you need to know about using the 5 year intrauterine device for birth control or hormonal therapy 

How does the Levonorgestrel IUD work?

  • The IUD is a device that sits inside the uterus and releases a small amount of the hormone progestin.
  • The progestin keeps the lining of the uterus very thin.
  • The IUD works for five years. After five years, it should be removed (and you can have a new one placed if desired). The IUD can be removed sooner if needed.

What are the benefits of using the IUD?

  • Progestin in the IUD thins the uterine lining, meaning periods will be lighter and some teens will have no periods at all (this is a safe and expected benefit).
  • The thinning of the uterine lining is also the reason that the IUD is such an effective way to treat pelvic pain, cramps and heavy periods.
  • The IUD is a highly effective method of birth control, preventing pregnancy by blocking sperm from reaching an egg, and also thickening the cervical mucus so the sperm do not enter the uterine cavity.

How do I get the IUD?

  • You need to see a trained healthcare provider for insertion and removal of the IUD.
  • The IUD is inserted during a pelvic exam:
    • First, a vaginal exam is done to feel the size and position of the uterus.
    • Then a speculum is placed into the vagina and the IUD is placed through the cervix and inside the uterus.
    • There may be cramping with the IUD insertion.

What are the side effects?

Common side effects do not mean that the IUD is harmful or dangerous. These can include changes in your menstrual bleeding, such as irregular and frequent bleeding at first. This will transition into lighter periods or no periods at all.

Following IUD insertion, menstrual bleeding generally follows this pattern:

  • In the first few hours and days after getting an IUD: Some teens will have cramps and bleeding, and some teens have no symptoms at all. If you are cramping, apply a hot pad or warm water bottle over you lower belly, and – if it’s OK for you to take – use Ibuprofen 600mg every six hours as needed. It’s fine to wear pads or tampons if you are bleeding.
  • Over the next three to six months: You may have irregular bleeding or you may have spotting (very light bleeding or brownish discharge) almost every day. Then your periods may start to get very light. It may take up to six months until the frequent bleeding and spotting goes away. It is important to remember that this is an expected side effect during the first three to six months of use.
  • By six months of use: Most teens will be have lighter periods, less frequent if any spotting, and maybe no bleeding at all.
  • After one year of use: One out of five (20 percent) of women will have no period at all.  The chance that you will have no periods becomes more likely over time.

There is a very small risk of infection and uterine perforation due to the insertion. There is a very small risk of pregnancy even with the IUD in place.

Call the clinic immediately if you experience any of the following:

  • Fever or chills
  • Severe pain, cramping or increased bleeding

What about “the strings”?

  • There are very small and thin strings or threads that are attached to the IUD. These threads sit at the very top of the vagina and can be very hard to feel.
  • The best way to check that the IUD is in place is to feel for these strings each month.
  • If you are able to feel the strings, then this will be a great way for you to check that the IUD is positioned correctly. If you cannot feel the strings, this may be OK, but discuss it with your health provider.

If I’m using the IUD for birth control – when is it safe to have sex? Will the IUD interfere?

  • Wait five days after the IUD is inserted to have sex.
  • Neither you nor your partner should be able to tell the IUD is there. Please call us if you have any concerns.
  • The IUD does not protect against STDs (sexually transmitted diseases). If you are sexually active, get tested for STDs regularly and use condoms every time you have sex to prevent STDs, including HIV.

Learn more about STDs