Mirena is a hormonal intrauterine device (IUD) that releases levonorgestrel, a synthetic form of progesterone. This IUD prevents pregnancy and can manage heavy menstrual bleeding, offering effective contraception for up to eight years. Removal may be desired for pregnancy, device expiration, or unwanted side effects.
The Mirena Removal Procedure
Mirena removal is typically a straightforward procedure performed in a healthcare provider’s office. A speculum is used to visualize the cervix, and the provider gently pulls on the IUD’s threads, which usually hang into the vagina. The device’s T-shaped arms fold upwards as it is withdrawn.
While generally well-tolerated, some individuals may experience brief discomfort, cramping, or light bleeding. If threads are not visible, the provider may use ultrasound or specialized instruments. Rarely, if the IUD has become embedded, a minor surgical procedure like a hysteroscopy may be necessary.
What to Expect After Removal
After Mirena removal, the body begins to adjust to the absence of synthetic levonorgestrel. Many people experience what is often called a “Mirena crash,” a collection of symptoms stemming from hormonal fluctuations as the body resumes natural hormone production. These symptoms can manifest shortly after removal and may persist for days, weeks, or months, varying in intensity and duration.
Physical symptoms commonly reported include withdrawal bleeding (not a true period), cramping, bloating, breast tenderness, headaches, nausea, acne flare-ups, fatigue, weight fluctuations, joint/muscle pain, or hair loss. Beyond physical symptoms, emotional shifts are also frequently noted. Mood swings, anxiety, irritability, depression, brain fog, difficulty concentrating, insomnia, and a diminished sex drive can occur. These emotional symptoms are attributed to the body’s adjustment to the sudden reduction in the synthetic hormone.
Your Menstrual Cycle and Fertility Post-Mirena
Following Mirena removal, the reproductive system typically returns to its baseline function. The menstrual cycle usually resumes within a few weeks to a few months, though initial cycles might be irregular as the body re-establishes its hormonal rhythm. Mirena’s levonorgestrel thins the uterine lining, so it takes time for the endometrium to rebuild to normal levels, influencing the return and regularity of periods.
A significant aspect of Mirena removal, especially for those planning pregnancy, is the rapid return of fertility. Ovulation can occur almost immediately after the device is removed. Studies indicate that about 8 out of 10 women who wish to become pregnant will conceive within the first year, with over half conceiving within three months.
Given this swift return, it is important to use an alternative contraceptive method immediately if pregnancy is not desired. Healthcare providers may recommend starting a new birth control method seven days before Mirena removal to ensure continuous protection. While the return to a regular cycle can vary, the ability to conceive is generally not impaired by prior Mirena use.
When to Seek Professional Guidance
While many post-Mirena removal symptoms are temporary, certain signs warrant professional medical attention. Contact a healthcare provider if experiencing severe or worsening pain in the uterus or abdomen. Report persistent, very heavy, or prolonged bleeding beyond normal spotting.
Signs of infection, such as fever, chills, or unusual vaginal discharge with an unpleasant odor, require immediate medical evaluation. Severe and persistent mood changes, including intense anxiety, depression, or thoughts of self-harm, should prompt consultation. Additionally, if pregnancy symptoms appear and contraception was not immediately used, seek guidance.