Mirena
Generic Name: Levonorgestrel
What is Mirena?
Mirena is a birth-control system called an intrauterine device (IUD) that is placed in your uterus to prevent pregnancy for up to 5 years. Mirena can also reduce menstrual blood loss in women who have heavy menstrual flow and who also want to use an implantable form of birth control.Mirena is recommended for women who have had at least one child.
What is the most important information I should know about Mirena?
Tell your doctor if you may be pregnant, have any type of abnormality of the uterus, have a history of pelvic inflammatory disease (unless you experienced a normal pregnancy after the infection was treated), have an untreated pelvic infection, experienced a serious pelvic infection within the last 3 months following a pregnancy, are susceptible to pelvic infections or have multiple sex partners, have uterine, cervical, or breast cancer, have problems with your immune system, have a previously implanted IUD that has not been removed, have unexplained vaginal bleeding, liver disease or tumors, or if you are allergic to levonorgestrel, silicone, or polyethylene.Call your doctor right away if you think you are pregnant. Severe infection, miscarriage, and premature delivery can occur with pregnancies that occur while an IUD is in place. There is also an increased risk of ectopic pregnancy.
Possible complications with Mirena include severe pelvic infections. Tell your doctor if you have symptoms of PID such as prolonged or heavy bleeding, unusual discharge from the vagina, abdominal or pelvic pain or tenderness, painful intercourse, chills, or fever.
Mirena may become attached to the uterine wall or perforate the uterus. Keep all follow-up visits with your doctor, who will monitor for complications.
Call your doctor if you develop severe pain within a few hours after Mirena is placed.
For the first 3 to 6 months, your monthly period may become irregular and the number of bleeding days may increase at first. You may also have frequent spotting or light bleeding. After your body adjusts, the number of bleeding days is likely to lessen, and you may even find that your periods stop altogether. The number of spotting and bleeding days may initially increase but then typically decreases in the months that follow.
Call your doctor if you think you might be exposed to sexually transmitted diseases (STDs), cannot feel Mirena's threads, develop very severe or migraine headaches, have yellowing of the skin or whites of the eyes (which may be signs of liver problems), have a stroke or heart attack, you or your partner becomes HIV positive, or have severe vaginal bleeding or bleeding that lasts a long time. Keep all follow-up visits with your doctor.
Mirena must be removed after 5 years. Your healthcare provider can insert a new Mirena during the same office visit if you choose to continue using Mirena. If you change your mind about birth control and want to become pregnant in less than 5 years, your healthcare provider can remove Mirena at any time.
Tampons may be used with Mirena.
Who should not take Mirena?
Tell your doctor if you may be pregnant, have any type of abnormality of the uterus, have a history of pelvic inflammatory disease (unless you experienced a normal pregnancy after the infection was treated), have an untreated pelvic infection, experienced a serious pelvic infection within the last 3 months following a pregnancy, are susceptible to pelvic infections or have multiple sex partners, have uterine, cervical, or breast cancer, have problems with your immune system, have a previously implanted IUD that has not been removed, have unexplained vaginal bleeding, liver disease or tumors, or if you are allergic to levonorgestrel, silicone, or polyethylene.Mirena has not been studied in women who have not started their period and in women >65 years old.
What should I tell my doctor before I take the first dose of Mirena?
Tell your doctor about all prescription, over-the-counter, and herbal medications you are taking before beginning treatment with Mirena. Also, tell your doctor if you have any of the conditions listed in "Who Should Not Take This Medication?" above, as well as your complete medical history, especially if you have or had a heart attack or stroke, were born with heart disease or defects, have problems with blood clotting or take medicine to reduce clotting, have high blood pressure, recently had a baby or if you are breastfeeding, have diabetes, use corticosteroid medications or insulin on a long-term basis, have severe migraine headaches, are at an increased risk of infection (e.g., because of leukemia, AIDS, or IV drug abuse), have a history of sexually transmitted diseases (e.g., gonorrhea, chlamydia), irregular bleeding, or endometrial polyps or cancer.What is the usual dosage?
The information below is based on the dosage guidelines your doctor uses. Depending on your condition and medical history, your doctor may prescribe a different regimen. Do not change the dosage or stop taking your medication without your doctor's approval.Your doctor will place Mirena into your uterus. Mirena contains 52 milligrams (mg) of levonorgestrel, which is released at a rate of about 20 micrograms (mcg) per day.
How should I take Mirena?
Mirena will be placed in the uterus by your healthcare provider.You should check that Mirena is in proper position by feeling the removal threads after each menstrual period. First, wash your hands with soap and water. Feel for the threads at the top of your vagina with your clean fingers. The threads are the only part of Mirena you should feel when Mirena is in your uterus. Be careful not to pull on the threads. If you feel more than just the threads, Mirena is not in the right position and may not prevent pregnancy. Call your healthcare provider to have it removed. If you cannot feel the threads at all, ask your healthcare provider to check that Mirena is still in the right place. In either case, use a non-hormonal birth control method (such as condoms or spermicide) until otherwise advised by your healthcare provider.
What should I avoid while taking Mirena?
Do not pull on the threads when checking if Mirena is in the proper position. If Mirena is misplaced or expelled, you may get pregnant if you have intercourse.What are possible food and drug interactions associated with Mirena?
If Mirena is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Mirena with the following: barbiturates, bosentan, carbamazepine, felbamate, griseofulvin, oxcarbazepine, non-nucleoside reverse transcriptase inhibitors, phenytoin, protease inhibitors, rifampin, St. John's wort, or topiramate.What are the possible side effects of Mirena?
Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking this drug.Side effects may include: Pain, bleeding or dizziness during and after placement of Mirena (alert your doctor if these symptoms do not stop 30 minutes after placement), expulsion (Mirena may come out by itself), missed menstrual periods, changes in bleeding (e.g., spotting), ovarian cysts
Can I receive Mirena if I am pregnant or breastfeeding?
Call your healthcare provider right away if you think you are pregnant or notice symptoms including unusual vaginal bleeding or abdominal pain.If Mirena cannot be removed, talk with your healthcare provider about the benefits and risks of continuing the pregnancy.
You may use Mirena when you are breastfeeding if more than 6 weeks have passed since you had your baby. If you are breastfeeding, Mirena is not likely to affect the quality or amount of your breast milk or the health of your nursing baby.
What should I do if I miss a dose of Mirena?
Mirena should be given under special circumstances determined by your doctor.How should I store Mirena?
Your doctor will properly store Mirena before implantation.
I'm Shereen A. Gharbia, PharmD. Welcome to PDR Health!
