My name is Stephanie Mitelman, and I am a certified sexuality educator. In this blog I will be addressing readers’ questions on sexuality, health, and relationships. Please don’t be shy to send me a question you have! I will be happy to answer one every month!
I just had the Mirena IUD inserted. My doctor explained the basics, but what else do I need to know?
This is a great question. More and more women are having the Mirena intra uterine device inserted. There are many things to know.
Firstly, The Mirena system is different from traditional IUD’s because they are not copper, and they also contain a synthetic form of progesterone that is slowly released into the body. One advantage here is for women who have a hormonal imbalance, such as estrogen dominance, which this helps to balance out. The Mirena is also now being recommended for women who have heavy bleeds due to fibroids or adenomyosis (an irregular growth of the uterine lining), as well as younger women, and those who have not had vaginal births.
While every woman is different, the great majority of women who use Mirena are satisfied with the contraception, as well as the other benefits. If any side effects are experienced, it is likely to be in the first three months and then they may subside.
Here are some other things to consider:
- The majority of women will have a significant reduction in menstruation or a complete absence from six months to a year’s time after insertion. But the first couple of months will probably be an increase in menstruation, with the first two to three months being much heavier and sporadic. The reason this is happening is that the Mirena thins out the endometrial lining. This is how the contraception primarily works. If there is no lining, then a fertilized egg (zygote) can not attach to the uterine wall and grow. The progesterone also acts as an additional barrier.
- It is important to know that the low dose of progesterone in Mirena does not stop ovulation like other forms of birth control. So while using the Mirena, you will still ovulate (release an egg), and will still have the cyclical changes you may have normally experienced, for example change in appetite or bowel movements through the cycle.
- Another important point to know is that you are likely to feel at least some cramping in the first couple of months This is normal as the uterine wall is decreased. And it is also good to know that anything that thins out this endometrial lining also helps to reduce endometrial cancer.
- It is also possible however that some women experience a vaginal infection, likely bacterial vaginosis after insertion, or even on and off throughout the use of the Mirena. For some women, having a foreign object inserted into the body creates an imbalance and overgrowth of bacteria, which can lead to an odor and discomfort. The incidence of bacterial vaginosis is higher in women with the Mirena. If you experience this, it is important to see a doctor. Too many women assume any difference in the vagina is a yeast infection, and treat inappropriately. Bacterial vaginosis can be treated naturally, but most cases will need a prescription for vaginal antibiotics. It is also especially important to stop sexual intercourse if there is an infection, as penetration tends to make the infection worse, as well as exposing your partner to the antibiotics if being used. Treat the case fully, then resume sexual intercourse.
- Another important issue to understand with the Mirena is how it affects our sexuality. For some women, it may increase or decrease sex drive because of the low does of progesterone. Additionally it may affect the sexual arousal response (lubrication), and some women find they are less lubricated than before even when turned on. It is recommended to use a water based lubricant to ease this problem and make the sex feel better. This is the case with most women anyways, but especially true for some Mirena users.
- There are also some concerns about a partner feeling the Mirena inside. This is a possibility, and it can depend on the depth of the position, but is not usually reported as a major concern. If this is happening, then you can change positions to an angle that is not likely to reach the back of the vagina. Additionally, some practitioners are more likely to leave the strings of the Mirena long so that they coil around the cervix, rather than cutting them short which can be pointy when touched.
For some women, these are a lot of drawbacks. But for others, who are being treated for extremely heavy bleeds, or who need a contraception that is effective for 5 years that does not require daily thought, all these problems become minor. And finally, the insertion is not complicated. Lots of women fear the pain associated, but the procedure is extremely quick and only slightly uncomfortable when you have a skilled doctor. Plus, it is effective as a contraception immediately, and can be removed by your doctor at any time.
Stephanie Mitelman, MA, CSE