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Factsheet
The Progestogen IUD (Mirena®)
Date 11 February 2008
WHAT IS THE PROGESTOGEN IUD?
This is a special IUD that contains the hormone progestogen. The progestogen IUD that is available in Australia is called the Mirena IUS (intra-uterine system). It is a small plastic T-shaped device with a cylinder containing progestogen around its stem. The cylinder is covered with a membrane that regulates the release of progestogen into the uterus (womb).
The device is placed inside the uterus to prevent pregnancy. It has a fine nylon string attached to it. When the device is in place, the string comes out through the cervix (the neck of the uterus) into the far end of the vagina. If you feel right up inside your vagina with your finger, you can check that the string can be felt coming out of the cervix and know it is still in place. The string also makes it easy for a doctor to remove the IUD.
HOW DOES THE PROGESTOGEN IUD WORK?
It changes the lining of the womb and causes the mucus in the cervix to become thicker so that sperm cannot enter the uterus. It also stops ovulation in some of the women who use it, especially in the first year of use.
WHO CAN USE THIS TYPE OF IUD?
You should be able to use it if:
- you have had a baby.
- after having your children, you want a reliable method of contraception that can be removed easily.
WHEN YOU SHOULD NOT USE THE PROGESTOGEN IUD
You should not use it if you:
- could be pregnant.
- have more than one sexual partner.
- have a partner who has other partners.
- have recently changed sexual partners.
- have a vaginal or pelvic infection (PID, infection in the tubes).
- have had more than one pelvic infection in the past.
- have abnormal bleeding from your vagina, which has not been diagnosed.
- have fibroids or other conditions that change the shape of your uterus or cervix.
WHEN YOU SHOULD THINK SERIOUSLY BEFORE CHOOSING THE PROGESTOGEN IUD
If any of these things apply to you, it is best to talk them over with your doctor before deciding to use this kind of IUD.
- You have not had children but want to have children in the future.
- You have had an ectopic pregnancy (a pregnancy in the tube).
- You have an abnormal Pap test that may require treatment.
- You have a medical condition that makes it very risky for you to have an internal infection, eg rheumatic heart disease, or treatment with steroids or other drugs that stop your immune system from working properly.
- You have already had an IUD that came out by itself.
- The space inside your uterus is fairly small or large (the doctor will be able to tell you when you are examined).
- You are going away to a place where you will be unable to have follow up checks.
THE PROGESTOGEN IUD AND BREASTFEEDING
Progestogen IUDs are considered to be safe in a lactating woman whose infant is younger than 6 weeks.
BENEFITS WITH USING THE PROGESTOGEN IUD
- This kind of IUD is more than 99% effective. This makes it more effective than the Pill.
- You can't forget to use it - it is always in place.
- It can stay in place and protect against pregnancy for five years.
- The cost of the device is subsidised for those with a Medicare card. This makes it an extremely inexpensive method of contraception.
- It is easy to remove the device, and fertility returns immediately.
- The Progestogen IUD reduces menstrual bleeding. This is good for women who normally have heavy or long lasting periods or for women who get heavy or long periods when they use a copper IUD.
POSSIBLE PROBLEMS WITH USING THE PROGESTOGEN IUD
- A change in your periods with irregular bleeding is likely for the first three to five months, but with longer use it is common to have light periods or none at all.
- The IUD may be pushed out of the uterus into the vagina and can even fall out eg when you go to the toilet, without you noticing. This can leave you at risk of getting pregnant (this is why you need to check for the string regularly). However if it is going to come out, it is more likely during the first few weeks after insertion. The chance of the Progestogen IUD coming out by itself is slightly higher than with copper IUDs.
- The risk of ectopic pregnancy is very low with a Progestogen IUD.
- Pelvic infections are less likely with Progestogen IUDs then with Copper IUDs. If a woman has a pelvic infection she has an increased risk of infertility (she may not be able to have children).
- Very rarely the device can pass into the wall of the uterus, and even more rarely through the wall of the uterus into the abdominal cavity, during insertion.
- Very occasionally a woman becomes pregnant with the Progestogen IUD in place. If the device is removed there is about a 30% chance of miscarriage. There are possible complications in continuing a pregnancy if the device cannot be removed straight away, and it is unclear what effect the hormone may have on the pregnancy.
- There is a slight chance there may be other effects to the body, eg. approximately 3% of women using the Progestogen IUD report symptoms such as vaginal dryness, flushing, headaches, nausea, acne, and mood changes.
Talk to a doctor if you are considering using the Progestogen IUD.
HOW DO YOU GET THE PROGESTOGEN IUD?
You will need to see a doctor twice for this device. On the first visit the doctor will ask you questions about your general and reproductive health. You will need to have a vaginal/pelvic examination, a Pap smear and possibly a test for vaginal infection, to make sure it is safe for you to use the Progestogen IUD.
On the second visit you will have the IUD inserted. You may have a local anaesthetic before it is inserted, but this is not always needed. Your doctor will explain the procedure to you. It takes about 10 minutes. Some women find it a little uncomfortable. You may have cramping low abdominal pain at the time of the insertion and this is why we ask you to have Naprogesic or Panadol before the insertion. You may feel faint during or after the insertion and you will probably be asked to rest for a while before you leave the clinic.
WHAT TO EXPECT AFTER THE PROGESTOGEN IUD INSERTION
You may have period-like cramps and bleeding or spotting in the first few days after the IUD is inserted. Take aspirin or paracetemol, and hold a hot water bottle on your belly to relieve any discomfort. If cramps, spotting or pain last more than a few days, see your doctor. You should avoid putting anything into your vagina (no vaginal sex, no tampons, baths, swimming or spas) for two to three days to reduce the risk of infection.
You will need to go back to the doctor for a check-up four to six weeks after the insertion. After that you will need a check up every year. If during that time you experience pelvic pain, fever, unusual vaginal discharge, heavy bleeding, or you think you may be pregnant, go to your doctor for another check up.
HOW IS THE PROGESTOGEN IUD REMOVED?
The device can stay in place for a maximum of five years. If you want to get pregnant or if you decide that you do not want to have the IUD for other reasons, it can be removed earlier. You will be given another vaginal/pelvic examination. Then the doctor will use a special instrument to remove the device by gently pulling on the string that can be seen coming through the cervix. This only takes a couple of minutes. Some women find it a little uncomfortable but some women don't feel much at all.
THINGS TO REMEMBER IF YOU DECIDE TO USE THE PROGESTOGEN IUD
Learn to check the string each month after a period to make sure it is still in the right place. If you have any unusual symptoms eg discharge from your vagina or pain in your lower abdomen, that could be PID, so see your doctor straight away.
If your period is more than a week overdue, see your doctor or clinic for a pregnancy test. If you or your partner ever have casual sex, of if you have a new sexual partner, use a condom every time until you both have been checked for sexually transmissible infections (STIs).
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For further information
Contact the Healthline on 1300 658 886.
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