Womens Health

Insertion of Mirena

Mirena is a type of intrauterine device (IUD) that's inserted into the uterus by a health care professional to help reduce the chance of pregnancy. It contains low doses of progestin, a hormone similar to what's found in birth control pills. The addition of progestin further helps reduce the chance of pregnancy by thickening the cervical mucus making it harder for sperm to swim and reach an egg for fertilization.

Traditional IUD vs. Mirena

Mirena is a more effective birth control option than traditional IUDs because of the addition of hormones. Mirena is about 99 percent effective which is as effective as the birth control pill when it's used properly. Traditional IUDs are 96 to 98 percent effective.

The appeal of Mirena for many women is its effectiveness and the low levels of synthetic hormones required to make it effective. While birth control pills are also highly effective, they contain a much higher dose of hormones. The majority of birth control pills also contain estrogen, although progestin-only birth control pills are available.

Mirena only uses about one seventh of the amount of hormones found in a birth control pill. Such a low amount can be used because the hormones are released directly into the uterus and don't need to travel throughout the entire body.

This type of birth control can be effective for up to five years and no additional hormones or steps are required once Mirena has been inserted.

Preparation for Insertion

Once you've discussed with your health care provider that you'd like to begin using Mirena, you'll be given some general information about the contraceptive as well as a patient information booklet.

If your provider doesn't already know your health history, he or she will likely go over it with you to make sure there are no contraindications to the use of this contraceptive. Mirena can't be used by everyone and there are certain health conditions that could make the use of this hormone IUD dangerous.

You will likely need to complete a urine pregnancy test.

At this point you may be given a choice to continue with the preparation or you may have the option to go home and think about the information you've been given if you're not sure if you would like to proceed.

When You're Sure You Want to Continue

Depending on how long it's been since your last appointment, your health care provider may administer another urine pregnancy test.

You will then be asked to lie in a lithotomy position -- on your back with your feet in stirrups just like you would for a pap smear -- so that he or she can examine your cervix. A speculum will be inserted and your health care provider will look for any genital conditions. Your physician may also perform a bimanual exam. This is where your abdominal will be pressed. This process helps your doctor figure out the size and position of your uterus to determine if there are any problems and to also exclude pregnancy.

A suitable antiseptic solution will be used to cleanse the cervix and vagina. If pain is a concern, you can ask your doctor to perform a paracervical block. This is a process where local anesthetic is injected between specific spots along the vaginal portion of the cervix to numb the area.

Examining the Cervix

Your doctor will use tenaculum forceps to gently grab the upper lip of your cervix. These forceps will remain in place to keep the cervix slightly open. A uterine sound will be carefully inserted to measure the depth of the uterine cavity and more thoroughly check for any uterine anomaly.

Mirena needs to be inserted into a uterus that sounds to a depth of at least six centimeters to reduce the chance of expulsion, perforation, bleeding and pain.

The Insertion Procedure

Your doctor will load Mirena into the insertion tube making sure the knobs at the ends of the arms meet to close. The flange will be set for the depth for the uterine depth number the sounding measured. Then the tube will be inserted into the uterine cavity through your cervix.

Once the Mirena has been correctly inserted, sterile curved scissors will be used to cut the strings so only about one inch is visible outside the cervix.


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