What should I expect after a Mirena IUD removal?

It is typically less painful to get your Mirena IUD removed than it is to get it inserted but for a few hours or days after the removal you may experience some light pain and bleeding, cramping, or feel dizzy. An IUD removal typically takes about 5 minutes, but you should allow 20 minutes for the whole appointment. Consider eating something before your appointment so you are less likely to feel dizzy, and take some painkillers, such as acetaminophen or ibuprofen one hour before to help with any pain. Most women can go straight back to work or study or usual activities after the IUD is taken out.

Bleeding after the removal of Mirena is not considered a period, it is your body just responding to the withdrawal of the hormone levonorgestrel. Wear a pad for the first 48 hours after your Mirena removal to catch any blood. After 48 hours you can use tampons or a menstrual cup if you need to.
Sometimes the strings of the IUD are not visible to the doctor or nurse, and this can make taking out the IUD more difficult. A scan may be needed to check the IUD is still in place. Rarely, an IUD can become embedded in the lining of your uterus or poke a hole through your uterus. This only happens in 0.14% (1.4 per 1000) IUD insertions and a minor surgical procedure may be needed to remove it. Most perforations cause no long-term harm.

Occasionally, unexpected issues can happen. If any of the following happen to you in the days or weeks after your IUD removal, contact the health provider that removed the IUD or your doctor:

• Pain in your lower abdominal area
• An unusual or smelly discharge from your vagina
• Bleeding between periods
• Very heavy or painful periods
• Pain while you are having sex
• A fever >100.4°F (>38°C) and abdominal pain, unusual vaginal discharge, or heavy bleeding.

How soon after can I get pregnant?

You can start trying to get pregnant as soon as your Mirena is removed. If you become pregnant soon after removal, there is no evidence that you are at an increased risk of miscarriage (about 26% of known pregnancies end in miscarriage in women who have never had an IUD inserted).

Studies have shown that normal fertility returns quickly in most women after the removal of the Mirena IUD, with 37% of females planning a pregnancy conceiving (becoming pregnant) within three months of removal and 71% within 12 months. However, this rate of conception is lower than what would be expected in women trying to get pregnant who have not used an IUD (the expected conception rate in these women is 85% to 92%).

One review investigated the return to fertility in women using IUDs and found a lack of studies regarding the long-term effect of hormonal IUDs on fertility and changes to the lining of the uterus.

They did report that a trend existed between women who had never been pregnant before and a longer time to conception after Mirena removal. A longer duration of Mirena use was also associated with a longer time to conception. There were not enough studies to establish if long-term exposure to levonorgestrel (contained in Mirena) dysregulates normal gene transcription patterns, affecting the structure of the endometrium and growth. But it is likely that it does because studies with the copper IUD have shown changes.

Other studies have confirmed no significant differences between conception and pregnancy rates between the removal of the Mirena IUD and copper IUDs.

Related Questions

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• Can you get pregnant with an IUD?

When will I get my first period?

Surveys have indicated 25% of women get their period within a month of Mirena removal, 14% after 2 months, and 20% in 3 to 6 months. For most women, it takes 3 months or longer for their periods to resume. Once they do return they may be irregular for several months.

This is because your period is when your endometrium sheds and is discharged out of your body through your vagina. The hormone levonorgestrel contained in Mirena thins your endometrium, so there is less available to shed, meaning your periods are lighter and shorter, and some women have no periods at all. It takes a while for your endometrium to build back up to normal levels again.

If you have not got your period within 6 months talk to your healthcare provider because there may be other underlying reasons for your periods not returning. Remember, you can still get pregnant without having a period as the ovaries can still release an egg.

What is the ‘Mirena crash’?

The 'Mirena crash' is a cluster of symptoms reported by some women who have had their IUD removed. Symptoms may include:

• Breast tenderness
• Headaches
• Mood changes
• Reduced interest in sex
• Tiredness

Some women experience recurrent 'Mirena crash' symptoms before each period, which may last for months.