Mirena aftercare: what happens next?
What to expect after the Mirena insertion?
Once you’ve had your Mirena fitted, in most cases you have nothing to worry about. Mirena will start releasing the hormone levonorgestrel into your womb.
It can stay in your body without being replaced for:
- Up to 8 years if it was prescribed as birth control
- Up to 8 years if it is being used to control heavy periods, unless your symptoms return earlier
- Up to 4 years if it was prescribed as a part of hormone replacement therapy (HRT)
However, there are certain things you may want to watch out for:
Immediately after Mirena is inserted
It is possible to experience some bleeding, cramping or pain during or immediately after Mirena is fitted. This is completely normal. If this happens, your doctor or nurse will ask you to rest for a while after the fitting.
If the bleeding continues, or you have a fever after your fitting, speak to your doctor. This might be a sign of:
- Infection: If you get severe pain or fever shortly after Mirena has been inserted, you may have a severe infection which must be treated immediately.
- Perforation: Severe pain and continued bleeding might be a sign of damage or a tear in the wall of the womb (perforation). Perforation is uncommon, but occurs most often during placement, although it may not be detected until sometime later.
- Ectopic pregnancy: Lower abdominal pain, especially if you also have a fever, or have missed a period, or have unexpected bleeding, should be reported to your doctor. This might be a sign of ectopic pregnancy. The absolute risk of ectopic pregnancy in Mirena users is low.
Follow-up appointments after Mirena insertion
You should have Mirena checked 6 weeks after it is fitted. Your doctor will tell you how often you need to get a check-up afterwards. This depends on your medical history. If your doctor has given you a patient reminder card, bring it to every appointment.
Checking your Mirena strings
Once fitted, you should periodically check if Mirena is in the correct place. Mirena will stop working if it is dislodged or pushed out from your womb.
Gently put a finger into your vagina and feel for the two thin threads attached to the lower end of Mirena. Your doctor or nurse will show you how to do this. Do not pull on the threads.
If you do not feel these threads, contact your doctor or nurse as soon as possible. Avoid vaginal intercourse or use another form of birth control such as condoms. There are many reasons you may not be able to feel your Mirena strings such as:
- Mirena threads being drawn up into the womb
- Threads breaking off
- Mirena coming out by itself
- In rare cases, Mirena may damage the wall of your womb
It may be necessary for you to have an ultrasound scan or X-ray to locate Mirena.
Your doctor or nurse may sometimes schedule a ‘thread check’ appointment if you need help learning how to feel for Mirena strings.
Clinical experts recommend that you check your Mirena strings/threads within 4–6 weeks of getting it fitted. After this, they might suggest you check it periodically, either once a month or after every period.
When will Mirena start working?
How quickly Mirena starts working depends on what you have been prescribed it for:
For birth control
Your protection from pregnancy on Mirena depends on when Mirena was fitted. If you had Mirena fitted within 7 days of your period, it works right away and will prevent you from getting pregnant.
However, if you had it fitted on any other day, it may not reliably prevent pregnancy right away. Ensure you are using another form of protection such as condoms for the first 7 days of having Mirena fitted.
As a part of hormone replacement therapy (HRT)
Once Mirena is fitted as part of your HRT treatment, you do not need to do anything, and it will start working right away.
However, keep a lookout if you develop any new bleeding or changes in bleeding patterns. Some women may experience this in the first 6 months of starting HRT when Mirena is used in conjunction with an oestrogen. You may also see changes in bleeding within 3 months of changing the oestrogen component of HRT. Your doctor may ask about any bleeding during your HRT check-in appointments.
Seek medical advice as soon as possible if you experience any unscheduled bleeding outside these timeframes.
For heavy periods
When fitted to control heavy periods, Mirena will start working gradually. You may have lighter periods, painful periods, some spotting (light bleeding in between periods), and irregular bleeding during the first few months after fitting.
You may have prolonged or heavy bleeding, or an increase in the frequency of bleeding, usually in the first 2 to 3 months, before you experience a reduction.
Will you have any pain after Mirena fitting?
You may have some pain or discomfort during and after your fitting. Everyone’s body is different – some women do not have any pain at all, while some may have severe pain. If you are experiencing pain during or after your fitting, you should let your healthcare provider know, and they will help you.
There are options such as painkillers available to manage this. If you are concerned about pain before your fitting, or experiencing pain during your fitting, talk to your doctor or nurse. They’ll advise on what options are available.
Pain after having Mirena fitted can have different causes:
- If you experience pain accompanied by fever after your fitting, speak to your doctor at the earliest. This might be a severe infection that needs to be treated urgently.
- Pain and bleeding might also signal that Mirena has been pushed out of the womb.
- Pain during sexual intercourse can be a symptom of Mirena moving out of place or damaging the womb.
If you experience pain for any reason after Mirena is fitted, contact your doctor as soon as possible. Also ensure you read your Mirena Patient Information Leaflet.
Bleeding and periods after Mirena insertion
It is normal to have bleeding in the first few months after the Mirena has been fitted. For up to 6 months after getting a Mirena inserted, you are likely to have unpredictable light bleeding or spotting.
This might initially be on most days, but as time goes on, you should have fewer days with bleeding. Studies show that, after six months of having Mirena fitted, the average number of spotting days per month decreases gradually from nine to four days.
What sanitary products can you use on Mirena?
Use of sanitary pads is recommended when on Mirena. However, if you have to use tampons or menstrual cups, you should change them with care so as not to pull the threads of Mirena.
Sexual activity after getting Mirena inserted
Mirena does not protect you from HIV or other sexually transmitted infections (STIs). You should use other methods such as condoms to protect yourself from these.
Some clinics advise waiting for 24 hours before having sexual intercourse, or till bleeding settles.
Will my partner be able to feel Mirena during sex?
You and your partner should not feel Mirena during sex. Mirena is placed in the womb, not in the vagina. Sometimes, your partner may feel the Mirena threads. If this happens, or you or your partner experience pain during sex, speak to your doctor.
Mirena aftercare: frequently asked questions (FAQs)
Glossary
Coil: A common name for an IUS or an IUD. It is a small device placed inside the womb to prevent pregnancy.
Hormone replacement therapy (HRT): Treatment that replaces the hormones that the body makes less of during menopause, including oestrogen to relieve menopause symptoms and progesterone to protect the lining of the womb.
Intrauterine system (IUS): A small T-shaped device placed inside the womb that slowly releases a hormone.
Levonorgestrel: One of the hormones that performs the function of a progestogen.
Menopause: Menopause is a condition caused by a fall in hormone levels in women between the ages of 45 or 55, but it can happen earlier.
Abbreviations
HMB, Heavy menstrual bleeding; HRT, hormone replacement therapy; IUS, intrauterine system.
PP-MIR-GB-0322 | October 2026