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Mirena intrauterine device
The Mirena intrauterine device (IUD) is a hormonal birth control method that involves inserting a small, T-shaped device into a woman’s uterus. The hormone levonorgestrel is then released into the uterus in a time-controlled manner over the next five years. At this point, Mirena removal is necessary.
INDICATIONS AND USAGE
- Mirena is indicated for intrauterine contraception for up to 5 years.
- Mirena is also indicated for the treatment of heavy menstrual bleeding in women who choose to use intrauterine contraception as their method of contraception.
- Mirena is recommended for women who have had at least one child.
- The system should be replaced after 5 years if continued use is desired.
DOSAGE AND ADMINISTRATION
- Mirena contains 52 mg of levonorgestrel (LNG).
- Initially, LNG is released at a rate of approximately 20 mcg/day. This rate decreases progressively to half that value after 5 years.
- Mirena must be removed by the end of the fifth year and can be replaced at the time of removal with a new Mirena if continued contraceptive protection is desired.
The hormone levonorgestrel is then released into the uterus in a time-controlled manner over the next five years. At this point, Mirena removal is necessary. Women may also choose to have the device removed at an earlier point, or premature removal may be needed due to serious and potentially life-threatening complications of the IUD.
 Normal removal of Mirena
Usually,Mirena removal is a routine procedure. The health care professional evaluates the uterus and the position of the strings attached to the IUD. Forceps or clamps are attached to the strings, which are then used to pull the device out. As the IUD is pulled out of the uterus, the flexible arms fold.
In some cases, the doctor or nurse is unable to remove Mirena normally. This may occur when the strings cannot be located. If the strings are not visible, the health care professional then checks to determine whether the IUD itself is still in the proper uterine position. If so, a minimally invasive procedure may be used to remove the device. If the device has migrated, more extensive surgery may be required.
Mirena removal may be conducted surgically.
The first and least invasive involves the use of forceps to take the Mirena out of the uterus. This often requires dilation of the cervical canal and possibly anesthesia.
In the event that the device has perforated the uterine wall and migrated, laparoscopic surgery is necessary.
The doctor is likely to run imaging tests on the patient, such as an ultrasound and a computerized tomography (CT) scan to determine the exact position on the device. Then, a series of small incisions is made over the area. The surgeon inserts a laparoscope, which is a small, tube-like device with a light and a camera at the end to allow for visibility. Additional small instruments are used for removal of the device. Laparoscopic surgery is generally preferred because it reduces the risk of surgical complications, offers the patient a shorter recovery time, and is less invasive than open surgery techniques.
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