The hormonal coil

Reading time about 12 minutes · Medically reviewed on 5 Sep 2026 by Dr. Linda Tamme

The most reliable reversible contraception – and at the same time a treatment for heavy bleeding. Everything about Jaydess, Kyleena and Mirena.

The hormonal coil is the most reliable reversible contraception there is – and at the same time a treatment for women who bleed too heavily. The two together explain why it makes up the greater part of contraception consultations in this practice. What it does, what it costs, how insertion works and what really happens in the first months: it is all set out here.

What a hormonal coil is

A hormonal coil is a small, T-shaped plastic body which is inserted into the uterus. The vertical arm carries a cylinder containing the progestogen levonorgestrel, which is released evenly and in very small amounts over years. At the lower end sit two fine threads which reach through the cervix into the vagina. They are used to check its position, and through them the coil is later removed again.

Its technical name is intrauterine system, IUS for short – as distinct from the hormone-free copper coil, the IUD. The difference is not merely one of terminology: both sit in the same place but work in completely different ways and do exactly the opposite with the bleeding. Anyone considering a coil therefore decides first between these two families and only afterwards about the model.

Three hormonal coils are on the market in Austria: Jaydess, Kyleena and Mirena. They differ in size, amount of hormone and duration, but not in how they work. All three are fitted at this practice.

How it works – and why that barely affects the whole body

The hormonal coil releases levonorgestrel directly where it is meant to act. With Jaydess that is about 14 micrograms a day at first, with Kyleena 17.5 and with Mirena 20. For comparison: a progestogen-only pill delivers a multiple of that, and does so through the bloodstream to the whole body. With the coil the hormone level in the blood stays so low that the typical side effects of systemic hormone administration occur considerably less often.

Three effects work together:

The cervical mucus becomes thick. That is the most important mechanism. A thick, impenetrable plug of mucus in the cervix stops sperm before they even reach the uterus.
The motility of the sperm decreases. What does pass the mucus moves more slowly and with less direction.
The lining of the uterus barely builds up any more. It stays thin. That is why the bleeding becomes lighter – and why in some women it stops altogether.

Ovulation is as a rule preserved with the smaller models. For many women that is precisely an argument in their favour: their own cycle carries on, only the bleeding is lighter. With Mirena and its higher amount of hormone, ovulation is suppressed more often, though not in everyone there either.

How reliable it is

The Pearl index states how many out of a hundred women become pregnant within a year. It is given in two versions: with perfect use and with typical use. With the pill the two figures differ by more than twentyfold – 0.3 against 7. Not because the pill is bad, but because it gets forgotten.

This is exactly where the strength of the coil lies: once it has been inserted there is nothing left to do and therefore nothing left to get wrong. Perfect and typical use coincide.

Method	Typical use	What you have to do
Contraceptive implant	0.05	nothing
Hormonal coil	0.2	nothing
Female sterilisation	0.5	nothing, and it is final
Copper coil	0.8	nothing
Three-monthly injection	6	one appointment per quarter
Combined pill	7	one tablet every day
Condom	13	every time

The third row deserves a second look: on the figures the hormonal coil is more reliable than sterilisation – and, unlike sterilisation, reversible at any time. All the methods side by side are in the contraception comparison.

The three models compared

Model	Levonorgestrel	Duration	Size	Price
Jaydess	13.5 mg	3 years	28 × 30 mm, tube 3.8 mm	€500
Kyleena	19.5 mg	5 years	28 × 30 mm, tube 3.8 mm	€600
Mirena	52 mg	up to 8 years	32 × 32 mm, tube 4.4 mm	€750

Jaydess is the smallest and has the least hormone. It stays in place for three years and is often chosen for young women and for women who have not given birth – not because the others would not work there, but because the thinner insertion tube makes insertion easier.

Kyleena has the same external dimensions and the same thin tube as Jaydess but contains more hormone and stays in place for five years. For many that is the sensible compromise: a small body, a long effect. It is the model most often chosen at this practice.

Mirena is the largest and has the most hormone. It is licensed for up to eight years for contraception and reduces bleeding most strongly. It is also the only coil that is additionally licensed as a treatment – more on that shortly.

All five coils offered at the practice, including the hormone-free ones, stand side by side with their price and cost per year in the coil comparison.

What happens to the bleeding

For most women this is the decisive question, and the answer has two parts which must not be separated.

In the long run the bleeding becomes lighter, shorter and less painful. After a year it stops altogether in about twelve out of a hundred women with Jaydess, in about 23 with Kyleena and in about 20 out of a hundred with Mirena. The absence of bleeding is not a sign that something is building up: the lining simply does not build up, so there is nothing there that would have to be shed. There is nothing medically worrying about it.

In the first three to six months it is the other way round. Irregular spotting is the rule during this time, not the exception – and it is the commonest reason why coils are removed early. Anyone who knows beforehand that this phase comes and goes again gets through it considerably more easily. Which is why this sentence stands here so expressly.

When the coil is a treatment as well

In Austria Mirena is licensed not only for contraception but also for the treatment of heavy menstrual bleeding. That is more than a formality: anyone coming because of bleeding that is too heavy who wants contraception anyway solves two questions with a single procedure.

What “too heavy” means is hard to describe in millilitres and easy in everyday life: when a pad or a tampon is soaked through in less than two hours, when bleeding lasts longer than seven days, when clots appear, when you plan your day around the bleeding or when your iron level is on the floor. The commonest causes are fibroids, polyps, a thyroid disorder or adenomyosis – all four belong investigated before a coil is inserted.

The hormonal coil is also used with endometriosis and adenomyosis, because the thin lining and the low local hormone level often relieve the pain markedly. And in the menopause Mirena serves as the progestogen component of hormone replacement therapy: anyone receiving oestrogen who has a uterus needs a progestogen with it in order to protect the lining. The coil takes that over without another tablet being needed.

Who it particularly comes into question for

After a thrombosis or with migraine with aura. The hormonal coil contains no oestrogen and does not increase the risk of thrombosis – unlike the combined pill, the ring and the patch.
For smokers over 35. The same consideration: without oestrogen the argument against the combined pill falls away.
While breastfeeding. Levonorgestrel at this dose does not impair milk production. It is usually inserted twelve weeks after the birth.
Where taking something daily does not reliably work. That is not a question of carefulness but of everyday life – shift work, travel, children, irregular days.
With heavy or painful bleeding. See above: here it is contraception and treatment at the same time.

When it is out of the question

in pregnancy
with an acute infection in the genital area – treat first, then insert
with unexplained bleeding – investigate first, then insert
with malformations or large fibroids that distort the cavity of the uterus
with a history of breast cancer – here the copper coil remains possible
with certain liver diseases

The procedure at this practice: two appointments

A coil is not inserted here on the same day as the consultation. That is not a detour but the reason why the second appointment is short and bearable.

First appointment: consultation and preliminary examination

First the conversation: history, bleeding pattern, family planning, how you tolerate hormones, what you have used so far and why it did not suit. Then the examination: ultrasound to assess the size, shape and position of the uterus, a wet mount and swabs for organisms. At the end it is settled which model fits – and that there is no infection that could be carried upwards during insertion. That is precisely the most important gain in safety from this appointment.

Second appointment: the insertion

The procedure itself takes a few minutes. The cervix is prepared, the coil in its insertion tube is pushed through the cervical canal and released, the threads are trimmed to length. A final ultrasound check confirms that it is correctly in place. Afterwards you may stay lying down as long as you wish.

The point in the cycle is not arbitrary: at the end of or shortly after a period the cervix is somewhat softer and more open of its own accord, and pregnancy is reliably ruled out.

Does it hurt?

Yes, insertion is unpleasant. Claiming otherwise helps nobody. But the honest answer goes further: how unpleasant it is depends considerably on how it is done. Four things make the difference – the preparation of the cervix, the point in the cycle, the diameter of the insertion tube (3.8 against 4.4 mm sounds like little and is not) and the time taken.

What to expect: a short, strong cramping pain at the moment when the tube passes the cervix, then a dragging pain like strong period pain which eases over some hours. Some women take the rest of the day off; many go back to work. A painkiller an hour beforehand makes sense and is discussed with you. Bring someone with you if you would prefer that.

The first weeks and the checks afterwards

In the first days afterpains and spotting are normal. Baths, swimming and tampons are not recommended for the first week, because the cervix is still slightly open; showering is of course possible.

A check takes place four to six weeks after insertion, and yearly after that. Ultrasound shows whether the coil is still in the right place – it can move or be expelled, most likely in the first months and most likely during a period. This happens in two to five out of a hundred women. You can also feel for the threads yourself from time to time; if they can suddenly no longer be found, or are noticeably longer, an appointment is worthwhile.

Risks you should know about

Perforation of the wall of the uterus during insertion: rare, of the order of one in a thousand, and if recognised in time mostly without consequences. Commoner shortly after a birth and while breastfeeding – which is why one usually waits twelve weeks there.
Ascending infection: somewhat more likely in the first three weeks after insertion and not afterwards. The cause is not the coil but the possibility of carrying an existing infection upwards – against which the consultation appointment with its swabs protects. Fever, increasing lower abdominal pain or foul-smelling discharge in the weeks afterwards belong investigated the same day.
Ectopic pregnancy: if pregnancy occurs despite the coil, it lies outside the uterus more often than usual – not because the coil causes that, but because it prevents implantation in the uterus particularly well. In absolute terms the risk with a coil is lower than with no contraception at all.
Cysts on the ovary: somewhat commoner, mostly harmless and disappearing again without treatment.

What it costs

The practice is a private practice. The price for the insertion appointment covers the whole package: the examination, the ultrasound, a pregnancy test, the wet mount, the medical preparation, the insertion and the coil itself. Jaydess costs €500, Kyleena €600 and Mirena €750. The preceding contraception consultation with swabs is charged at €250.

Calculated over the time in place, the most expensive coil is the cheapest: Mirena costs around €94 a year over eight years, Kyleena €120 over five years, Jaydess €167 over three. Which one fits is nevertheless decided not by the price but by size, hormone dose and by what is meant to happen to the bleeding. All the amounts are on the page fees.

You submit the invoice to your health insurance fund, which reimburses 80 per cent of the corresponding public tariff – that is, 80 per cent of what the same service would have cost with a contracted doctor, not 80 per cent of the fee. The difference stays with you. Contraceptives themselves are not covered by public insurance in Austria. If you are insured outside Austria, the route is set out under health insurance and reimbursement.

Removal and afterwards

Removal takes seconds: a short pull on the thread, the coil folds its arms in and slides out. It hurts considerably less than insertion. Fertility returns immediately – unlike after the three-monthly injection there is no delay. Pregnancy is possible in the very first cycle afterwards.

Anyone who wants to continue with contraception can have the new coil inserted at the same appointment. Anyone who wants to conceive should think about folic acid beforehand: four weeks before conception, not afterwards.

Three ideas that persist stubbornly

“A coil is only possible if you have already given birth.” That was the teaching of the 1980s and is outdated. With the small models and thin insertion tubes it is well suited to young women and women who have not given birth; the professional bodies expressly recommend it there too.

“The hormonal coil makes you put on weight.” In the licensing studies the development of weight did not differ from that without hormones. What many experience is an effect of the passing years, not of the coil – which does not make the annoyance any smaller but locates the cause elsewhere.

“It causes an abortion.” The most important mechanism is the thick cervical mucus; as a rule fertilisation does not occur in the first place. Anyone asking this question for reasons of belief gets it answered here at length rather than brushed aside.

What happens next

If you are considering a hormonal coil, the next step is the contraception consultation – that is where it is decided which model comes into question and when the insertion appointment sensibly falls. Arranging an appointment, or get an overview beforehand: coils in overview, coil comparison and contraception comparison.

Patient information leaflet, Mirena 52 mg

This is a translation. Below is the manufacturer's patient information leaflet for Mirena 52 mg intrauterine delivery system (levonorgestrel), Bayer, rendered into English for convenience. The authoritative text is the German original, which is reproduced word for word on the German version of this page and enclosed with the product. This translation replaces neither that leaflet nor the conversation at the practice.

1. What Mirena is and what it is used for

Mirena is an intrauterine delivery system (IUS, a “hormonal coil” inserted into the uterus) and is used for or in

contraception (the prevention of pregnancy)
hypermenorrhoea (very heavy periods)
endometrial protection (protection against excessive growth of the lining of the uterus) during hormone replacement therapy with an oestrogen.

Mirena consists of a plastic body in the shape of a T. On the vertical part there is a cylinder containing the progestogen levonorgestrel, a substance similar to the body's own corpus luteum hormone. The effectiveness of Mirena rests mainly on a local hormonal effect in the uterus, the hormone being released evenly in low doses (about 20 μg in 24 hours at the start, 10 μg/24 hours after 5 years) into the uterus and thereby suppressing the build-up of the lining. The contraceptive effect also rests on a thickening of the mucus in the cervix, through which sperm cannot enter the uterus. At the same time Mirena relieves the symptoms occurring during the period. Children and adolescents: Mirena must not be used before the first period (menarche).

The contraceptive effectiveness of Mirena has been examined in 5 larger clinical studies. With correct use of Mirena in accordance with the instructions for insertion, 2 in 1000 women become pregnant in the 1st year of use, and 7 in 1000 women after 5 years of use. This includes pregnancies due to unnoticed expulsion and perforation.

With excessively heavy periods (hypermenorrhoea) the amount and duration of bleeding are reduced through the direct influence on the lining of the uterus. If Mirena is used as part of hormone replacement therapy with an oestrogen for menopausal symptoms, regardless of how the oestrogen is administered, it prevents excessive growth of the lining of the uterus.

2. What you need to know before you use Mirena

General remarks
Before you can use Mirena, your doctor will ask you some questions about your personal medical history and that of your immediate family. Like other hormonal contraceptives, Mirena does not protect against HIV infection (AIDS) or other sexually transmitted diseases.

Warnings and precautions
Please talk to your doctor or pharmacist before Mirena is used. If you are using Mirena as part of hormone replacement therapy with an oestrogen, the safety information in the leaflet of the oestrogen preparation must be observed.

Mirena must not be used:

if you are pregnant or pregnancy is suspected in you,
if you have, or are suspected of having, a tumour whose growth is influenced by sex hormones (for example breast cancer),
if you have current or recurrent inflammation of the internal reproductive organs,
if you have an infection of the lower genital tract (of the vagina or of the cervix) (cervicitis),
if you have inflammation of the lining of the uterus after a birth,
if you have had an infection of the uterus after a miscarriage (within the last 3 months),
if you have an increased susceptibility to infection,
if you have cell changes of the cervix (cervical dysplasia),
if you have malignant tumours of the cervix or of the uterus,
if you have unexplained bleeding from the uterus,
if you have congenital or acquired malformations of the cervix or of the uterus, including fibroids, which distort the cavity of the uterus,
if you have acute liver disease or a liver tumour,
if you are allergic to levonorgestrel or to any of the other ingredients of this medicine listed in section 6.

Particular care is required when using Mirena

If you suffer from one of the conditions named below, Mirena should only be used after seeing a specialist, and should where appropriate be removed if one of these conditions occurs for the first time while Mirena is in place:

migraine; migraine with visual disturbance or other symptoms suggesting a temporary disturbance of the blood supply to the brain (for example difficulty in speaking or hearing, dizziness);
exceptionally severe headache;
jaundice;
a marked rise in blood pressure;
severe vascular disease such as stroke or heart attack;
acute venous thrombosis (blood clots in the veins). Mirena must be used with caution with congenital heart disease or heart valve disease carrying a risk of infective endocarditis (inflammation of the lining of the heart).

When it is inserted or removed, antibiotics should be taken as a precaution. In women with diabetes who use Mirena, blood sugar levels should be monitored. A change in diabetes treatment is not normally necessary for the duration of Mirena use, however.

For young women who have not yet given birth, or for women in the menopause with a shrunken uterus, Mirena is not a method of first choice.

Mirena is not suitable as a post-coital contraceptive (an “emergency contraceptive” immediately after intercourse).

Medical examinations/consultation

Before Mirena is inserted, your doctor will carry out a gynaecological examination (including the breasts and a smear). The position and size of the uterus are determined and pregnancy or sexually transmitted diseases are excluded; genital infections must be treated with demonstrable success. Your doctor will hand you the package leaflet for your information.

4 to 12 weeks after insertion you should attend a check-up so that the position of Mirena can be verified.

Further checks should take place at yearly intervals, and at shorter intervals if clinically necessary. Insertion or removal of Mirena can lead to pain and bleeding as well as to circulatory disturbances with loss of consciousness due to a sudden fall in blood pressure and pulse, or, where epilepsy is known, to seizures. Irregular bleeding can mask some symptoms of serious changes of the lining of the uterus (endometrial polyps and carcinoma), which is why appropriate diagnostic measures should be taken. Since irregular bleeding and spotting are usual in the first months after insertion, pathological changes of the lining of the uterus (the endometrium) are to be excluded before Mirena is inserted. This also applies where Mirena continues to be used for endometrial protection during oestrogen replacement therapy following previous use as a contraceptive. If irregularities of bleeding occur during prolonged use, appropriate diagnostic measures must be taken.

Oligomenorrhoea/amenorrhoea (infrequent/absent periods):

About 20% of women of childbearing age gradually develop oligomenorrhoea and/or amenorrhoea. If no bleeding begins within 6 weeks of the start of the last period, the possibility of pregnancy must be considered. A repeat pregnancy test is not necessary in women with no period unless other signs suggest pregnancy. When Mirena is used in combination with continuous oestrogen replacement therapy, bleeding mostly ceases gradually within the first year.

Infections of the internal reproductive organs

The insertion tube protects Mirena from contamination with organisms during insertion; it was developed in order to keep the risk of inflammation as low as possible. In users of copper intrauterine devices the frequency of infections of the internal reproductive organs is highest during the first month after insertion and decreases thereafter. Known risk factors for infections of the internal reproductive organs are sexually transmitted diseases. The risk of infection with sexually transmitted diseases can be reduced by using condoms. Infections of the internal reproductive organs can have serious consequences which affect fertility and increase the risk of pregnancies outside the uterus. As with other gynaecological or surgical procedures, a serious infection or sepsis (a very serious general infection which can be fatal) can occur after an intrauterine device has been inserted. With endometritis (inflammation of the lining of the uterus) or inflammation in the pelvic area, or if an acute infection is serious or does not respond to treatment within a few days, Mirena must be removed by your doctor without delay. See your doctor immediately if you have the following symptoms: persistent pain in the lower abdomen, fever, pain during sexual intercourse or irregular bleeding. Severe pain or fever occurring shortly after insertion can mean that you have a serious infection which must be treated immediately.

Expulsion

A partial or complete expulsion is mostly accompanied by bleeding or pain, but it can also occur unnoticed and lead to a loss of contraceptive protection. A partial expulsion can impair the effectiveness of Mirena. If the IUS is expelled, you are no longer protected against pregnancy. Since Mirena reduces the amount of menstrual bleeding, heavier bleeding can indicate an expulsion. Your doctor will explain to you how you can feel the removal threads of Mirena yourself. You should regularly satisfy yourself that the threads of the device are present, ideally directly after your period. If you cannot feel the threads or have indications of an expulsion, you should refrain from sexual intercourse or use another contraceptive and consult your doctor. A displaced Mirena should be removed and can be replaced by a new one at any time. See your doctor promptly.

Perforation

Perforation of or penetration into the wall of the uterus mostly occurs during the insertion of Mirena, although it may only be discovered later. A Mirena that has been displaced outside the cavity of the uterus cannot effectively prevent pregnancy and must be removed as soon as possible. Surgery may be necessary in order to remove the Mirena. The risk of perforation when Mirena is inserted is increased in breastfeeding women and in women up to 36 weeks after a birth, and may be increased in women with a retroflexed (backward-angled) uterus.

If you suspect that a perforation has occurred in you, see a doctor without delay and remind them that you have a Mirena in place, particularly if it is not the doctor who carried out the insertion.

Possible signs and symptoms of a perforation:

severe pain (similar to period cramps)
heavy bleeding (after insertion)
pain or bleeding lasting more than a few weeks
sudden changes in your period
pain during sexual intercourse
you can no longer feel the removal threads (see section 2, “Warnings and precautions” – threads that cannot be found)

Breast cancer

Women who take a combined oral contraceptive (“the pill”) have a slightly increased risk of breast cancer, chiefly with contraceptives containing oestrogen and progestogen. The increased risk gradually returns to the baseline risk for the woman's age within 10 years of stopping “the pill”. Since Mirena is likewise a hormonal contraceptive, it can be assumed that such a breast cancer risk also exists with the use of Mirena, possibly as great as with the use of combined oral contraceptives.

Ectopic pregnancy (pregnancy outside the uterus)

Women with a previous pregnancy outside the uterus, operations on the fallopian tubes or infections of the internal reproductive organs have an increased risk of pregnancies outside the uterus. If you have lower abdominal pain while using Mirena, particularly in connection with the absence of your period or with sudden bleeding after a longer bleeding-free interval (amenorrhoea), the possibility of a pregnancy outside the uterus must be considered. Very rarely a pregnancy outside the uterus can occur while Mirena is being used (in approximately 1 in 1000 women). The risk is higher in women who use no contraceptive method (3 to 5 in 1000 women per year). The absolute risk of a pregnancy outside the uterus is low with Mirena. If a Mirena user does become pregnant, however, the relative probability of a pregnancy outside the uterus is increased. See your doctor immediately if you suddenly suffer pain in the lower abdomen.

Threads that cannot be found

If at check-ups with the doctor the removal threads are not visible at the cervix, pregnancy must first be excluded. The removal threads may have moved into the uterus or the cervical canal and may become visible again during the next period. Once pregnancy has been excluded, the removal threads can usually be brought into the correct position by your doctor with the aid of a suitable instrument. If this is not successful, Mirena may have been expelled or may have perforated the wall of the uterus. Its correct position can be verified by ultrasound; otherwise Mirena can be located by X-ray examination.

Enlarged follicles (functional ovarian cysts)

The contraceptive effect of Mirena does not as a rule rest on inhibition of ovulation. Since Mirena acts mainly locally, women of childbearing age usually have cycles with ovulation and rupture of the follicle. Sometimes the regression of the follicle is delayed. These enlarged follicles cannot be distinguished by the doctor from ovarian cysts (fluid-filled growths of the ovary). Enlarged follicles were found in approximately 12% of Mirena users. Mostly these follicles cause no symptoms; rarely, pain in the pelvis or pain during sexual intercourse occurs. In most cases the enlarged follicles disappear spontaneously within 2 or 3 months. Should this not be the case, they are to be monitored by ultrasound or other diagnostic/therapeutic measures are to be initiated. In individual cases surgery may be necessary.

Psychiatric disorders:

Some women using hormonal contraceptives such as Mirena report depression or depressed mood. Depression can be serious and may occasionally lead to suicidal thoughts. If you experience mood changes and depressive symptoms, seek medical advice from your doctor as soon as possible.

Other medicines and Mirena
Tell your doctor or pharmacist if you are taking or using, have recently taken or used, or intend to take or use any other medicines. The breakdown of progestogens can be accelerated by the simultaneous administration of certain (enzyme-inducing) substances such as anticonvulsants (medicines against seizures; for example phenobarbital, phenytoin, carbamazepine) and anti-infectives (medicines against infections; for example rifampicin, rifabutin, nevirapine, efavirenz). The influence of these medicines on the contraceptive effect of Mirena is not known, but is assessed as not significant because of its predominantly local action.

Pregnancy, breastfeeding and fertility

Pregnancy

Mirena must not be used during an existing or suspected pregnancy. If you believe you are pregnant, see your doctor immediately. It is recommended that Mirena be removed, since the risk of a spontaneous miscarriage or premature labour is increased with a Mirena in place. Removal of Mirena or examination of the uterus can lead to a spontaneous miscarriage. If Mirena cannot easily be removed, termination of the pregnancy should be considered. If you wish to continue the pregnancy and Mirena cannot be removed, your doctor will inform you about any risks and the possible consequences of a premature birth. The course of such a pregnancy must be monitored carefully. A pregnancy outside the uterus must be excluded. Report to your doctor any symptoms that suggest complications with the pregnancy, such as cramping pain in the lower abdomen with fever. Because Mirena is used in the uterus, an effect on the unborn child (for example masculinisation) cannot be excluded. Experience of the outcome of pregnancies with Mirena is limited because of its high contraceptive effectiveness. In the cases in which a pregnancy has been carried to term with a Mirena in place, there is to date no indication of malformations or complications caused by Mirena.

Breastfeeding

Levonorgestrel has been found in breast milk (approximately 0.1% of the dose is taken up by the infant); however, it is unlikely that the dose released by Mirena after insertion into the cavity of the uterus carries a risk for the child. It appears to have no harmful effects on the growth or development of the child when Mirena is used six weeks after the birth. Progestogen-only methods appear to have no influence on the quantity or quality of breast milk.

In rare cases bleeding from the uterus has been reported in women who used Mirena while breastfeeding.

Fertility

The use of Mirena has no effect on future fertility. After Mirena is removed, women attain the same fertility as before. Driving and using machines

No effects on the ability to drive or to use machines have been observed.

Mirena contains barium sulphate
Mirena contains barium sulphate and is visible on X-ray examinations.

3. How to use Mirena

Mirena is inserted into the cavity of the uterus by the doctor. The maximum duration in place is 5 years. For contraception Mirena is as effective as the most effective copper coils available today. In clinical studies about 2 pregnancies occurred in the first year of using Mirena among 1000 women. In women undergoing hormone replacement therapy, Mirena can be used in combination with oral (hormone tablets) or transdermal oestrogen preparations (hormone patches on the skin). The insertion and removal of Mirena may only be carried out by a specialist experienced in and/or specially trained in handling Mirena.

Contraception or treatment of hypermenorrhoea (very heavy periods):
In women of childbearing age Mirena should be inserted within 7 days of the start of the period. Mirena can be replaced by a new intrauterine device at any point in the cycle. After a miscarriage in the first third of pregnancy, Mirena can be inserted immediately afterwards. After a birth, insertion should only be carried out once the uterus has fully returned to its normal size, but not earlier than 6 weeks after the birth (see section 2, “What you need to know before you use Mirena – perforation”). If the return to normal size is substantially delayed, waiting until up to 12 weeks after the birth should be considered, since the risk of perforation of the uterus is increased after a birth. If insertion is difficult and/or unusual pain or bleeding occurs during or after insertion, an ultrasound check should be carried out without delay in order to exclude a perforation.

Endometrial protection (protection against excessive growth of the lining of the uterus) during oestrogen replacement therapy:

If Mirena is used to protect the lining of the uterus during oestrogen replacement therapy, insertion can take place at any time in women who no longer have bleeding, or during the last days of the bleeding or of the withdrawal bleed.

Removal/replacement:

Mirena is removed by pulling gently on the removal threads with forceps. If the removal threads are not visible and the system is in the cavity of the uterus, Mirena can be removed with the aid of a particular grasping forceps. This may make dilatation (widening) of the cervical canal necessary. Mirena should be removed after 5 years. If you wish to stay with the same method, a new intrauterine device can be inserted immediately after the previous one has been removed. If pregnancy is not desired, Mirena should in women of childbearing age be removed during the period, provided there is a menstrual cycle. If Mirena is removed in the middle of the cycle and you have had unprotected sexual intercourse within the last week, there is a risk of pregnancy unless a new Mirena is inserted immediately after removal. After Mirena has been removed, the intrauterine device should be checked to make sure it is intact. Where there have been difficulties during removal, it has been reported in individual cases that the hormone cylinder slides over the horizontal arms and that these become covered inside the cylinder. Once the completeness of the IUS has been established, no further action is necessary. The end knobs of the horizontal arms usually prevent the cylinder from becoming completely detached from the T-shaped body.

Notes on handling

Mirena is supplied in sterile packaging which may only be opened immediately before insertion. Once removed from the pack, the product must be handled under sterile conditions. If the sterile packaging is damaged, Mirena is to be discarded.

Contact your doctor immediately if you experience the following (see also sections 2 and 4):

if you can no longer feel the threads in your vagina.
if your partner feels the removal threads during sexual intercourse.
if you or your partner can feel the lower end of the Mirena. Avoid sexual intercourse until your doctor has checked that the IUS is correctly in place.
if you think you are pregnant.
if you have persistent abdominal pain, fever or unusual discharge from the vagina; this may be a sign of an infection. Infections have to be treated immediately.
if you have pain or discomfort during sexual intercourse; this may be a sign of an infection or an ovarian cyst, for example, or an indication that the Mirena is not in the correct position.
if sudden changes occur in your periods (for example if you have little or no bleeding and begin to have persistent bleeding or pain, or begin to bleed heavily); this may indicate, for example, that the Mirena is not in the correct position or has been expelled.
severe pain (like period cramps) or heavy bleeding after the insertion of the Mirena.
if you have other symptoms, such as migraine; recurrent intense headache, sudden visual disturbance, jaundice and a marked rise in blood pressure.

The use of sanitary towels is recommended. If you use tampons, you should change them carefully and not pull on the threads of Mirena.

Additional notes on particular groups of patients

Older patients

The use of Mirena in women over 65 has not been studied.

Patients with impaired liver function

Mirena must not be used in women with acute liver disease or liver cancer (see section 2, “Mirena must not be used”).

Patients with impaired kidney function

The use of Mirena in women with impaired kidney function has not been studied.

If you have any further questions about the use of Mirena, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

What follows is a list of possible side effects ordered by frequency:

Side effects occur more often during the first months after Mirena is inserted and subside with longer use. In addition to the undesirable effects listed in section 2, “What you need to know before you use Mirena”, the following side effects have been reported in women using Mirena.

In women of childbearing age the average number of days per month on which spotting occurs falls gradually from nine to four days in the first six months of use. The proportion of women with prolonged bleeding (more than eight days) falls from 20% to 3% in the first three months of use. In clinical studies, 17% of women showed amenorrhoea lasting at least three months in the first year of use.

In combination with oestrogen replacement therapy, most Mirena users during or after the menopause had spotting and irregular bleeding during the first months of treatment. After that, bleeding and spotting decreased and about 40% of users have no further bleeding during the last 3 months of the first year of use. Disturbances of bleeding were commoner in women during the menopause compared with women after the menopause.

The frequency of enlarged follicles depends on the diagnostic method used; in clinical studies enlarged follicles were found in 12% of Mirena users. Most follicles are asymptomatic (cause no symptoms) and disappear within 3 months.

Very common side effects: affects more than 1 user in 10

Headache, abdominal pain, pain in the pelvis, changes in the bleeding pattern: heavier bleeding (hypermenorrhoea), infrequent periods (oligomenorrhoea), reduced bleeding (hypomenorrhoea), absence of periods (amenorrhoea), spotting, inflammation of the vagina and the external genitals (vulvovaginitis), discharge from the vagina.

Common side effects: affects 1 to 10 users in 100

Depressed mood, depression, nervousness, reduced sex drive (libido), migraine, nausea, acne, excessive hair growth with a male pattern of distribution (hirsutism), back pain, ovarian cysts, painful periods (dysmenorrhoea), breast pain, breast tenderness, expulsion of Mirena, weight gain.

Uncommon side effects: affects 1 to 10 users in 1,000

Wind, hair loss (alopecia), itching (pruritus), eczema, discolouration of the skin (chloasma), increased pigmentation of the skin (hyperpigmentation), inflammation in the pelvic area, inflammation of the lining of the cervix (cervicitis) and of the uterus (endometritis), Papanicolaou smear normal, class II, perforation of the uterus, retention of fluid in the tissues (oedema).

Rare side effects: affects 1 to 10 users in 10,000

Rash, hives (urticaria).

Infections

Cases of sepsis (a very serious general infection which can be fatal) have been reported after the insertion of the intrauterine device (see section 2, “What you need to know before you use Mirena”).

Pregnancy, the postnatal period and perinatal conditions

Should you become pregnant with a Mirena in place, the probability of a tubal or abdominal pregnancy developing is increased (see section 2 under “Pregnancy outside the uterus”). The removal threads may be noticeable to your partner during sexual intercourse.

Disorders of the reproductive organs and the breast

Cases of breast cancer have been reported (the frequency is not known).

The following side effects have been observed during the insertion and removal of Mirena:

Pain, bleeding, circulatory disturbances with dizziness or brief loss of consciousness (syncope). In women with epilepsy, seizures may occur.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly (see the details below). By reporting side effects you can help provide more information on the safety of this medicine.

Federal Office for Safety in Health Care (Bundesamt für Sicherheit im Gesundheitswesen)
Traisengasse 5
1200 Vienna
Fax: + 43 (0) 50 555 36207
Website: http://www.basg.gv.at/

5. How to store Mirena

Keep this medicine out of the sight and reach of children. Do not open the blister. The pack should only be opened by your doctor or the healthcare staff. Do not use this medicine after the expiry date stated on the outer carton and on the blister pack after “Use by”. The expiry date refers to the last day of the month stated. Do not dispose of medicines in waste water or household waste. Ask your pharmacist how to dispose of the medicine when you no longer use it. You will thereby be helping to protect the environment.

6. Contents of the pack and other information

What Mirena contains:

The active substance is levonorgestrel. 1 intrauterine device contains 52 mg of levonorgestrel.

The other ingredients are: polydimethylsiloxane elastomer, polyethylene, barium sulphate, black iron oxide (E172).

What Mirena looks like and contents of the pack:

Mirena is an intrauterine delivery system and is available in a pack of 1.

Marketing authorisation holder and manufacturer:
Marketing authorisation holder:

Bayer Austria Ges.m.b.H.
1160 Vienna

Manufacturer:
Bayer Oy, 20101 Turku, Finland
Authorisation no.: 1-21529

This leaflet was last revised in December 2018.

Frequently asked questions

Will my partner notice the threads?

Occasionally, above all in the first weeks, while the threads have not yet softened. They can be trimmed afterwards – a short appointment with no fuss.

Does the coil work immediately?

If it is inserted in the first seven days of the cycle, it works immediately. At a later point additional protection with a condom for seven days makes sense.

Can I do sport, go to the sauna or use a menstrual cup with a coil?

Sport and sauna without restriction. With a menstrual cup, release the suction deliberately before removing it, so that it does not pull on the threads.

Does a hormonal coil protect against sexually transmitted infections?

No. For that the condom is the only method â with changing partners, therefore, in addition.

What happens if I do become pregnant with a coil in place?

That is rare. If it happens, it first has to be established by ultrasound whether the pregnancy is in the uterus. Where it is inside the uterus, the coil is as a rule removed early, because that makes the course more favourable.

Do I have to change the coil immediately once the duration has expired?

Yes â after the licensed period, contraceptive protection is no longer assured. The change takes place in one appointment: the old one out, the new one in.

Sources

Summaries of product characteristics for Jaydess, Kyleena and Mirena, Bayer Austria, as at 2025.
Faculty of Sexual & Reproductive Healthcare: Intrauterine Contraception. FSRH Clinical Guideline, London 2023.
Trussell J: Contraceptive failure in the United States. Contraception 2011;83(5):397â404.
World Health Organization: Medical eligibility criteria for contraceptive use. 5th edition, Geneva 2015.
Austrian Society of Obstetrics and Gynaecology: recommendations on contraception, Vienna 2024.

This text is general information and cannot replace a consultation: it does not know your history and cannot examine you. If something about your situation differs from what is described here, that difference is what matters.

Arrange an appointment →

Read on

IUD & coils

The only reversible method as reliable in practice as on paper – and an honest answer to the question about fi…

Jaydess

The smallest coil with the least hormone – often the first one. Why three years is sometimes exactly the right…

Kyleena

The most frequently chosen hormonal coil: as small as Jaydess, effective for five years. Who it suits – and wh…