Mirena
Published by Andrea Stearns
Last Updated On August 18, 2025

Mirena Insertion – How Do You Do It?

Aug 12, 2025

Uterine fibroids are the most common benign tumors in the female reproductive system, affecting up to 68.6% of women worldwide. These fibroids can significantly impact reproductive health and quality of life, making effective treatments essential. As awareness grows, long-acting contraceptive options like Mirena have become popular, not only for preventing pregnancy but also for helping manage symptoms related to conditions like uterine fibroids, particularly heavy menstrual bleeding.

Mirena, a hormonal intrauterine device (IUD), is a widely trusted option for long-term contraception and symptom relief. The insertion process itself is quick and typically done in a clinic, but it’s essential to get it right to ensure the procedure is comfortable, safe, and effective for the patient.

In this article, we’ll walk you through the Mirena insertion process, step by step, covering everything from preparation to aftercare, and offering key safety tips to ensure both patients and providers are well-prepared.

Key Takeaways

• Mirena IUD offers long-term contraception, effective for up to 8 years for pregnancy prevention and 5 years for managing heavy menstrual bleeding.
• Proper patient preparation and medical evaluation are essential before insertion, ensuring no active infections, unexplained bleeding, or pregnancy.
• The Mirena insertion procedure follows a standardized step-by-step process to ensure accurate placement and minimize complications.
• Pain management options, such as NSAIDs like naproxen or local anesthetics, can enhance comfort during insertion, while gentle cervical dilation may be needed for women with a narrow cervix.
• Post-insertion care includes precautions like avoiding vaginal insertion for 24–48 hours and monitoring for symptoms like severe pain, heavy bleeding, or signs of infection.
• A follow-up appointment is usually scheduled 4–6 weeks after insertion to ensure proper positioning and address any concerns.
• Mirena is a safe and effective long-term contraception option, with quick fertility recovery upon removal, and is recommended for women seeking both pregnancy prevention and symptom management.

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Preparing Patients and Selecting Candidates for Mirena

Before moving forward with a Mirena IUD, the provider must conduct a thorough patient evaluation. This ensures that Mirena is a suitable option and helps minimize risks. The first step is reviewing the medical history, current medications, and reproductive goals. 

Important screening considerations include:

• No Active Pelvic Infections: These could increase the risk of infection-related complications during the insertion process, so it’s essential to confirm that the patient is infection-free.
• No Unexplained Abnormal Uterine Bleeding: Any bleeding must be evaluated and treated before insertion to ensure safe and effective placement.
• Confirm Non-Pregnant Status: Before proceeding, it’s critical to verify that the patient is not pregnant. This ensures the insertion is safe and prevents any harm to an existing pregnancy.
• No Known Uterine Anomalies: Uterine abnormalities can interfere with proper Mirena placement, potentially reducing its effectiveness and increasing the risk of complications during insertion.

In addition to reviewing medical history, providers must educate patients about Mirena’s benefits, potential side effects, and any risks involved. A key part of counseling includes answering the common question, “How does Mirena work?” 

It’s essential for patients to fully understand Mirena’s mechanism of action, ensuring informed consent and a smooth insertion process. This step ensures that patients are aware of what to expect before, during, and after the procedure.

Step-by-Step Guide to Inserting the Mirena Device

The Mirena insertion steps are standardized to ensure the device is positioned correctly, minimize complications, and ensure long-term contraceptive effectiveness. By following proper technique, healthcare providers can offer a smoother experience for patients and achieve optimal results.

Steps in the Procedure

1. Prepare the Patient: First, the patient should be placed in the lithotomy position. A thorough pelvic examination is conducted to assess uterine size and position. This helps ensure that the procedure will go smoothly. The provider will also review any last-minute questions or concerns with the patient before proceeding.
2. Insert Speculum: The next step is to carefully insert the speculum to visualize the cervix. The cervix and surrounding area are cleaned with an appropriate antiseptic solution to maintain a sterile environment and reduce the risk of infection during the insertion.
3. Stabilize the Cervix: The tenaculum is used to hold the cervix in place gently. This step ensures proper alignment, prevents movement, and allows for precise placement of Mirena.
4. Measure Uterine Depth: A sterile uterine sound is inserted to measure the exact depth and orientation of the uterine cavity. This is critical for proper device placement, reducing the risk of expulsion or incorrect positioning.
5. Load the Device: The device is loaded into the inserter, following the Mirena manufacturer’s guidelines to ensure sterility. The device must be securely positioned in the applicator before proceeding.
6. Insert and Release: The inserter is advanced to the previously measured depth. The Mirena device is gently released, and the inserter is slowly withdrawn. Controlled movement during this step ensures the device remains in the correct position for maximum effectiveness.
7. Trim the Strings: After insertion, the Mirena strings are trimmed to about 2–3 cm, ensuring they are accessible for self-checks and follow-up visits. This helps both the patient and provider confirm proper placement.

Pain Control and Complication Management During Mirena Placement

Effective pain management during the Mirena IUD placement ensures a more comfortable experience for the patient and smooth cooperation during the procedure. While some individuals tolerate the insertion without medication, others may benefit from pre-procedure analgesia or local anesthesia.

Pain Management Options

• NSAIDs: Nonsteroidal anti-inflammatory drugs (such as naproxen) may help minimize cramping and discomfort during the insertion process. While ibuprofen is commonly used, studies suggest that naproxen or ketorolac may be more consistently effective for this purpose.
• Local Anesthetic: Applying a local anesthetic to the cervix can provide targeted relief, improving comfort throughout the procedure.
• Gentle Cervical Dilation: If the patient has a narrow cervical canal, gentle dilation may be necessary to ease the passage of the Mirena IUD. This should only be done if resistance is encountered, as routine dilation is not typically recommended.

Most patients will experience mild cramping, light bleeding, or dizziness during or shortly after the procedure. Although rare, serious complications such as uterine perforation or infection can occur and require immediate attention. Proper training in Mirena insertion allows providers to quickly recognize and address these potential issues.

Post-Insertion Monitoring and Follow-Up for Mirena Users

After Mirena insertion, monitoring the device’s position and ensuring the patient adjusts well to the IUD are critical to long-term success. Patients should take it easy immediately following the procedure and rest briefly before resuming normal activities. Mild cramping and light bleeding are common during the first few days.

Key Care Guidelines

• Vaginal restrictions: While not mandatory in all cases, patients should avoid inserting anything into the vagina (such as tampons) or engaging in intercourse for 24–48 hours as a precautionary measure.
• Monitor for complications: Patients should be aware of warning signs like severe pelvic pain, heavy bleeding, fever, or foul-smelling discharge, which could indicate complications such as infection or device expulsion.
• String check: Patients should perform a string check after each menstrual period to ensure the Mirena IUD remains in place. Regular self-checks and follow-up visits help ensure the device remains effective.

Patients usually schedule a follow-up appointment 4–6 weeks after the procedure to confirm the device is in the correct position. Some guidelines suggest follow-up at 4–12 weeks, and annual checkups are standard to maintain contraceptive effectiveness and address any concerns.

Conclusion

The Mirena IUD insertion process, when performed with proper technique and patient preparation, is a safe and effective way to provide long-term contraception. By following the correct insertion steps, using appropriate pain management strategies, and providing thorough post-insertion care, providers can ensure a positive experience and minimize complications.

Mirena is a trusted option for those seeking long-term contraception, and proper training in the Mirena IUD insertion procedure is key to ensuring both safety and patient satisfaction. Regular monitoring, timely follow-ups, and prompt reporting of symptoms will support the long-term success of Mirena use.

FAQs

1. How long does a Mirena insertion take?

The actual procedure usually takes less than 10 minutes, though the overall visit may be longer for counseling and preparation.

2. Is the insertion painful?

Discomfort varies from person to person. Many women report mild to moderate cramping during the insertion. Pain relief options can help manage the discomfort.

3. How soon does Mirena start working?

If inserted within the first seven days of the menstrual cycle, Mirena works immediately. If inserted at other times, use backup contraception for seven days.

4. Can I remove Mirena anytime?

Yes, Mirena can be removed at any time by a trained healthcare provider. Fertility typically returns quickly after removal.

5. What are the common side effects after insertion?

Mild cramping, spotting, or changes in bleeding patterns are common. These typically improve within a few months.

6. When should I call my doctor after insertion?

Seek medical attention if you experience severe pain, heavy bleeding, fever, or suspect the device has shifted out of place.

7. Is there special training for providers?

Yes, Mirena insertion training ensures that healthcare providers understand proper placement techniques and how to handle complications.

References

Lou Z, Huang Y, Li S, et al. Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990–2019: an age-period-cohort analysis for the global burden of disease 2019 study. BMC Public Health. 2023;23(1). doi:10.1186/s12889-023-15765-x

Tang WZ, Cai QY, Huang KJ, et al. The global burden of polycystic ovary syndrome, endometriosis, uterine fibroids, cervical cancer, uterine cancer, and ovarian cancer from 1990 to 2021. BMC Public Health. 2025;25(1). doi:10.1186/s12889-025-22881-3

Chabot S. Mirena (levonorgestrel): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing. WebMD. https://www.webmd.com/drugs/2/drug-20420/mirena-intrauterine/details