Mirena IUS Request

You have been directed to this form because you have asked about having a Mirena (hormone) intrauterine system (coil). Please read it carefully and fill in the sections that need completing, and you will be contacted with a date to attend for fitting.

Background

What is a Mirena IUS and how does it work?

The IUS is a plastic T shaped device which contains a hormone called levonorgestrel. This is a hormone similar to those found in the injectable contraceptive, the implant or the minipill, but is released locally into the womb and therefore has fewer side effects.

The device works by preventing implantation of a fertilised egg, by thinning out the lining of the womb and also by thickening up the mucus at the neck of the womb to stop sperm getting through in the first place.

How long does it last for?

The Mirena IUS is licensed for 8 years for contraception, and for 4-5 years if fitted for HRT. There is evidence that it may work for longer and if fitted after the age of 45 it is often left in until menopause (‘the change’). If used as part of HRT treatment it must be changed after 4-5 years.

What are the benefits of a Mirena IUS?

Contraception – the Mirena is a very reliable contraceptive with failure rates of less than 1 in 100.
The Mirena can help to reduce pain from period pain and from endometriosis
The Mirena can help to treat heavy periods
The Mirena can be used to protect the lining of the womb from HRT hormones

What are the potential problems with a Mirena IUS?

After the first insertion of a Mirena your bleeding pattern changes and for the first 3-6 months you may bleed erratically and on more days than usual but it tends to improve with time. By 1 year infrequent or no bleeding is usual
Ectopic (‘tubal’) pregnancy – pregnancy rates are very low in women who have a Mirena, and the overall risk of an ectopic pregnancy is low, but if a pregnancy does happen it is more likely to be in the tube than for a woman who does not have a Mirena fitted. For this reason if a woman becomes pregnant with a Mirena in place they should tell their doctor straight away so that a scan can be arranged, and if they have a positive pregnancy test and develop worsening pain in the lower tummy they should seek medical help straight away. If the pregnancy is in the womb and the plan is to continue it you are usually advised to have the Mirena removed but this increases the miscarriage risk
Complications of Mirena insertion:

It is common to get a bit of bleeding and cramping pain immediately after insertion – this should settle in a day or two
Expulsion – the risk of the Mirena falling out or being pushed out by the womb is said to be as high as 1 in 20 and commoner in the first year. I do not find this to be so common in my experience
Infection - if you develop any symptoms of infection, particularly smelly discharge, temperature or worsening pain in the lower abdomen after the Mirena is inserted you should let the surgery know via the duty doctor system. Infection is rare but we need to be aware of it as a possibility. Sometimes Mirenas that have been in place a while can have a type of bacteria on them called ‘ALO’ bacteria – these usually don’t cause any problems but can be seen on a smear result. They only require the Mirena to be removed if they are causing pain or discharge.
Damage to the womb during insertion – this is rare (around 2 per 1000 insertions in studies, higher if you are breast feeding). Generally it is obvious if it happens, and the womb will heal itself after the Mirena is removed. Occasionally it isn’t recognised at the time and the device moves within the tummy, and very occasionally it has to be removed by a gynaecologist via keyhole surgery.

Ovarian cysts – these can occur in patients using a Mirena, but they usually don’t cause any problems and they go away themselves

Swabs to make sure there is no chlamydia or gonorrhoea infection

Chlamydia is a common sexually shared infection that often causes no symptoms. Gonorrhoea is less common but again often causes no symptoms. Both cause infection at the cervix (the neck of the womb), and there is a risk that if a Mirena is inserted through a cervix that is infected then the infection can be spread into the womb and tubes and cause a pelvic infection – and there is a risk that if so it can affect your future ability to get pregnant.

Both infections can be detected using a single vaginal swab which you take yourself.

A swab doesn’t have to be done before a Mirena is inserted unless you are in a group where there is a higher risk of infection being present – remember it often causes no symptoms. If you are in one of the following groups you will need to take a swab before we can arrange for you to have a Mirena fitted:

Under the age of 25
Having a new sexual partner within the last 3 months
Having more than one sexual partner in the last year
Having a regular sexual partner who has other sexual partners
Having previously had a sexually shared infection (eg chlamydia)
Having previously been a sexual contact of someone diagnosed with a sexually shared infection
Using drugs or having problems with alcohol

Do you fit into any of these groups? (*)

Yes
No Invalid Input

If you answer yes we will arrange for you to have a swab to take a sample before your Mirena insertion appointment.

The swab packet contains two cotton bud swabs – you only need to use one of them, insert it into your vagina and swizzle it round 5 times. Then place the swab in the tube and break it off at the black line on the swab handle. Close the tube and attach the sticky label from the form to the tube, adding the date that you have taken the swab. Return it to reception in either Mold or Buckley. Results take about a week to come back. We need an up to date phone number to contact you on if the result is positive so please check we have this when you bring the swab in. If it is positive then you and any sexual partners will need a course of antibiotics, and will be advised to have a follow up check at a sexual health clinic.

If you aren’t in one of these groups but would still prefer to take a swab that is OK - please select yes(*)

Yes
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Timing of insertion

Mirena coils are licensed to be inserted between days 1 to 7 of your cycle (day 1 is the day your period starts). They can be inserted at other times if pregnancy has been reasonably excluded but extra protection is needed for the 7 days after insertion

Please answer the following questions:

When was your last period?(*)

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How often do your periods happen? (count from day 1 of a period to day 1 of the next one)(*)

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How long does the bleeding last?(*)

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Are they regular?(*)

Yes
No Invalid Input

Are you currently using contraception?(*)

Yes
No Invalid Input

What method of contraception are you using at the moment?(*)

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A note about the threads

The Mirena IUS has thin threads attached to the bottom that are used when it is time to remove the device. The threads are left so that they can be seen and felt at the cervix – you shouldn’t be able to feel them unless you feel your cervix, and your partner shouldn’t be aware of them. To check the Mirena hasn’t moved it is advised that you check the threads are there after any heavy bleeding. The easiest way to do this is to feel inside your vagina towards the small of your back – you should feel your cervix inside, it is a smooth rubbery round structure with a hole in the middle, the threads come through the hole. If you can’t feel them, don’t panic – they are usually there - but use additional contraception and contact the surgery so that a doctor or nurse can have a look and check. If the threads are not seen then we advise ongoing use of extra precautions and arrange a scan to look for the Mirena in the womb.

What about if I want the Mirena removed?

If you don’t want to be at risk of pregnancy you must have been using an alternative form of contraception for at least 7 days beforehand. Because the bleeding that happens in the early days with a Mirena usually improves with time you will be encouraged to persevere for at least 6 months before it is removed for bleeding reasons.

What happens now?

The doctor or nurse will review your answers on this form and work out when the best time to fit a Mirena for you will be. You will be contacted with a date – please let us know as soon as possible if you aren’t able to keep the appointment so we can offer it to someone else.

Please fill out the consent form below and press submit. We will then contact you with a date for insertion. Coil fitting clinics are held in the Mold surgery on Thursdays

Please bring a urine sample to your appointment.

Patient agreement for fitting of a Mirena IUS

Your Name(*)

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Contact Number(*)

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Email(*)

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Date of Birth(*)

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Address Line 1(*)

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Address Line 2

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Postcode(*)

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Mirena IUS Request

Background

What is a Mirena IUS and how does it work?

How long does it last for?

What are the benefits of a Mirena IUS?

What are the potential problems with a Mirena IUS?

Who can’t have a Mirena IUS?

Please select yes or no for each one:

Swabs to make sure there is no chlamydia or gonorrhoea infection

Timing of insertion

Please answer the following questions:

Changing from another method of contraception

Do any of the following apply:

Patients wanting replacement of an existing Mirena

Other ways to reasonably exclude pregnancy

A note about the threads

What about if I want the Mirena removed?

What happens now?

Patient agreement for fitting of a Mirena IUS

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