When it comes to birth control, there’s no one-size-fits-all. Among the many options available, the Mirena — a hormonal intrauterine device (IUD) — has become increasingly popular for women seeking long-term, low-maintenance contraception.
But what if you’re considering the Mirena not for contraception, but as part of an endometriosis treatment plan?
As someone unable to undergo laparoscopic surgery for endometriosis, I recently had a long, challenging conversation with my gynaecologist. We spoke about quality of life, the monthly pain I endure, and how to find some immediate relief. That conversation raised questions, anxieties, and a deep need for clarity — especially because hormonal treatments and I don’t exactly have the best relationship. Truthfully, I’m scared of anything hormonal.
Whether you’re considering the Mirena for birth control, heavy periods, endometriosis, or hormonal regulation, here’s what you should know before making your decision.
What is the Mirena?
The Mirena is a small, T-shaped plastic device inserted into your uterus by a healthcare provider. It releases a low dose of levonorgestrel, a hormone that thickens cervical mucus, thins the uterine lining, and sometimes prevents ovulation. It provides up to eight years of contraceptive protection — but you can have it removed at any time if you want a change.
Benefits of the Mirena
Long-term protection
Mirena is over 99% effective and lasts up to eight years, making it ideal if you want to avoid daily pills or monthly appointments.
Lighter or no periods
Many women find their periods become much lighter or stop altogether within the first year. This can be life-changing for those with heavy bleeding, endometriosis, or anaemia.
Lower systemic hormone exposure
Because the hormone is released locally in the uterus, it tends to have fewer systemic effects compared to the pill.
Quick return to fertility
Once removed, most women regain normal fertility relatively quickly.
More than contraception
Mirena is also prescribed for managing hormonal acne, endometriosis, perimenopausal symptoms, and heavy menstrual bleeding.
Risks and side effects
Like any intervention, Mirena isn’t without potential downsides:
Insertion discomfort
Insertion can be painful or uncomfortable. Cramping, dizziness, or anxiety during the procedure are common. Many women find it easier if scheduled during their period when the cervix is softer, or they take pain relief beforehand.
Spotting and irregular bleeding
The first 3–6 months may bring spotting, irregular cycles, or prolonged bleeding as your body adjusts.
Hormonal side effects
Some women experience mood swings, acne, breast tenderness, or weight fluctuations, despite the hormone being localised.
Expulsion or perforation (rare)
There’s a small risk the device could be expelled or perforate the uterine wall during insertion. Your doctor will show you how to check the strings and watch for warning signs.
Ovarian cysts
Mirena can increase the risk of small ovarian cysts. These usually resolve on their own but may cause bloating or discomfort.
The emotional side: common fears
Deciding on any hormonal treatment can feel loaded, especially one involving your reproductive system. Many women share these concerns:
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Will I still feel like myself?
Hormonal shifts can be unsettling. Mood changes or emotional ups and downs are a common worry. -
What if it hurts or goes wrong?
Fear around insertion, especially for those with chronic pelvic pain or past trauma, is valid and should be discussed with your provider. -
Will I regret it?
The idea of committing to a device that stays in your body for years can feel overwhelming — even though it’s reversible. -
Will my partner feel it?
It’s rare, but if necessary, your doctor can trim the strings. -
What about my future fertility?
Even if children aren’t on your radar right now, altering your cycle can raise questions about what comes next.
Questions to ask your doctor
To feel more confident in your choice, consider asking:
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Is Mirena suitable for my health history and condition?
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What should I expect in the first few months?
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How will I know if it’s working properly?
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What non-hormonal alternatives do I have?
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Can I have it removed earlier than planned?
Choosing the Mirena is a personal decision. It offers freedom from daily pills and potential relief from heavy periods — but it also calls for self-awareness and informed discussion.
You’re allowed to take your time. You’re allowed to change your mind. You’re allowed to prioritise your body, your peace, and your power.
Whatever you choose, know this: you’re not alone. Talk to women who’ve been there. Consult your healthcare provider. Trust yourself. Your decision, made with care, is valid.
Your body. Your choice. Your timeline.
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