From the Guidelines
Yes, someone can experience daily bleeding with a Mirena IUD, and treatment options such as NSAIDs, hormonal treatment, or antifibrinolytic agents may be considered, depending on the patient's preferences, treatment goals, and medical history, as recommended by the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1.
The Mirena IUD, which releases levonorgestrel, a progestin hormone, can cause irregular spotting or breakthrough bleeding, especially during the first few months after insertion. According to the 2024 guidelines, for LNG-IUD users, such as Mirena, treatment options for spotting or light bleeding, or heavy/prolonged bleeding, may include NSAIDs, 5–7 days, hormonal treatment, 10–20 days, or antifibrinolytic agents, 5 days 1.
If daily bleeding persists, it is essential to explore patient goals, including continued method use or method discontinuation, and to consider underlying health conditions, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, as recommended by the guidelines 1.
Key considerations for managing bleeding irregularities with Mirena IUD include:
- Providing reassurance and advising the patient to contact their provider to discuss bleeding irregularities or other side effects
- Offering treatment options, such as NSAIDs, hormonal treatment, or antifibrinolytic agents, depending on the patient's preferences and medical history
- Considering underlying health conditions and treating or referring for care if necessary
- Removing the IUD if the patient desires discontinuation, and offering counseling on alternative contraceptive methods 1.
From the Research
Daily Bleeding due to Mirena IUD
- Daily bleeding can be a side effect of the Mirena IUD, especially during the initial months after insertion 2.
- The Mirena IUD releases levonorgestrel, a progestin hormone that can cause changes in menstrual bleeding patterns, including irregular bleeding or spotting 3, 4.
- Studies have shown that the Mirena IUD can reduce menstrual bleeding volume and frequency over time, but some women may experience persistent or increased bleeding 5, 4.
- The effectiveness of the Mirena IUD in reducing bleeding varies depending on the individual and the underlying cause of the bleeding 5, 4.
Management of Bleeding associated with Mirena IUD
- Non-steroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid may be effective in reducing bleeding associated with IUD use 6, 5.
- Vitamin B1 and mefenamic acid may also be effective in treating heavy menstrual bleeding associated with IUD use 5.
- In some cases, the Mirena IUD may need to be removed or replaced if bleeding persists or is severe 3.