From the Guidelines
If you are pregnant with a Mirena IUD in place, it is recommended to remove it as soon as possible if the strings are visible, as this improves pregnancy outcomes by reducing the risks of spontaneous abortion, preterm delivery, and infection. According to the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, adapted from the World Health Organization 1, removing the IUD is beneficial when the strings are visible or the device can be safely retrieved from the cervical canal.
The potential risks associated with leaving the IUD in place during pregnancy are substantial, including spontaneous abortion, preterm delivery, and infection. Although the effect of hormonal exposure from an LNG-IUD on the fetus is unknown, the overall risks of adverse pregnancy outcomes are higher when the IUD is not removed 1.
Key considerations for removal include:
- The procedure is typically quick and performed by a healthcare provider
- Removal is safest during the first trimester
- If the strings aren't visible, ultrasound guidance may be needed to locate and remove the IUD
- In some cases, removal may be difficult or risky, and the provider might recommend leaving it in place and monitoring closely throughout pregnancy
After removal, it is essential to monitor the pregnancy carefully, especially in the following weeks, as the risk of pregnancy loss after IUD removal is approximately higher than normal but lower than if the IUD remains in place 1. It is crucial to contact the healthcare provider immediately if any symptoms such as vaginal bleeding, cramping, or fluid leakage occur after removal.
From the Research
Mirena IUD Removal While Pregnant
- The removal of a Mirena IUD while pregnant is a complex issue, and there are several factors to consider, as indicated by studies 2, 3, 4.
- According to a study published in 2005, pregnancy is a contraindication to IUD use, and insertion of the IUD can take place at any time during the menstrual cycle provided the woman is not pregnant 2.
- A case report published in 2012 describes a situation where a levonorgestrel-releasing intrauterine system (LNG-IUS) was inserted in a woman who was unknowingly pregnant, and the device was not detectable in the uterine cavity by ultrasound, making removal impossible without causing miscarriage 3.
- Another study published in 2017 compared expulsions and adverse events between immediate and delayed insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) following medical termination of pregnancy (MTOP), and found that immediate insertion increased the expulsion rate 4.
- However, there is limited research specifically addressing the removal of a Mirena IUD while pregnant, and more studies are needed to fully understand the risks and complications associated with this procedure 5, 6.
Risks and Complications
- The risks and complications associated with Mirena IUD removal while pregnant include miscarriage, premature delivery, and preterm rupture of the membranes, as well as potential masculinisation of the fetus by levonorgestrel 3.
- The expulsion rate of the IUD may also be increased if it is inserted immediately after medical termination of pregnancy (MTOP) 4.
- However, one study found that a healthy infant can be delivered at term with an IUS in situ, probably without causing any abnormalities 3.
Current Research Gaps
- There is a need for further research on the effects of Mirena IUD removal while pregnant, particularly in terms of the risks and complications associated with this procedure 5, 6.
- Additionally, more studies are needed to understand the interaction between nulliparity, long-term use of LNG-IUD, and return to normal fertility 5.