What are the uses of Mirena (levonorgestrel)?

Uses of Mirena (Levonorgestrel Intrauterine System)

Mirena is primarily used as a highly effective long-acting reversible contraceptive method with additional therapeutic benefits for heavy menstrual bleeding, making it an excellent dual-purpose option for women seeking both contraception and menstrual blood loss reduction. 1, 2

Primary Uses

Contraception

• Mirena is a highly effective contraceptive with a failure rate of less than 1%, providing protection for up to 8 years, though officially approved for 5-7 years depending on formulation 1, 3
• The 52-mg levonorgestrel IUD (Mirena) has demonstrated high contraceptive efficacy with a Pearl Index of 0.28 for years 6-8 of use 3
• Provides immediate contraceptive effect upon insertion with rapid return to fertility after removal 2
• Suitable for nulliparous adolescents and women who cannot use estrogen-containing contraceptives 1

Management of Heavy Menstrual Bleeding

• Highly effective for treating heavy menstrual bleeding (menorrhagia) with 80-95% reduction in menstrual blood loss within the first year of use 4, 5
• Many women experience amenorrhea by the second year of use, which can significantly improve quality of life 4
• More effective than oral medications for treating heavy menstrual bleeding 6
• NSAIDs can be used for 5-7 days to manage any unscheduled spotting or bleeding during initial use 1

Additional Therapeutic Uses

• Management of dysmenorrhea (painful periods) with significant symptom improvement 1
• Treatment of adenomyosis 2
• Management of endometrial hyperplasia in some cases 2
• Can be used in women with abnormal uterine bleeding to avoid hysterectomy 4
• Effective for managing heavy menstrual bleeding in women with spontaneous coronary artery dissection (SCAD) who require antiplatelet therapy 1

Special Populations

HIV-Infected Women

• HIV infection is not a contraindication to Mirena use (CDC US medical eligibility criteria category 2) 1
• Benefits generally outweigh theoretical or proven risks in HIV-infected women 1
• Not recommended in women with advanced HIV disease (category 3) until immunologic and clinical status improves with treatment 1

Women with Cardiovascular Disease

• Levonorgestrel-releasing intrauterine devices are among the safest contraceptive options for women with cardiovascular disease 1
• Particularly useful for women with cyanotic congenital heart disease and pulmonary vascular disease 1

Contraindications and Precautions

• Active pelvic infection or sexually transmitted infection (should be treated before insertion) 1
• Pregnancy (known or suspected) 7
• Uterine or cervical malignancy
• Distorted uterine cavity that would prevent proper IUD placement
• Unexplained vaginal bleeding 1
• Women taking medications that might reduce effectiveness (e.g., certain antiretrovirals) should be counseled about potential interactions 1

Side Effects and Management

• Most common side effects include irregular bleeding patterns, especially during the first few months 1
• Overall bleeding typically decreases over time, with many women experiencing amenorrhea 1, 4
• Minor adverse effects may include pelvic pain, breast tenderness, and ovarian cysts 6
• For unscheduled spotting or light bleeding, NSAIDs can be used for 5-7 days 1
• If bleeding persists and is unacceptable to the patient, alternative methods should be considered 1

Follow-up Recommendations

• No routine follow-up visits are required after insertion 1
• Women should be advised to return if they experience problems or side effects 1
• Consider checking for the presence of IUD strings during follow-up visits 1
• Assess satisfaction with the method and any concerns about use 1

Mirena offers a unique combination of highly effective contraception and therapeutic benefits for menstrual disorders, making it an excellent option for women seeking long-term, reversible birth control with additional health benefits.