Can Mirena (levonorgestrel-releasing intrauterine system) insertion cause itching?

Mirena Insertion and Skin Reactions: Itching as a Potential Side Effect

Yes, Mirena insertion can cause itching in some patients, which may present as urticaria (hives) or other skin reactions. While not among the most common side effects, skin reactions including itching have been documented following Mirena insertion.

Evidence of Skin Reactions with Mirena

• Case reports have documented acute urticaria (hives) developing shortly after Mirena insertion, suggesting a potential allergic or hypersensitivity reaction to the device or its components 1
• Another documented skin reaction associated with Mirena is seborrheic dermatitis, which can cause itching and scaling of the skin, particularly on the scalp and face 2
• These skin reactions appear to be rare but significant adverse effects that can occur following Mirena insertion 1, 2

Timing and Presentation

• Skin reactions like urticaria can develop within hours of Mirena insertion, as documented in a case where symptoms appeared approximately two hours post-procedure 1
• The itching may be accompanied by:
  • Pruritus (intense itching sensation)
  • Visible skin rash or hives
  • Occasionally other symptoms like slight abdominal pain or dizziness 1

Management of Skin Reactions

• If a patient develops significant itching or urticaria after Mirena insertion, removal of the device should be considered, especially if symptoms are severe 1
• Treatment may include:
  • Oral antihistamines (such as desloratadine)
  • Corticosteroids (such as methylprednisolone) for more severe reactions
  • Topical treatments for localized skin conditions 1, 2

Risk Factors and Considerations

• Patients with no prior history of allergic reactions to materials used during the procedure (plastic, metal, alcohol, medications, povidone-iodine) may still develop skin reactions to the Mirena device itself 1
• The levonorgestrel hormone in Mirena appears to be the most likely trigger for these skin reactions, rather than the physical components of the device 1, 2

Other Common Side Effects of Mirena

• While skin reactions are less common, healthcare providers should be aware of more frequent side effects to distinguish them from allergic reactions:
  • Irregular menstrual bleeding or spotting, especially in the first 3-6 months 3
  • Amenorrhea in approximately 29.5% of women within the first six cycles 3
  • Breast tenderness 3
  • Transient ovarian cysts 3

Clinical Implications

• Despite these potential side effects, Mirena remains a highly effective contraceptive with a failure rate of less than 1% 4
• For most patients, the benefits of Mirena for contraception and treatment of conditions like menorrhagia outweigh the risks of rare adverse effects like skin reactions 4
• Patients should be counseled about the possibility of skin reactions, including itching, as part of informed consent prior to Mirena insertion 1

If itching or skin reactions develop after Mirena insertion, prompt evaluation is warranted to determine if the device should be removed and appropriate treatment initiated.