From the Guidelines
If the strings of your Mirena IUD are unable to be visualized after 8 years of use, you should schedule an appointment with your healthcare provider promptly to determine the location of the IUD and assess the need for replacement. The Mirena IUD is FDA-approved for up to 7 years (or 8 years off-label in some cases), so it may need replacement 1. Your provider will likely perform an ultrasound to confirm the IUD is still properly positioned in your uterus, as recommended by the U.S. Selected Practice Recommendations for Contraceptive Use 1. Missing strings can occur when they curl up into the cervical canal, are cut too short, or if the IUD has moved out of position. While waiting for your appointment, use a backup contraception method like condoms to prevent unintended pregnancy. Don't attempt to remove the IUD yourself or insert anything into your vagina to locate the strings, as this can cause complications. If you experience severe pain, abnormal bleeding, fever, or signs of pregnancy, seek immediate medical attention as these could indicate complications such as perforation, infection, or pregnancy with an IUD in place 1. It's essential to follow up with your healthcare provider to ensure the IUD is still effective and to discuss any concerns or symptoms you may be experiencing 1.
Some key points to consider:
- The location of the IUD should be confirmed using ultrasonography, if available 1
- If the IUD cannot be located, it might have been expelled or have perforated the uterine wall 1
- Advise the woman to seek care promptly if she has heavy bleeding, cramping, pain, abnormal vaginal discharge, or fever 1
- The U.S. Medical Eligibility Criteria for Contraceptive Use provides guidance on the use of IUDs in various clinical scenarios, including conditions such as pelvic inflammatory disease, STIs, and HIV/AIDS 1
From the Research
Unable to Visualize Mirena Strings
If the Mirena (levonorgestrel-releasing intrauterine system) strings are unable to be visualized after 8 years of use, the following steps can be considered:
- Use ultrasound to locate the IUD, as it is a cost-effective, accurate, safe, and accessible imaging solution for the assessment of IUDs 2
- Measure the distance from the top of the device to the fundal serosa (IUD-fundus) and upper margin of the endometrial cavity (IUD-myometrium) to determine the position of the IUD 3
- Consider the possibility of expulsion or removal for side effects, although the risk is rare 4, 3
- Counsel patients that their Mirena IUD retains contraceptive effectiveness for extended use up to 8 years, with a cumulative failure rate of 0.68% for years 6 through 8 5
Important Considerations
- The position of the IUD on ultrasound may not predict complications such as expulsion or removal for symptoms 3
- Patient-initiated discussions of Mirena IUDs are associated with a significantly longer duration of use 6
- The levonorgestrel-releasing IUD (LNG-IUD) provides non-contraceptive health benefits, including improvement in dysmenorrhea and heavy menstrual bleeding 4