Mirena® IUD's are plastic devices that fit inside your uterus and provide contraception. They have several advantages. First they are very effective with greater than 99% prevention of pregnancy.  The stem of the Mirena® contains levonorgestrel, a part of many popular birth control pills.

Second, once inserted, they are almost maintenance free. Some women will have almost no periods with the Mirena®, especially if inserted while breast feeding. From a health standpoint this is perfectly OK.

The problems with any IUD

1. Irregular bleeding- periods can happen at any time
2. Risk of infection- the IUD is a foreign body in your uterus and can increase risk of infection
3. Pain- some women experience either cramping or painful sex with an IUD
4. Expense- the most recent price increases make the purchase of 1 Mirena® more than $800
5. Pain at insertion of the IUD is like a bad cramp, but lasts a short time
6. Progestin side effects- some women will feel PMS type side effects, oily skin or acne (not common)

The advantages are many

1. Freedom from daily birth control routine
2. Immediate return of fertility if removed
3. Light or absent periods- unfortuantely they may not occur on schedule, but many women with time will have no periods at all
4. Can be used safely with breast feeding, high blood pressure, or estrogen sensitive problems, as the stem contains only progestins

Overall, the biggest problem with Mirena® is that most women will have a 2 to 3 month break in time period when they are likely to have irregular bleeding. If you make it through the first three months and are doing well, the odds are that  you will continue to experience the benefits of the Mirena® without much further problem.

For some women, that isn't the case and the side effects are excessive. These women often have the Mirena® removed, and choose another method of birth control.

If you have a Mirena®, the following should cause you to call your doctor for evaluation:

1. Fever associated with pelvic pain or discharge
2. Positive pregnancy test.- risk of tubal pregnancy  is significant
3. Persistent abnormal vaginal discharge
4. Known or suspected exposure to a sexually transmitted disease

In summary, Mirena® IUDs are very effective, safe, long lasting methods of birth control. If you are one of the women who has no side effects, and possibly also no periods, it may well seem like the perfect form of birth control. If you are not so fortunate, you may have irregular bleeding or pain which causes you to terminate your Mirena® experiment. If you are young, anticipate changing sexual partners, have no children, or have bacterial vaginosis, this method is probably not for you.