Mirena or Levosert (IUS)

Mirena or Levosert (IUS)

Patient Information

Gynaecology Department

• Author ID:           WW-T
• Leaflet Ref:         Gyn 003
• Version:              13
• Leaflet title:         Mirena or Levosert (IUS)
• Date Produced:   September 2024
• Expiry Date:        September 2026

What is it?

An intrauterine system (IUS) is a small T-shaped plastic device which is fitted into the uterus by a trained Doctor or Nurse either for contraception or to treat heavy periods. It releases a small amount of a progestogen hormone into the uterus. (The hormone released is like the progesterone that is produced in the ovaries).  There are two different brands, Mirena and Levosert which are very similar and contain the same progestogen. In addition, there are two other IUS devices available (Jaydess and Kyleena) which contain a lower dose of progesterone. The Jaydess and Kyleena devices have a smaller frame and are more suitable for insertion in ladies who have not previously been pregnant.

How reliable is it?

Contraception

It is as effective as sterilisation, or possibly more effective, in preventing pregnancy but it is not permanent, your fertility will return almost immediately when it is removed.  If 1000 women use the IUS for one year, only two will become pregnant.

Reducing heavy periods

• In the first three to four months, it is likely that you will have bleeding on more days than not, but this is usually light enough that you only require a panty liner for protection.  Occasionally it may be heavier than this.
• After the first few months your periods will become more regular but are usually very light and in some cases they may stop altogether.  If the flow remains fairly heavy, then tampons may be worn but these should be avoided if there is only a very light loss.

Hormone replacement therapy

Hormone replacement therapy (HRT) for women who have not had a hysterectomy consists of 2 different hormones, oestrogen and progestogen, usually given as tablets or skin patches.  Some women find that progestogen give as tablets or patches makes them feel unwell, but it is very important that it is taken to help prevent cancer of the lining of the womb which can occur if oestrogen is taken without progestogen. As a Mirena IUS contains progestogen it can be used instead of tablets or patches for the progestogen part of HRT. If it is used for this purpose it needs to be changed every 4 years.   The Levosert device does not yet have a license for this use so a Mirena will always be used. The Jaydess and Kyleena IUS also do not have a licence for this use.

Fitting & checking

• The IUS is ideally fitted either during a period or within a week of the period starting.
• Usually, the IUS can be fitted in clinic but may require an anaesthetic especially if you have never had children.
• You may experience period like pain during fitting and for a few hours afterwards which should respond to mild pain killers.
• The IUS has two fine threads attached to it which can be felt sticking out of your cervix. You can use these to check the IUS is still inside, but you will not feel them unless you try to do so.

Side Effects

• You may experience some period type pain in the lower abdomen which will gradually reduce with time. If the pain is severe you should attend for a check-up as it may indicate that the Mirena/Levosert has been partly expelled or is displaced.
• The level of hormone released into the blood stream is very low and so usually there are no side effects from this.  There are, however, a few women who seem very sensitive to the hormone and who may experience mood changes, acne, headache or breast tenderness. Usually, these effects lessen with time.
• Your periods may change in a way that is not acceptable to you (your periods may stop altogether).
• The hormone in the Mirena/Levosert does occasionally cause small cysts on the ovaries which may be noted if you have a scan.  These do not cause any problems and usually disappear spontaneously.

Benefits

• It provides very effective contraception for eight years.
• Your fertility will return to normal almost immediately when it is removed.
• Your periods are likely to become much lighter and shorter and less painful or may stop altogether.

Risks

There is a small chance of getting a pelvic infection during the first three weeks after a Mirena/Levosert IUS is fitted. Pelvic infections are uncommon after the first three weeks because the progesterone in the IUS thickens the cervical mucus. However, an IUS does not protect you against sexually transmitted infections, so you need to use condoms if you are at risk of getting a sexually transmitted infection.

There is a small risk that the IUS might go through (perforate) your uterus or cervix when it is put in. This may cause pain but often there are no symptoms. If the IUS perforates the uterus or cervix it may have to be removed by surgery.

If you do become pregnant while you are using the IUS there is a small risk of ectopic pregnancy. The risk of ectopic pregnancy is less in women using an IUS than in women using no contraception.

For whom is it not suitable?

There are very few women for whom a Mirena/Levosert is not suitable, but it is important to tell the doctor fitting the Mirena/Levosert about any medical conditions, which you have.

It is suitable for those with high blood pressure, migraine, or a history of a thrombosis in the past.

Duration of use:

The Mirena IUS can be used for 8 years for contraception. It can be used as part of HRT for four years. 

The Levosert IUS can be used for 8 years for contraception. 

The Jaydess IUS can be used for 3 years for contraception. 

The Kyleena IUS can be used for 5 years for contraception. 

Alternatives to the IUS:

The copper IUD may be used for contraception in place of the Mirena/Levosert IUS. The copper IUD is effective for contraception for 5 to10 years. Periods may be heavier/longer/more painful with a copper IUD. The copper IUD is suitable for women who wish to continue to have periods.

Phoning for advice

Advice may be sought from:  The clinic in which it was fitted.

or

Swinley Ward, Royal Albert Edward Infirmary 01942 822568