Please note this blog has recently been updated.
The Mirena coil is a common method of contraception and is most loved for its effectiveness, convenience, longevity and role in treating heavy periods and other medical conditions. It appears that there’s always a lot of talk about how it goes in, but do we know how it comes out?
This post covers everything you need to know about the Mirena coil removal, from what to expect, to possible side effects, and even the ‘Mirena crash’.
When to remove the Mirena coil
The most common reasons for having your Mirena coil removed include, if your coil is due to be replaced, you wish to switch to another method of contraception, you’re not tolerating the side effects of the coil, or you wish to become pregnant. For some women, removal may be recommended by their doctor.
The Mirena coil removal can happen at any time by a trained doctor or nurse, most commonly in a GP practice or sexual health clinic. It’s simpler than having it fitted – you will need to get undressed from the waist down and have a vaginal examination using a speculum, the same examination as when the coil is inserted.
They will gently pull on the coil threads that should be easily visible in the vagina at the neck of the womb. The T shaped coil folds up and it can be pulled out of the womb. Some coil removals can be more difficult, for example if the threads are not easily visible, and you may need to be referred for an ultrasound scan or to a gynaecologist or contraception clinic.
If you don’t want to get pregnant, you’ll need to make sure you don’t have sex or will need to use condoms for the seven days before you have the Mirena coil removed. This is advised even if you are having the coil replaced in case there is a problem with fitting a new coil. If you wish to switch to another method your healthcare professional may advise you start this before you have your coil removed.
Is your Mirena coil running out?
After it is inserted, the Mirena coil releases a hormone called levonorgestrel, much like progesterone which is normally produced by the female body. This works to prevent pregnancy by thinning the lining of your womb so it’s less likely to accept a fertilised egg. It also thickens the mucus in your cervix. This makes it difficult for sperm to move through it and reach an egg. In some people, it stops the ovaries releasing an egg (ovulation), but most women continue to ovulate.
The Mirena coil is licensed for contraception for 5 years of use, however we know women often worry their Mirena coil may stop working before then or that its effects may be wearing off. According to the Faculty of Sexual and Reproductive Health (FSRH) in the UK, the Mirena coil releases approximately 20μg of levonorgestrel a day, reducing to 10μg per day after 5 years. There is also some limited evidence to suggest it may provide effective contraception beyond 5 years.
At the moment, to avoid unnecessary risk of coronavirus transmission, the FSRH advise Mirena coil replacement may be delayed for up to a year after expiry. However contraceptive effectiveness is not guaranteed during the sixth year and women may wish to use additional contraceptive precautions (e.g. condoms or progesterone only pill) until the coil can be replaced.
If you are over 45 years old at the time you have your Mirena coil fitted then you can rely on it for contraception, without getting it replaced, until you are 55 years old. However, if you are using your Mirena coil as part of hormone replacement therapy (HRT) to manage menopausal symptoms, then this must be changed after 5 years.
What is the ‘Mirena crash’?
The ‘Mirena crash’ refers to symptoms some women have reported experiencing after having their Mirena coil removed. These include many varied symptoms ranging from mood changes, fatigue and reduced libido to headaches or tender breasts.
For some women, Mirena crash symptoms appear recurrently before each period, lasting for months. Some other women report symptoms ongoing for extended periods of time. There is no definition of this in medical literature and there is no scientific evidence for or research into this.
Side effects of Mirena coil removal
Following your coil removal you may experience mild pain, cramps or bleeding which should resolve within a few days. If these persist or you feel unwell please consult your GP or sexual health clinic.
Depending on your reason for having the Mirena coil removed and whether you switch to another contraceptive method, you may experience symptoms associated with a return of your normal menstrual cycle, which could include symptoms of premenstrual syndrome (PMS), or other underlying conditions previously masked by the action of the Mirena coil. It is possible this may explain many of the varied symptoms some women report after Mirena coil removal. If you are concerned about the symptoms you are experiencing, or are worried about your health, please speak to your GP.
Check out our Mirena coil reviews to read about women’s experiences of having the Mirena coil removed.
Published 01/09/2020. Reviewed and edited by Dr Melanie Davis-Hall on 15/12/2020