*This is a two-part story. Read the second half for my experience with Mirena post-pregnancy.
I don’t know if I’ll be having more kids or if I’ll stop at one, but regardless of my eventual choice, I know I’m not aiming to be part of the Two Under Two club. So it was an obvious choice after the birth of my daughter that I needed to get back on some type of contraception. The big question was which kind. I had tried a variety in the previous decade but the Mirena IUD seemed like the best choice. I had Mirena for three years before I had it removed in order to start a family. For the most part I was happy with it, happy enough that when my doctor asked me at my postpartum visit which contraception I’d like to go with, it was a no-brainer to try Mirena again. My experiences with Mirena pre- and post- pregnancy were somewhat different however both times I was able to forget about birth control and just live my life. When/if I’m ready to try again, I can just have my doctor remove it and I can try right away.
Overview of Mirena and IUDs
As of the time of this writing, I believe there are four IUDs on the market in the US. ParaGard, Mirena, Skyla, and Liletta. All of the IUDs are T-shaped and have a string connected to the bottom. ParaGard is the only IUD that is hormone-free and it can last for up to ten years; the others have differing amounts of hormones and last for anywhere from three years to five years. Placement and removal of these IUDs requires a trip to the doctor’s office but after they are placed, you’ll have no more monthly trips to the pharmacy. IUDs work via several mechanisms, including thinning the uterine lining, thickening cervical mucous, and preventing sperm from reaching the fallopian tubes. When you’re ready to try for a pregnancy, you go back to the doctor’s office, they pull on the string and it comes right out, so there is no waiting period to try to conceive.
Mirena – Pre-Pregnancy
Back in 2010, when I first decided to get an IUD, I only had two options: Mirena and ParaGard. From reading the advertising materials, I believed I couldn’t get Mirena since I had not yet had a child so I fully expected to get ParaGard. At my pre-placement visit, the nurse practitioner explained the all the nitty gritty legalese of the IUDs, you know, the side effects and whatnot. Then she told me that I was eligible for Mirena, even though it was considered “off-label”. I liked the idea of the hormonal IUD because it meant that I had yet another mechanism (hormones!) working to keep me child-free. At the end of the pre-placement visit, I had blood taken to test for pregnancy and assuming it came back negative I was to return in a day or two for placement. I was also given a prescription for Cytotec and instructed to use it the night before. Since I had not had given birth before, my cervix was tightly closed and the Cytotec was supposed to help soften and dilate the cervix.
To say I was anxious about the insertion procedure was an understatement. The nurse practitioner refused to provide strong numbing medication (i.e. lidocaine) before or during the procedure and since I have an extremely low pain tolerance I was sweating bullets. In a desperate attempt to get through the procedure, I called my primary care provider the day before and asked for something to be called into my pharmacy. I love that doctor; after some expected hesitation, she called in one pill of Xanax. I don’t know if it worked or not, my husband says I sounded loopy as I called him on my way to the doctor’s office, but I don’t remember feeling any different.
Per the nurse practitioner’s instructions, I had inserted the Cytotec (spoiler: it wasn’t orally) the night before and had proceeded to experience some pretty strong cramps all night. When I arrived to the office, I got set up in a room and the insertion procedure began. It started with a speculum and a sounding. Basically what that is, is the nurse takes a metal instrument and sticks it into your uterus to determine how deep your uterus is and how far they need to insert the actual IUD. When the uterine sound was inserted, I felt a very strong cramping, but I held it together. The sounding was over pretty quickly all things considered. Next, she applied a weak topical numbing agent that came with the Mirena package and put a stabilizing apparatus onto my cervix. Want a visual? Close your eyes and imagine those claw machines in the arcades. Yea. That. So she tells me to take a breath and inserts a hollow tube, inside of which is the actual IUD. From the moment it touched my cervix, I felt the most extreme cramping I’d ever felt in my life. Then came the tears. I grabbed onto my stomach in an attempt to soothe the cramps and tried to breathe through it. The nurse practitioner even asked if I wanted her to stop to which I replied “No! Then I’ll have to go through this all over again!”. Once the tube was inserted the appropriate distance, she pushed the IUD out of it and I felt another strong cramp which I can only imagine was the IUD arms flying outwards and battering my uterus from the inside. Throughout this entire process I started feeling that wierd sensation you get right before you pass out, so I just kept coaching myself to breathe in and breathe out. Finally, she removed the speculum and the stabilizer and let me sit up. Apparently, I looked white as a ghost, because she told me to stay seated and then got me a Snickers bar.
I went home that day with the expectation that I would be crampy for the next couple of hours. I don’t remember the cramps, but I do remember the spotting. The spotting continued almost every day for the next six months. It was light, but it was annoying as hell. When it finally stopped, I didn’t have a period for the several months and when I did, it was a day or two, and it was only spotting. I loved Mirena 95% of the time; I just hated that initial spotting.
When it came time to remove the Mirena I searched the internet for other people’s accounts of what the experience would be like. After hours of reading forum after forum, I had no answer. Every time someone asked a similar question on the forums, there would be always be ten or more responses of “I was wondering the same thing”! The closest I came to a real answer was women warning others to stay away from Mirena because the strings got pulled up inside the uterus and the doctor had to go searching for them (a painful process) or that the IUD perforated the uterine wall and was floating somewhere next to their intestines. As much as I tried to give those horror stories no mind, I kept wondering if my strings were still in the correct spot and if removal would be as easy as advertised by the manufacturer. Regardless of all that, though, I knew that the IUD had to come out.; it couldn’t stay in there forever. So I resigned myself to the idea that I’d be going through the same painful experience as I did when the IUD was inserted. I arrived to the doctor’s office and assumed the position. I held my breath expecting her to tell me that the strings were missing and that she’d have to do exploratory surgery; but quite the opposite. The strings were there and easily accessible. So I started to take a deep breath as part of my breathe-through-it pain-coping-plan and I felt a strong cramp which got stronger and stronger. At the peak of that cramp, when I thought I’d start tearing up, it suddenly stopped. I went to take another breath in preparation for the next cramp when the nurse practitioner said “all done”. At that moment, I realized the cramping only lasted 1-2 seconds and there were no additional cramps after that. The removal was nowhere near as difficult as the insertion!
I waited a few months to start trying to conceive, but when the time came, I was successfully pregnant within a year.