•Mirena is a hormone-releasing system placed in your uterus to prevent pregnancy for up to 5 years. •Mirena can also lessen menstrual blood loss in women who have heavy menstrual flow and who also want to use a birth control method that is placed in the uterus to prevent pregnancy. •Mirena is recommended for women who have had at least one child. Mirena is T-shaped. It is made of flexible plastic and contains a progestin hormone called levonorgestrel that is often used in birth control pills. Mirena does not contain estrogen. Mirena releases the hormone into the uterus. Only small amounts of the hormone enter your blood. Mirena can cause your menstrual bleeding to be less by thinning the lining of the uterus.

It is not known exactly how Mirena works. Mirena may work in several ways. It may thicken your cervical mucus, thin the lining of your uterus, inhibit sperm movement and reduce sperm survival. Mirena may stop release of your egg from your ovary.

In the clinical trial performed in women with heavy menstrual bleeding and treated with Mirena, almost 9 out of 10 were treated successfully and their blood loss was reduced by more than half.

You might choose Mirena if you: •Want birth control that provides a low chance of getting pregnant (less than 1 in 100). •Want birth control that is reversible. •Want a birth control method that does not require taking it daily. •Have had at least one child. •Want treatment for heavy periods and want to use a birth control method that is placed in the uterus to prevent pregnancy.

Do not use Mirena if you: •Might be pregnant. •Have had a serious pelvic infection called pelvic inflammatory disease (PID) unless you have had a normal pregnancy after the infection went away. •Have an untreated pelvic infection now. •Have had a serious pelvic infection in the past 3 months after a pregnancy. •Can get infections easily. For example, if you have: - More than one sexual partner or your partner has more than one partner. - Problems with your immune system. - Intravenous drug abuse. •Have or suspect you might have cancer of the uterus or cervix. •Have bleeding from the vagina that has not been explained. •Have liver disease or liver tumor. •Have breast cancer now or in the past or suspect you have breast cancer. •Have an intrauterine device in your uterus already. •Have a condition of the uterus that changes the shape of the uterine cavity, such as large fibroid tumors. •Are allergic to levonorgestrel, silicone, or polyethylene. Before having Mirena placed, tell your healthcare provider if you: •Have had a heart attack. •Have had a stroke. •Were born with heart disease or have problems with your heart valves. •Have problems with blood clotting or take medicine to reduce clotting. •Have high blood pressure. •Recently had a baby or if you are breast feeding. •Have diabetes (high blood sugar). •Use corticosteroid medications on a long-term basis. •Have severe migraine headaches.

Yes, you should return to your healthcare provider for a follow-up visit 4 to 12 weeks after Mirena is placed to make sure that Mirena is in the right position

Tampons may be used with Mirena.

Call your healthcare provider right away if you think you are pregnant. If you get pregnant while using Mirena, you may have an ectopic pregnancy

For the first 3 to 6 months, your monthly period may become irregular and the number of bleeding days may increase at first. You may also have frequent spotting or light bleeding. A few women have heavy bleeding during this time. After your body adjusts, the number of bleeding days is likely to lessen, and you may even find that your periods stop altogether. In some women with heavy bleeding, the total blood loss per cycle progressively decreases with continued use. The number of spotting and bleeding days may initially increase but then typically decreases in the months that follow

You may use Mirena when you are breastfeeding if more than six weeks have passed since you had your baby.

You and your partner should not feel Mirena during intercourse. Mirena is placed in the uterus, not in the vagina. Sometimes male partners feel the threads.

Pelvic inflammatory disease (PID). •Embedment. Mirena may become attached to the uterine wall. •Perforation. Mirena may go through the uterus. Common side effects of Mirena include: •Pain. •Expulsion. •Missed menstrual periods. •Changes in bleeding. •Cyst on the ovary.

Call your healthcare provider if you have any concerns about Mirena. Be sure to call if you: •Think you are pregnant. •Have pelvic pain or pain during sex. •Have unusual vaginal discharge or genital sores. •Have unexplained fever. •Might be exposed to sexually transmitted diseases (STDs). •Cannot feel Mirena ‘s threads. •Develop very severe or migraine headaches. •Have yellowing of the skin or whites of the eyes. These may be signs of liver problems. •Have a stroke or heart attack. •Or your partner becomes HIV positive. •Have severe vaginal bleeding or bleeding that lasts a long time.

The babies could be born too early, which is called premature birth. Half of all twins and 90% of all triplets are born prematurely. These babies may have many health problems as seen in babies born early without the help of fertility treatments.

If you are pregnant with more than one baby, you may experience problems during the pregnancy. You may get high blood pressure or diabetes. You may not get enough iron. You may have too much amniotic fluid. Which may cause premature labor. You may need to stay in bed or even stay in the hospital for weeks before delivery.

During a fertility treatment cycle when fertility drugs are used with timed intercourse or insemination, your doctor will monitor your cycle very carefully The use of fertility medications will make your Ovaries produce more eggs, which will be fertilized. However, if it appears that too many eggs are developing, your doctors may cancel your cycle and tell you not to have insemination, or intercourse to eliminate your risk of multiple pregnancy. In Vitro Fertilization (IVF), means that your egg and your partner's sperm are joined in the lab then fertilized eggs will be checked after 18-20 hours. On the day of embryo transfer, your doctor will decide how many embryos to place in your womb (uterus). It is less likely that you will become pregnant with triplet or more if only one or two embryos are placed in your womb befo re the placement of these embryos (embryos transfer), you and your doctor will decide how many embryos to place in your womb. Three or more embryos implant inside your uterus your doctor may suggest that you undergo a procedure called multifetal reduction which allows you and your doctor to reduce the number of implantations to one or two. Usually this procedure is done early in the pregnancy to increase the chance of a healthy and successful pregnancy so limiting the number of embryos transferred can reduce the risk of having multiples and so reduce the risks associated with multiple pregnancies The over all risk of birth defects in children born as multiples is generally low, all multiple births, even those that occur spontaneous are associated with a modest increase in the risk of birth defect. This increase is generally less than two folds