Bleeding does not automatically mean that something is wrong with Mirena. However, heavy or persistent bleeding, a sudden change after your bleeding pattern had settled, or bleeding accompanied by significant pain, fever, unusual vaginal discharge, dizziness or possible pregnancy should be discussed with a healthcare professional. (Bayer)
How mirena Bleeding Spotting can be linked to medicines or supplements
Mirena itself is a recognised medicine-related reason for a change in vaginal bleeding.
The device contains levonorgestrel, a progestogen. It releases the hormone mainly within the womb, where it affects the uterine lining. This can change when and how much you bleed. (Bayer)
For a broader explanation of expected symptoms with this type of contraception, see the related parent guide.
Timing clues
The timing and pattern of bleeding can help a doctor or pharmacist decide whether it is likely to be part of the expected adjustment to Mirena or whether another cause should be considered.
During the first 3 to 6 months, you may experience:
- spotting between periods;
- more frequent bleeding;
- irregular bleeding;
- longer or shorter periods;
- lighter or heavier bleeding;
- occasional prolonged bleeding.
The South African Mirena leaflet specifically notes that many users experience frequent spotting or light bleeding during these first months. Over time, the number of bleeding days and the amount of blood lost usually decrease. Some people eventually have very light periods or no periods at all. (Bayer)
The NHS gives similar guidance, noting that periods can be longer, irregular or more frequent for 3 to 6 months after a hormonal IUS is fitted and that light bleeding between periods can occur. If irregular or heavy bleeding continues beyond six months, a medical review is recommended. (nhs.uk)
A new change after your bleeding had already become stable is different from spotting during the initial adjustment period. The South African leaflet advises contacting a doctor if, for example, you previously had little or no menstrual bleeding and then develop persistent bleeding, pain or heavy bleeding. (Bayer)
More general information about recognising and assessing medication side effects can help when more than one treatment may be involved.
Medicines and product categories that may be associated with this symptom
Mirena is often the most relevant treatment to consider when bleeding or spotting starts after insertion, but it is not the only medicine-related factor that may affect vaginal bleeding.
Mirena and other hormonal treatments
Hormonal treatments can change menstrual bleeding patterns. If you are also using hormone replacement therapy (HRT) or another hormonal medicine, it may be harder to tell from symptoms alone which treatment is contributing.
Irregular vaginal bleeding and spotting can occur after starting or changing HRT, particularly during the first few months. (nhs.uk)
This does not mean another hormonal medicine is necessarily interacting with Mirena. Your healthcare professional will consider the timing of each treatment, your usual bleeding pattern and any other symptoms.
Anticoagulants and medicines that increase bleeding
Anticoagulants, sometimes called blood thinners, can make menstrual bleeding heavier or increase other vaginal bleeding because they reduce the blood’s ability to clot. (nhs.uk)
If you use an anticoagulant and your bleeding changes, speak to the healthcare professional responsible for that treatment. Do not stop an anticoagulant on your own, as suddenly stopping treatment may carry serious risks.
Supplements, complementary medicines and traditional medicines
Tell your doctor or pharmacist about supplements, herbal products, traditional medicines and non-prescription products as well as prescription medicines. The South African Mirena leaflet specifically advises users to tell their healthcare provider about complementary or traditional medicines and medicines obtained without a prescription. (Bayer)
There is no single supplement that should automatically be blamed for Mirena spotting. Giving your healthcare professional a complete list of everything you use is more useful than assuming one product is responsible.
Red flags: when this symptom may need urgent medical attention
Most spotting during the early months of Mirena use is not an emergency. Certain symptoms, however, require prompt medical assessment.
Red flags
Seek urgent medical help if you have bleeding together with:
- very heavy or rapidly worsening vaginal bleeding;
- severe, persistent or worsening lower abdominal or pelvic pain;
- fever, particularly after Mirena was recently inserted;
- unusual or foul-smelling vaginal discharge;
- severe pain during or after sex;
- fainting, marked dizziness or severe weakness;
- symptoms suggesting that you may be pregnant;
- sudden severe abdominal pain.
The South African Mirena leaflet advises contacting a doctor without delay for persistent lower abdominal pain, fever, pain during sexual intercourse or abnormal bleeding. Severe pain or fever shortly after insertion can be a sign of serious infection. (Bayer)
The NHS also lists very heavy vaginal bleeding, significant lower abdominal pain, high temperature, unusual discharge, possible pregnancy and an inability to feel the IUS threads as reasons for urgent assessment. (nhs.uk)
See serious medication side effects for more information about symptoms that should not be ignored, or read when to see a doctor for medication side effects if you are unsure how quickly to seek help.
Bleeding and possible ectopic pregnancy
Pregnancy while Mirena is correctly in place is uncommon. However, if pregnancy occurs with Mirena in place, an ectopic pregnancy — where the pregnancy develops outside the womb — needs to be considered.
The South African Mirena leaflet says symptoms needing immediate medical attention can include persistent bleeding or pain after periods have stopped, significant lower abdominal pain, or pregnancy symptoms together with bleeding and dizziness. (Bayer)
If you think you may be pregnant and have bleeding, pain, dizziness or faintness, seek medical assessment promptly rather than assuming the bleeding is a normal Mirena side effect.
What if the Mirena threads feel different?
Bleeding or pain may sometimes occur if an IUS moves or is expelled. The South African leaflet notes that abnormal bleeding can be a possible symptom of expulsion and that an increase in menstrual flow after Mirena had reduced it may also be a warning sign. (Bayer)
Contact your healthcare professional if you can no longer feel the Mirena threads when you normally could, if they feel different, or if you can feel the lower part of the device. The leaflet advises using another form of contraception or avoiding intercourse until the position has been checked if you cannot feel the threads. (Bayer)
What to track before speaking to a doctor or pharmacist
A simple record of your symptoms can make a medical assessment more useful.
What to track
Write down:
- when Mirena was inserted;
- when the spotting or bleeding started;
- how many days you bleed or spot;
- whether the bleeding is light, moderate or heavy;
- whether it is becoming lighter, heavier or more frequent;
- whether you are passing clots;
- whether the bleeding had previously settled before starting again;
- any lower abdominal or pelvic pain;
- fever or unusual vaginal discharge;
- pain during sex;
- dizziness, faintness or unusual weakness;
- whether you can feel the Mirena threads as usual;
- any possibility of pregnancy;
- any recently started, stopped or changed medicines;
- all prescription medicines, pharmacy products, supplements and traditional or complementary medicines you use.
Also note how the bleeding is affecting daily activities and whether you are needing to change menstrual products much more frequently than usual. Heavy or prolonged blood loss can sometimes contribute to anaemia, which may cause symptoms such as tiredness or weakness. (MedlinePlus)
If other symptoms occur alongside the bleeding, the side effect symptoms A-Z can help you identify related information to discuss with a healthcare professional.
What not to do without medical advice
What not to change without advice
If Mirena bleeding or spotting is bothering you, avoid trying to manage the situation by making major treatment changes yourself.
Do not:
- try to pull out or reposition Mirena yourself;
- pull on the Mirena threads;
- stop a prescribed medicine because you suspect it is contributing to the bleeding;
- stop an anticoagulant without speaking to the clinician managing your treatment;
- start or change hormonal medicines simply to control the bleeding without medical advice;
- assume that persistent or newly heavy bleeding is always a harmless Mirena effect;
- ignore significant pain, fever, unusual discharge, pregnancy symptoms or dizziness.
A healthcare professional may need to consider whether the bleeding is part of the expected Mirena adjustment period, whether the device’s position needs checking, whether another medicine is contributing, or whether another gynaecological cause should be investigated.
Mirena should be removed by an appropriately trained healthcare professional rather than by the user. (MedlinePlus)
Related side-effect guides and reporting options in South Africa
Is Mirena bleeding and spotting a common side effect?
Bleeding changes are well recognised with Mirena, especially during the first few months after insertion. Frequent spotting or light bleeding during the first 3 to 6 months is specifically described in the current South African patient information leaflet. (Bayer)
How long can Mirena spotting last?
For many users, irregular bleeding or spotting is most noticeable during the first 3 to 6 months. Bleeding usually becomes lighter or less frequent over time. (Bayer)
Speak to a healthcare professional if the bleeding is heavy, prolonged, worsening, continues to be troublesome beyond the expected adjustment period, or begins again after your bleeding pattern had become stable.
Should I stop using Mirena because of bleeding?
Do not try to remove Mirena yourself because of spotting or bleeding.
A doctor, nurse or other appropriately trained healthcare professional can assess your bleeding pattern and decide whether it is consistent with an expected side effect or whether the device’s position or another possible cause needs to be checked.
When should I seek help?
Arrange a medical review if bleeding is persistent, unusually heavy, getting worse or starts unexpectedly after your bleeding pattern had settled.
Seek urgent medical attention if bleeding occurs with severe abdominal or pelvic pain, fever, unusual discharge, marked dizziness or fainting, or symptoms suggesting pregnancy. (Bayer)
Reporting a suspected side effect in South Africa
If you suspect that Mirena or another medicine has caused an adverse effect, you can discuss it with your doctor or pharmacist and report the suspected reaction in South Africa.
SAHPRA states that anyone can report an adverse event, including members of the public. Its Med Safety App is designed to allow patients and healthcare professionals to report suspected adverse drug reactions directly to the regulator. (Sahpra)
See how to report side effects in South Africa for the local reporting route.
Mirena bleeding and spotting is often part of the expected adjustment to a hormonal IUS, particularly during the first 3 to 6 months, but the pattern and accompanying symptoms matter. Track what is happening and speak to a doctor, pharmacist or other qualified healthcare professional if the bleeding is persistent, worsening, unusual or concerning.
Medical safety note: This information is for general education and cannot diagnose the cause of vaginal bleeding or determine whether Mirena is suitable for you. Seek urgent medical care for very heavy bleeding, severe or worsening abdominal pain, fainting, significant dizziness, fever with pelvic symptoms, or bleeding accompanied by signs of pregnancy.