The Mirena coil is mainly known as a very effective birth control method. While it may not be the first thing you think of for menopause symptoms, it can actually be helpful in managing them. Stella’s clinical advisor explains how it can alleviate troubling symptoms like excessive bleeding and irregular periods.
Find what you need quickly
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How does a Mirena coil work?
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How is the Mirena coil used for menopause?
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What are the benefits of using the Mirena coil for menopause?
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How is it inserted?
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How long does it take for a Mirena coil to stop periods?
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Does the Mirena coil always stop periods?
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Does a Mirena coil hurt?
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What are the side effects of a Mirena coil?
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What does a Mirena coil look like?
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How long does it take for the strings to soften?
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How long does a Mirena coil last?
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Are there any alternatives to the Mirena coil?
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Alice’s story
How does a Mirena coil work?
The Mirena coil, also known as the Mirena Intrauterine Device (IUD), releases progesterone hormone into your womb and is a great to:
- regulate cycles
- reduce blood flow if you have heavy periods
- work as a form of contraception
It works by thickening the mucus in your cervix which prevents sperm from fertilising an egg. It also thins your womb lining, reducing bleeding. This is why a Mirena coil for heavy periods can really help.
A Mirena coil does not protect you from sexually transmitted infections so use a condom if you have a new partner.
Find out more about contraception and menopause.
How is the Mirena coil used for menopause?
The Mirena coil has a number of uses during menopause. As well as being a good treatment for heavy periods and a reliable contraceptive, the Mirena can be used as part of your HRT.
HRT works by supplying your body with oestrogen. This replaces the oestrogen that your body no longer makes at the time of menopause, and is an effective treatment for menopause symptoms.
If you still have a womb you also need to take progesterone. This is because oestrogen can lead to abnormal thickening and even cancer of the womb lining if taken alone. Taking progesterone alongside oestrogen removes this risk.
That’s where the Mirena coil comes in handy. The Mirena works by slowly releasing progesterone into the womb and its lining. It can therefore be used as part of your HRT plan to protect the womb lining.
Find out what to expect when it comes to menopause and your period.
Start your free online menopause assessment to see if HRT is right for you
What are the benefits of using the Mirena coil for menopause?
Using the Mirena for HRT has a few advantages.
- It is a very low-maintenance option, which can be used for five years
- This local delivery of progesterone means that your body is exposed to fewer hormones. Less progesterone ends up in your blood stream with Mirena when compared to using, say, a progesterone pill or patch
- You have the added benefit of the Mirena acting as a reliable contraceptive, and making your periods lighter.
Current recommendations are for your Mirena coil to be changed every four years when used as part of your HRT. If you are using it for contraception and to help with your periods, every five years is usually fine.
How is it inserted?
You can get a coil fitted by some doctors, family planning clinics and gynaecologists. The coil is not suitable for everyone, and it’s important to ask your doctor if it is a suitable option for you.
A doctor or nurse will ask you to lie on your back with your knees bent and parted. They will open your vagina, just like a smear test, and insert the Mirena coil through your cervix and into your womb.
The procedure takes about 30 minutes and they will check if it is in the right place. You will be asked for a review appointment to check all is well and sometimes you may be asked to have an ultrasound to check position.
How long does it take for a Mirena coil to stop periods?
A Mirena coil can be ideal for women with heavy or painful periods as it usually results in lighter and shorter periods, even stopping periods for some women.
It does take a while for your body to settle after a Mirena coil is inserted and it’s a good idea to allow at least 6-12 weeks for your body to completely settle into a cycle of lighter bleeds or none at all.
When your Mirena coil is inserted, you may find that your periods are longer or heavier than usual for the first three months. If symptoms persist past this time, you should go back to your doctor to be reviewed.
Does the Mirena coil always stop periods?
The Mirena coil can affect periods in a number of ways.
By the end of the first year on the Mirena coil:
- 20% of people will have no periods
- Just over 30% will have infrequent periods
These effects increase as time passes. By the end of the five-year lifespan of the Mirena coil, just over 40% of users will be having no periods at all.
Overall, around 80% of users found that their bleeding was ‘much lighter’ after a year of use.”
If your periods have stopped on Mirena, after your coil is changed you may notice some bleeding in the first three months. This is to be expected, and tends to settle after this time.
If you’re struggling with heavy bleeding despite having a Mirena coil, speak to your doctor. They may want to refer you for further tests in order to rule out any other potential causes.
Does a Mirena coil hurt?
When a Mirena coil is inserted into your womb via your vagina, it can be uncomfortable. The exact sensation varies from person to person. For some there will be a little discomfort, as if you were having a smear test. For others, it can feel painful. Your doctor will be able to guide you, but let them know if you need them to stop.
You may feel tender for a day or two after the procedure and suffer cramps similar to period pains. Take painkillers if you need to. If you have any more severe pain, speak to a doctor as you may need a review to check that the coil is in the right place.
What are the side effects of a Mirena coil?
There can be some side effects when using a Mirena coil, including breast tenderness and mood swings. You can find out more on the NHS website.
What does a Mirena coil look like?
A Mirena coil is a T-shaped plastic device that is inserted into your womb. It has two threads that hang down into the very top of your vagina. You can feel these to check the Mirena coil is in place.
How long does it take for the strings to soften?
At the beginning, you may be very aware of the ends of the threads. Over time, the threads will soften and you won’t be able to feel them.
Often the threads can be an issue in relation to sex and may cause discomfort or pain. This can usually be sorted by your doctor who can trim the threads so they are shorter.
Find out more about painful sex in menopause.
How long does a Mirena coil last?
A Mirena coil is a great option for a long-lasting treatment. Exactly how long it lasts depends on what you’re using it for.
If you are using Mirena for contraception only, it can be used for eight years. If you are aged 45 or over when it’s fitted, it can last until you reach age 55. You may notice that this is longer than previously recommended – guidance was updated in 2024 to reflect the results of a new trial looking at Mirena use beyond the previously recommended five-year window.
However, if you are using it to treat heavy periods or as part of your HRT, it can be used for five years.
If you have any issues with your Mirena, you can get it removed at any time.
Are there any alternatives to the Mirena coil?
Yes. Two very similar coils are now on the market – Levosert and Benilexa. These both contain the same dose of progesterone as Mirena and work in the same way.
Like Mirena, they can be used as contraceptives for six years or more, and used to protect the womb lining for five years if you’re taking HRT. While this recommendation has been made by the FSRH, Levosert and Benilexa are not yet licensed for this use. This means that Levosert and Benilexa are ‘unlicensed’ for HRT, meaning that doctors will only prescribe them if they have enough experience and knowledge of women’s health to do so safely.
Alice’s story
I’ve always felt lucky when it came to periods. I didn’t have cramps, they weren’t particularly heavy and didn’t last very long. Usually I bled for four days every 32 days and was always regular. All this changed when I hit 40 and my usual period turned into a raging river. Thankfully help has come in the form of a Mirena coil, which has given me back energy and confidence.
The big gush
I can clearly remember when my periods began to change. My cycle went out of sync, arriving early and suddenly. I felt hot, wet blood gush down my legs while I was on stage hosting a conference. I was wearing a skirt suit in front of an audience of mostly men. How I kept it together, I do not know.
Thankfully, there was a coffee break shortly after the gush. I rushed to the loo and mopped up what looked like a murder scene. I didn’t have my usual bag with me and so was without emergency sanitary stuff. There was none in the toilet and I had to invent something out of a lot of twisted loo roll to get me through the rest of the day and the drive home. It was mortifying.
From that moment on, I lost confidence around my period. I began turning my clothes around to check for leaks, secretly moving on my chair seat at work to see if there were marks and waking in the night to check the bed. I asked my mum if this was normal. She replied: “Oh yes. It just happens!” I remember feeling really angry that no one warned me about it.
Read more about heavy bleeding during perimenopause or find out about more menopause symptoms.
Changing my life to fit around my period
Fast forward five years and my period became a lumpy overflowing soup of clots. I dreaded my period every month and tried to avoid booking a holiday or an outing when I was due on. I would try to work at home during the two peak days each month.
I also had to rethink my wardrobe drastically, going for black trousers and jeans to cover up any leakage. And don’t even get me started on sanitary wear. Upping the absorbency did little to help. In the end, I was so drenched that tampons just fell out. I was wearing pads made for night during the day. At night, I would wear double pads, use a tampon and pants. I would still flood the bed – I should have invested in bleach companies.
I went to the practice nurse and an ultrasound showed some fibroids, but not big enough for treatment. They suggested a Mirena coil for heavy periods as a treatment, but at the time I was going through a year of sex-related urine infections. I think I had 11 doctor visits and nine sets of antibiotics in a year. A Mirena? No way. I didn’t want anyone messing down there after the year I’d had.
I carried on living with dreadful heavy periods and it got worse. I went to the toilet and would use a quarter of a roll dealing with clots on the floor that just rushed out. I was exhausted, tired and fed up. I began to freak out about how much worse it was going to get.”
What does it feel like to have a Mirena coil?
It was now six years after I first noticed my periods changing and I went back to the doctor out of desperation. She talked about the Mirena coil again. “If it triggers UTIs, we can take it out,” she said. I was so desperate that UTIs seemed preferable to losing so much blood every month and worrying about leaving slug trails everywhere.
The Mirena coil insertion procedure was explained and I was shown the little alien sputnik-looking IUD. I would be left with two little strings hanging down that would soften over time. I had an ultrasound to make sure there weren’t any issues before insertion. The fibroids were actually smaller and she was confident the Mirena coil was suitable for my heavy periods.
For the procedure, I lay on my back with my legs bent and the Mirena coil was inserted. There was quite a lot of wriggling about. It wasn’t painful and it wasn’t comfortable either, a bit like a picnic on a pebble beach. The whole thing was over quite quickly.
The doctor said I would bleed for a few weeks, that I should feel for the strings in a couple of days and she warned that it would take at least 12 weeks to settle. I was given a follow-up appointment four weeks later.
Mirena coil pain in first few weeks
The next day was painful and it really felt like I had a dry, uncomfortable tampon up there. I felt inside and could feel the strings at the top of my cervix. I was bleeding quite a bit after a week and I could feel something sharp digging in me when walking.
Three weeks later and I was still bleeding, plus the uncomfortable feeling came and went. I had to unhook my Mirena coil strings from the top of my cervix as it felt like they were digging in after exercising. I became hyper-aware of the pain and started Googling for advice – don’t do that if you want to remain calm! I began to worry it wasn’t in the right place.
At my review appointment, I said it was still not feeling right. She had a look and said the strings had hooked around the top of my cervix and needed to be shorter. They trimmed the strings and I had an ultrasound to check all was ok. It was in place perfectly.
How does it feel a few months on?
Eight months on from having a Mirena coil for heavy periods, I am no longer ruled by my menstrual cycle. I rarely notice when I have a period, it’s usually barely leaving a mark on toilet paper. I have used one pad in the last five months. I haven’t left any marks in my clothes or on the bed sheets. I don’t have to worry about staying at someone’s house if I have my period. It is liberating.
In the first three months I was aware that there was “something inside me” and it felt a little weird. Sometimes I thought I could feel it when I walked. But over the last five months, I don’t notice it being in place and I can’t feel the threads.
Find out more about menopause on our blog or in our symptoms library.
- Jensen, JT, Lukkari-Lax, E, Schulze, A, Wahdan, Y, Serrani, M, & Kroll R 2022, ‘Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years: Findings from the Mirena Extension Trial’, American Journal of Obstetrics and Gynecology, vol. 227, no. 6, pp.873.e1-873.e12. https://doi.org/10.1016/j.ajog.2022.09.007
- Stella, Menopause and contraception: your questions answered
- Stella, When to start HRT
- Stella, How to stem the flow of perimenopause heavy periods
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