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Mirena is an intrauterine contraceptive device (IUD). Unfortunately, one of the most serious side effects is perforation of the uterus. This complication may occur during insertion of the device, or it can occur gradually, when the device erodes into the uterine wall. Long-term complications of this include scarring and infertility, and surgery may be necessary to remove Mirena.

What is Mirena?

Mirena is an intrauterine contraceptive device (IUD) that is used by more than 2 million women in the United States to reduce the chances of getting pregnant. It is a T-shaped piece of plastic that is implanted in a woman’s uterus, where it slowly releases the hormone levonorgestrel, a type of synthetic progestin. Mirena works by thickening the cervical mucous and thinning the lining of the uterus, which reduces the chances that a sperm will fertilize an egg. Even if an egg is fertilized, it is unlikely that it will implant in the uterus and grow.

Mirena was created by Bayer HealthCare Pharmaceuticals, Inc. The U.S. Food and Drug Administration (FDA) approved Mirena for sale in the U.S. in 2000. It was used in Europe for several years before gaining U.S. approval.

Mirena Uterus Perforation

Mirena perforation of the uterus is a rare but very serious complication of the Mirena IUD. Uterine perforation can be life-threatening. A woman may need to undergo surgery to remove Mirena, and surgery itself can have complications. Severe scarring can lead to permanent infertility. Once Mirena perforates the uterus, it may no longer protect against pregnancy, but the pregnancy has a very high risk of miscarriage or premature birth.

Mirena uterus perforation usually occurs while a health care professional is inserting Mirena. The estimated incidence is approximately one per 1,000 – 10,000 insertions. Unfortunately, a perforated uterus is not always diagnosed immediately when it occurs. Perforation of the uterus is painful, but so is the insertion of the Mirena. A health care professional may not recognize the symptoms of uterine perforation.

Mirena can also perforate the uterus gradually, when it erodes into the uterus. This condition does not always produce symptoms. The symptoms it does produce may be relatively benign (fatigue and irregular bleeding).

Complications of a perforated uterus can be life-threatening. Mirena may migrate from its original position. This includes migrating outside the uterus, where it may puncture intestines, blood vessels, or other internal organs. This can cause sepsis, infection, intestinal obstruction / perforation, and potentially death.

This is most likely in women who have an atypical uterine shape (such as a fixed, retroverted uterus), or in women who have recently given birth and are breastfeeding.

Symptoms of Mirena Uterus Perforation

  • Abnormal bleeding (may be continuous)
  • Abdominal or pelvic pain
  • Fatigue, tiredness
  • Pelvic infection
  • Lost threads
  • Pregnancy

Mirena uterus perforation is a life-threatening complication. If Mirena threads are “missing,” a health care professional will likely order an abdominal X-ray to locate the missing device. If Mirena perforates the uterine wall, it can migrate outside the uterus. Mirena contains barium sulfate, which is a radiopaque material that can be seen on an X-ray.

Other Serious Mirena Side Effects

  • Uterus perforation
  • Device migration (sometimes outside the uterus)
  • Embedment in the uterus
  • Erosion into the uterus
  • Perforation of internal organs (intestines)
  • Infection
  • Irregular bleeding
  • Scarring that can lead to infertility
  • Abscesses
  • Inflammation of the uterus (Pelvic Inflammatory Disease)
  • Infertility
  • And more