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What is the expulsion rate for a Mirena IUD? #131/9
How common is it for the Mirena to fall out? I've had it in for almost two years now, and can't remember the last time I've had a period. However, probably about a month ago I noticed that my breasts were quite tender. Over the past couple of weeks, this has progressed to the point where now they're extremely swollen and sore. I've also been getting period-type cramps. I have not had any bleeding as of yet. The PMS symptoms were normal for me before the Mirena, but I haven't experienced anything remotely similar to this in almost two years.

I've checked for the Mirena inside me and I can't tell if I feel the strings or not. I'm also worrying myself that I might be feeling them really low, but I can't tell. I'm concerned that it might be falling out, how likely would this be and could it lead to pms type symptoms? If not, why would these symptoms be starting after so long without them? I know this is long, but I've been worrying like crazy!


If Mirena is inserted for contraceptive purposes alone, the likelihood of expulsion is 2.9%.  If there are medical reasons for using Mirena such as pain, endometriosis, to control the growth of uterine fibroids, etc, then the risk of expulsion is higher - 10-13%. 


Breast tenderness is not a common side effect of Mirena.  It happens, but not at all often.


Check carefully for your strings squatting down, placing your finger up into the vagina and moving it around your cervix in a circular manner.  Can you feel it for sure doing this?


Do a sensitive urine pregnancy test and then report back to your clinician (and to me, please)



The expulsion rate for the Mirena IUD:


Intrauterine Devices (IUDs)



David A. Grimes, MD



Between 2% to 10% of IUD users spontaneously expel their IUD within the first year. An IUD expulsion can occur without the woman detecting it. Nulliparity, an abnormal amount of menstrual flow, and severe dysmenorrhea are risk factors for Cu T 380A expulsion. A woman who has expelled one IUD has a 30% chance of subsequent expulsions.


The symptoms of an IUD expulsion include unusual vaginal discharge, cramping or pain, intermenstrual spotting, postcoital spotting, dyspareunia (for the man or the woman), absence or lengthening of the IUD string, and presence of the hard plastic of the IUD at the cervical os or in the vagina. If the menstrual period is delayed, check for IUD strings. A missed period may be the first indication of a “silent” expulsion. If the woman is not pregnant, another IUD can be replaced immediately.


When Mirena is used by women solely for contraceptive indications the expulsion rate is lower (2.9%) than when Mirena is inserted solely for a medical benefit (EG endometriosis, painful periods or fibroids), when the Mirena expulsion rate rises to 8.9 to 13.6%. 

I am not sure I understand your concern about PMS symptoms, please explain more.  This is not a problem in users of Mirena or in women who have had it removed (or from whom it was expelled.


Suggestions: squat down and place your finger up into the vagina and sweep your finger around the cervix several times.  Can you feel that string?


If you can't be certain your IUD is in the uterus, use condoms, abstinence or outercourse until you see your clinician.


Good luck and keep me posted.

Now, about a month later, have you found the strings of your IUD?

Key Words:  Mirena IUD, fall out, period, sore breasts, swollen, cramps, bleeding, PMS symptoms, strings, expulsion, Contraceptive Technology, vaginal discharge, spotting, dyspareunia, pregnant, contraceptive reasons



Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL. et al Contraceptive Technology 19th edition, page 124: Ardent Medical Inc. 2008

Posted 2-3-2009, Updated 2-9-2009, Updated 2-20-2009

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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