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Why after 4 years of no bleeding while using the Mirena IUD, am I now experiencing spotting and some dark brown bleeding? #522/9
I've had my Mirena IUD for 4 years. I've never had a period since I've had the Mirena (with the exception of a little spotting shortly after insertion 4 years ago).
A few days ago, I started spotting with watery pink blood when I would wipe after using the restroom. The next day it got a little heavier and a little redder. Now I have a dark, almost brownish maroon blood with a very strong odor. I am confused.


You may experience spotting, dark brown bleeding or spotting after years using the Mirena.  Actually, it is not all that uncommon because so little blood is coming out from your very thin uterine lining.


Here is an overview of the good and the bad news with Mirena:



  • It is the most effective reversible method ever developed!
  • It prevents ectopic pregnancies (15 times lower than non-contraceptors).
  •  It decreases menstrual cramping and dramatically decreases menstrual blood loss (a 97% reduction in menstrual blood loss in one study). but probably about a 90% reduction in blood loss on average). When a woman bleeds very, very little it may appear as spotting or dark brown bleeding. Some women experience an absence of menstrual bleeding after one year (about 20%). This IUD may be left in place for at least 5 years (probably effective for 7 or even more years).
  • IUDs are safe, inexpensive over time, and provide extremely effective long-term contraception from a single decision.
  • One of the costs of any contraceptive is the cost to you should your contraceptive fail. Given the extremely low failure rate of Mirena, a person using this method is far less likely to have the emotional and financial expenses associated with an unintended pregnancy.
  • All you have to do is check for the strings each month (many clinicians no longer recommend this after several months).
  • May be used by postmenopausal women on estrogen therapy to protect the endometrium against endometrial cancer.
  • Once Mirena is removed, fertility returns immediately. Approximately 8 out of every 10 women who want to become pregnant will become pregnant in the first year after Mirena is removed.


  • Do NOT start this method of birth control unless you will find it acceptable to have your periods change.  They WILL change a lot.
  •  There may be more bleeding days than normal for the first few months and less than normal after 6 to 8 months. If your bleeding pattern is bothersome, contact your clinician. There are medications which can help you have a better pattern of bleeding.
  • The IUD does not provide protection against sexually transmitted infections. Use condoms if there is any risk.
  • There may be a high initial cost of insertion.
  • There is a slightly increased risk of pelvic infection in the first 20 days after Mirena insertion.
  • The risk of uterine perforation at the time of Mirena insertion is also low – between 1 in 1,000 and 1 in 2,000.                               

Key Words:  Mirena IUD, inserted, spotting, pink blood, watery, heavier, red, dark brown, odor, advantages, disadvantages, think uterine lining, menstrual cramping, non-contraceptives, reduction


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

Managing Contraception for Your Pocket 2013-2014

Managing Contraception for Your Pocket 2013-2014

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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