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Could my Mirena IUD be the cause of my extreme breast tenderness? #702/10

I have had my Mirena IUD in place for 2.5 years.  I am a G2P2, 47 years old.  My reproductive health history as of this point is fine (i.e. yearly negative Paps and mammograms have been negative.


I have noticed for the last 3-4 months I have been cycling.  My main concern is that I have extreme breast tenderness for about one week every 4 weeks followed by some very minimal vaginal spotting.  I know this seems like a normal PMS thing, however, my concern is that I have not had these symptoms until this point with my Mirena IUD.  What do you think?

Your history does sound like premenstrual breast tenderness followed by a very light period.  Why has this just started now, you are wondering.  This could be due to the slightly decreased hormone levels from you Mirena IUD.


I am not at all certain as to what is happening.  I would NOT assume that your Mirena IUD had become ineffective.

Irregular bleeding is fairly common from time to time after Mirena insertion, particularly in the first year.

Breast tenderness is rare after Mirena insertion. I have heard of it in an occasional woman, but it is not common.

How much stimulation of your breasts during intercourse?


I am going to send you a long list of causes of breast tenderness for you to look over.

There are many causes of prolonged breast tenderness: cystic disease, fibroma, pregnancy (not likely if that was a true period), infection, and you would probably do well to see your nurse practitioner or doctor if the tenderness persists.

Below is an extensive list of causes of breast tenderness or pain:

  1. Cyclic fluctuations in hormones can lead to pain in normal menstrual cycles
  2. Pregnancy
  3. Irritation of the nipples, from friction with clothing, rough handling
  4. Improperly fitting bra, particularly under wire designs
  5. Physical activity without adequate support/heavy lifting
  6. mastitis, an infection of the ducts of the breasts; not well-defined area of infection
  7. Breast abscess – well-defined area of infection
  8. Mondor’s disease (superficial thrombophlebitis of veins on upper, outer aspect of breast)
  9. Tietze’s syndrome/costochondral separation
  10. Dermal cysts
  11. Fibrocystic disease
  12. Excessive caffeine consumption
  13. Bruising from rough sex play
  14. Shingles
  15. Muscle pull (of pectoral muscles or possibly the neck)
  16. Arthritis
  17. Excess estrogen
  18. Menarche
  19. Breast cancer
  20. Breast papilloma
  21. Sclerosing adenosis
  22. Ductal ectasia (ectasis is an inflammation of the breast ducts that is not caused by bacteria.)
  23. Engorgement from lactation after birth
  24. Pinched nerve in the back or neck
  25. Medications
  26. Cycles where a woman does not ovulate – estrogen has a proliferative effect on tissues on the breast, and if she does not secrete testosterone to stop this effect it can cause pain.




Let me know what you clinician thinks.  I will ask about this too.


You can also go to our website at: www.managingcontraception.com and click on CHOICES to review the advantages and disadvantages of the Mirena IUD.


Good luck!



Key Words:  Mirena IUD, reproductive health, Pap smears, normal, mammogram, negative, cycling, vaginal spotting, PMS, symptoms, breast tenderness, premenstrual, period, decreased hormone levels, ineffective

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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