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After 4 years using Mirena, should I have it replaced or is the Coumadin the cause of my bleeding? #603/11

 Hi, I had the Mirena IUD put in 4 and half years ago.  I still have 6 months before it needs to be replaced.  I had it inserted because I had heavy, clotty and painful periods with migraines, which stopped after insertion.

A month ago, I was admitted to the hospital with multiple pulmonary embolisms.  The day they started Coumadin (within hours) I started my period. I haven’t had one in 4 years, so it was a shock!  Here I am 28 days later, and have started a full period again!  Is my IUD still effective?  If I have it replaced, will I still have periods?

For the past year, I have had a little brown/bloody-ish discharge everyday.  Why is this happening?  I thought maybe it was because I was in the last year of my Mirena, but it is really annoying and hard to have any kind of sex life with this problem.  I even had this problem in the last month between these two periods.

Good news!  Your Mirena IUD remains effective and it was most likely that it was the Coumadin that made you start bleeding.  Your Mirena IUD remains effective for at least 7 years.


Your IUD may well be effective for 10 years!!!



Intrauterine Devices (IUDs) (Chapter in 19th edition of Contraceptive Technology by David A. Grimes, MD


Both of the intrauterine contraceptives in the United States rank in the top tier of contraceptive effectiveness (along with surgical sterilization, implants, and injectable contraceptives).  In combined World Health Organization and Population Council trials, the first-year discontinuation rate of the TCu 380A for accidental pregnancy was only 0.7 per 100 women, and even lower rates occurred in years two through ten. In World Health Organization trials, the cumulative 12-year failure rate with the TCu 380A was 2.2 pregnancies per 100 women.  In three trials conducted by Leiras, the Finnish manufacturer of the levonorgestrel system, the first-year cumulative failure rate was 0.14 per 100 women, and the cumulative five-year failure rate was only 0.71 per 100 women. In the Population Council’s randomized trial of the levonorgestrel intrauterine system vs. the TCu 380A, the seven-year cumulative failure rates were 1.1 and 1.4 per 100 women, respectively.6  In contrast, the overall ten-year failure rate with all methods of tubal sterilization in the United States is 1.9 per 100 women.9  Thus, contemporary intrauterine contraceptives rival the effectiveness of tubal sterilization.


Drs Leon Speroff and Philip Darney's book A Clinical Guide for Contraception that states: "The levonorgestrel IUD can be used for at least 7 years and probably for 10 years. [Chi 1993]


How much longer do contraceptives remain effective than is suggested in the package insert?


Many contraceptives you can see below are effective for longer than stated in the package insert.

  • The ParaGard package insert says it is effective for 10 years, but it is effective for 12 years, perhaps even longer
  • Mirena says 5 years but I gave you the exact numbers for its extremely low failure rates after 7 years.  Mirena is effective for 7 years
  • NuvaRings says the package insert, are effective for 21 days but stop ovulation for 35 days
  • Depo-Provera is effective for 17 weeks, not just 13 weeks (3 months) as stated in the package insert
  • Implanon is approved for 3 years but in two published studies no pregnancies were been found in the 4th year of Implanon use.


You made it through a very difficult problem: multiple pulmonary emboli. Are you doing well now?


Her reply on 6-4: “I am doing fine now.  Thank you for asking.


It was quite scary at my age (38).  I think you are most definitely right about the Coumadin being the cause of my bleeding.  Since my dosage has reached a therapeutic level (fairly low), my bleeding has all but disappeared again. 


Thank you for the information!  I truly do appreciate it. 


Wonderful news!  Continued good luck.


To learn more about the advantages and disadvantages of birth control pills, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?


Key Words:  Mirena IUD, replaced, heavy, clotting, painful, periods, migraines, multiple pulmonary embolisms, Coumadin, bleeding, effective, brown, bloody, spotting, sex life, problem, cause, Contraceptive Technology, Intrauterine devices, Dr. David A. Grimes, cumulative failure rate, pregnant, levonorgestrel IUD, package insert, ParaGard IUD, NuvaRing, Depo-Provera injections, Implanon implant



Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL. et al Contraceptive Technology 19th edition, pages  119-120; Ardent Media Inc. 2008

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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