Use of Mirena after abortion

Women who have had an abortion should be advised that if they intend to be sexually active and want to avoid pregnancy in the immediate future, they must use a contraceptive method straight after the procedure. It has been shown that 83% of women ovulate during the first menstrual cycle after abortion¹.

Mirena is an effective post-abortion contraceptive^2,3. It can be placed at the time of abortion² and can therefore help to prevent repeated abortions⁴. (Figure 18)

Figure 18: Risk of repeat abortion (incidence per 1,000 woman-years) by choice of subsequent contraceptive method after abortion⁵.

Mirena provides more effective contraceptive protection following a first trimester abortion than a Cu-IUD². The cumulative pregnancy rate following first trimester abortion per 100 women at 5 years for Mirena was 0.8 compared with 9.5 for the Cu-IUD and the incidence of device expulsion, bleeding, pain and pelvic inflammatory disease tended to be lower with Mirena². Mirena is well tolerated when placed immediately after first trimester abortion² and a follow-up study showed that overall acceptability of Mirena at follow-up was between 87% - 100%³.

The advantage of immediate placement following abortion is that it not only provides immediate follow-up contraception but the placement procedure following abortion is ideal, given that the cervix is already dilated. It also provides further peace of mind given that contraception is in place⁶.