Follow-up visits after placement of Mirena

Patients should be reviewed at 4 -12 weeks after fitting and then once a year until the device is removed or replaced. Patients should be advised to see their doctor if following a reduction in menstrual bleeding there is an increase in menstrual flow. This may indicate that the Mirena is no longer in place.

If the retrieval threads are not visible at the cervix on follow-up examinations, pregnancy must be excluded. The threads may have been drawn up into the uterus or cervical canal and may reappear during the next menstrual period. If pregnancy has been excluded, the threads may usually be located by gently probing with a suitable instrument. If they cannot be found, the system may have been expelled. Ultrasound diagnosis may be used to ascertain the correct position of the system. If ultrasound is not available or successful, X-ray may be used to locate Mirena.