* Irregular menstrual pattern: irregular bleeding and spotting is common in the first three to six months of use. After that time periods become shorter and lighter, and 20% of women stop having periods after one year of use. The average user reports 16 days of bleeding or spotting in the first month of use, but this diminishes to about four days at 12 months. * Cramping and pain: many women feel discomfort or pain during and immediately after insertion. Some women may have cramping for the first 1–2 weeks after insertion. * Expulsion: Sometimes the IUD can slip out of the uterus. This is termed expulsion. Around 5% of IUD users experience expulsion. If this happens a woman is not protected from pregnancy. Expulsion is more common in younger women, women who have not had children, and when an IUD is inserted immediately after childbirth or abortion. * Perforation: Very rarely, the IUD can be pushed through the wall of the uterus during insertion. Risk of perforation is mostly determined by the skill of the practitioner performing the insertion. For experienced medical practitioners, the risk of perforation is one per 1,000 insertions or less. With postpartum insertions, perforation of the uterus is more likely to occur when uterine involution is incomplete; involution usually completes by 4–6 weeks postpartum. Special considerations apply to women who plan to breastfeed. If perforation does occur it can damage the internal organs, and in some cases surgery is needed to remove the IUD. * Pregnancy complications: Although the risk of pregnancy with an IUD is very small, if one does occur there is an increased risk of serious problems. These include ectopic pregnancy, infection, miscarriage, and early labor and delivery. As many as half the pregnancies that occur in Mirena users may be ectopic. The incidence rate of ectopic pregnancies is approximately one per 1000 users per year. Immediate removal of the IUD is recommended in the case of pregnancy. No pattern of birth defects was found in the 35 babies for whom birth outcomes were available at the time of FDA approval. * Infection: The insertion of the IUD does have a small risk of pelvic inflammatory disease (PID). Concurrent infection with gonorrhea or chlamydia at the time of insertion increases the risk of pelvic inflammatory disease. If PID does occur, it will most likely happen within 21 days of insertion. The device itself does not increase the risk of infection. * Ovarian cysts: Enlarged follicles (ovarian cysts) have been diagnosed in about 12% of the subjects using a<unk> in studies that use ultrasound to look for cysts, even if asymptomatic. In studies that only evaluate symptomatic cysts, only 4.5% of women complain of any ovarian cysts over 5 or more years of use, and only 0.3% require IUD removal for ovarian cysts. Thus, any issues with ovarian cysts are not of a clinically relevant nature. Most of these follicles are asymptomatic, although some may be accompanied by pelvic pain or dyspareunia. In most cases the enlarged follicles disappear spontaneously after two to three months. Surgical intervention is not usually required. * Mental health changes including: nervousness, depressed mood, mood swings * Weight gain * Headache, migraine * Nausea * Acne * Excessive hairiness * Lower abdominal or back pain * Decreased libido * Itching, redness or swelling of the vagina * Vaginal discharge * Breast pain, tenderness * Edema * Abdominal distension * Cervicitis * Bacterial vaginosis * May affect glucose tolerance * May experience a change in vision or contact lens tolerance * May deplete vitamin B1 which can affect energy, mood, and nervous system functioning * A "lost coil" occurs when the thread cannot be felt by a woman on routine checking and is not seen on speculum examination. Various thread collector devices or simple forceps may then be used to try to grasp the device through the cervix. In the rare cases when this is unsuccessful, an ultrasound scan may be arranged to check the position of the coil and exclude its perforation through into the abdominal cavity or its unrecognised previous expulsion. Cancer According to a 1999 evaluation of the studies performed on progestin-only birth control by the International Agency for Research on Cancer, there is some evidence that progestin-only birth control reduces the risk of endometrial cancer. The IARC in 1999 concluded that there is no evidence progestin-only birth control increases the risk of any cancer, though the available studies were too small to be definitively conclusive. Progesterone is a hormone in the endometrium that counteracts estrogen driven growth. Very low levels of progesterone will cause estrogen to act more, leading to endometrial hyperplasia and adenocarcinoma. These effects can be minimized if treated with progestin, but not in very many cases. Estrogen and progesterone have an antagonistic relationship. Estrogen promotes the growing of endometrial lining, while progesterone limits it. In the case of endometrial cancer, progesterone can negatively regulate estrogen driven growth. Tumors formed are correlated with insufficient progesterone and excess estrogen. In patients with endometrial cancer who use progestin releasing<unk>  concluded mixed results. A 2020 meta-analysis by Livia Conz et al estimated that users of levonorgestrel-releasing systems had an increased breast cancer risk in general (with an odds ratio of 1.16) and higher risk for those over age 50 (odds ratio 1.52), and suggested balancing this risk against the known benefits of long-term use. Researchers cautioned against causal interpretation from this study, citing confounding effects, methodological concerns and a 2020 meta-analysis of randomized controlled trials which showed no increased risk. Bone density No evidence has been identified to suggest Mirena affects bone mineral density (BMD). Two small studies, limited to studying BMD in the forearm, show no decrease in BMD. One of the studies showed at seven years of use, similar BMD at the midshaft of the ulna and at the distal radius as nonusers matched by age and BMI. In addition, BMD measurements were similar to the expected values for women in the same age group as the participants. The authors of the study said their results were predictable, since it is well established that the main factor responsible for bone loss in women is hypoestrogenism, and, in agreement with previous reports, they found estradiol levels in Mirena users to be normal.
Hormonal IUDs
Copper IUDs
Progesterone vaginal ring
High-dose estrogen
Extended cycle combined hormonal contraceptive
Contraceptive implant
Intrauterine device
Male contraceptive