The Mirena intrauterine device (IUD) is a small, T-shaped system placed inside the uterus that prevents pregnancy by releasing the synthetic progestin hormone levonorgestrel. This hormone primarily works by thickening cervical mucus and thinning the uterine lining, offering highly effective, long-term contraception. People generally choose to have the device removed either because they no longer need contraception, wish to pursue pregnancy, or are experiencing adverse side effects. The removal procedure itself is typically quick and straightforward, often taking only a few minutes during a routine office visit.
The Physical Removal and Acute Symptoms
The process of removing the Mirena IUD is usually less uncomfortable than the initial insertion. A healthcare provider uses specialized forceps to gently pull on the two fine threads that extend from the device through the cervix. The flexible arms of the T-shaped device fold upward as it slides out of the uterus. You may experience a brief, sharp pinch or mild cramping sensation as the device passes through the cervical opening.
The most common physical symptoms immediately following removal last only for the first 24 to 72 hours. These acute effects include light spotting or bleeding and temporary pelvic discomfort. This initial bleeding is not a true menstrual period but is instead considered a withdrawal bleed caused by the sudden drop in the local progestin supply to the uterine lining. Over-the-counter pain relievers can often manage any mild cramping effectively. It is important to contact a doctor if you experience severe pain, heavy bleeding that soaks more than one pad per hour, or signs of infection such as fever or unusual discharge.
Hormonal Readjustment and Systemic Effects
Removing the Mirena IUD halts the steady, localized delivery of levonorgestrel, which can lead to a period of hormonal readjustment. This adjustment period is sometimes anecdotally referred to as the “Mirena Crash,” a non-medical term describing a cluster of systemic symptoms.
The body must now reactivate and regulate the hypothalamic-pituitary-ovarian (HPO) axis, the complex signaling pathway that controls the menstrual cycle and natural hormone production. This reset can take weeks or even months as the body’s endocrine system attempts to stabilize. The resulting hormonal fluctuations can manifest as psychological and physical symptoms.
Users often report mood changes, including increased anxiety, irritability, and even depression, as their body adjusts to the lack of synthetic progestin. Other physical changes may include temporary skin issues, such as acne flare-ups, changes in hair texture, or mild shedding. Fatigue, breast tenderness, and headaches are also common experiences. These symptoms are generally temporary, gradually resolving as the HPO axis fully reasserts control over natural estrogen and progesterone levels.
Resuming Menstruation and Fertility Timeline
A primary reason for Mirena removal is the desire to become pregnant, and fertility can return almost immediately. Levonorgestrel is not stored in the body’s tissues, meaning its contraceptive effect stops as soon as the device is taken out. Ovulation, the release of a mature egg from the ovary, can resume within days or weeks following removal.
The average time until a person has their first full menstrual period after removal typically ranges from four to eight weeks. Importantly, the return to fertility after Mirena removal is not delayed compared to women discontinuing non-hormonal contraception. Because ovulation can occur before the first post-removal period, pregnancy is possible immediately.
For those not seeking conception, it is advised to begin a new form of birth control before or immediately after the IUD removal procedure to prevent unintended pregnancy. Many people who wish to conceive do so quickly, with approximately 8 out of 10 women becoming pregnant within the first year after Mirena removal.
The initial periods after removal are often different from the light or absent bleeding experienced while the IUD was in place. Since the levonorgestrel thins the uterine lining, the first few natural periods may be heavier, longer, and involve more painful cramping. This change is simply a return to the person’s baseline menstrual pattern from before the IUD insertion.