How to Choose the Right Contraceptive Method

A small polyethylene T-shaped frame.  The stem of the T has a cylindrical reservoir that contains levonorgestrel.  The cylinder slowly releases the hormone through a rate-limiting membrane.

The Mirena IUS is available in only one dosage of levonorgestrel.  It is effective for up to five years.  The IUS can be inserted at any time during the menstrual cycle once pregnancy or the possibility of pregnancy has been ruled out.  Insertion may be easier at the time of menstruation, or 3-4 hours after the vaginal insertion of 400 mcg of misoprostol.  It is effective immediately. 

1. Reversible, private, and coitally independent method of contraception..
2. Less adherence demanding
3. May be used by women who have contraindications or sensitivity to estrogen, for example women over age 35 who smoke.
4. May be used by breastfeeding mothers.
5. May be used for family spacing or in women considering long term contraception.
6. May be used in women with menorrhagia, dysfunctional uterine bleeding, or perimenopausal menstrual irregularity, provided pathology has been ruled out.  IUS users experience a significant reduction in menstrual bleeding and may even become amenorrheic.
7. May be considered in special needs patients who need long term assistance with menstrual management.

1. Perforation at the time of insertion.  Incidence of perforation is 0.6 to 1.6 per 1000 insertions.
2. Infection may occur at the time of insertion.
3. Expulsion may occur .  This is most common in the first year of use.  The 5 year cumulative expulsion rate for the IUS is about 6%.
4. Irregular menstrual bleeding or spotting may occur, more often in the first 4-6 months of use.  This usually improves after that time.
5. The IUS does not increase the risk of ectopic pregnancy.  However, if a woman were to become pregnant with an IUS in place, there is an increased risk that this will be an ectopic pregnancy. 

Absolute

1. Current or recurrent Pelvic Inflammatory Disease or STI
2. Known or suspected pregnancy
3. Immediately post septic abortion
4. Severely distorted uterine cavity
5. Known allergy to any component of the device
6. Undiagnosed irregular genital tract bleeding
7. Malignant trophoblastic disease, breast, cervical or endometrial cancer

Relative

1. Very high individual likelihood of exposure to gonorrhea or Chlamydia
2. <48 hours to <4 weeks post-partum
3. Benign gestational trophoblastic disease
4. IUS users with AIDS should be closely monitored for pelvic infection.