What could happen if an expired Mirena IUD is not removed?
February 3, 2015 1:39 PM   Subscribe

I currently have a Mirena IUD inserted which is about 3 or so years out of date. What are the health implications if I don't have it removed soon? I am 47.
posted by anonymous to Health & Fitness (9 answers total) 3 users marked this as a favorite
Likely, none, other than unintended pregnancy. In fact, Mirena IUDs are actually thought to be effective for about 7 years, although they're only approved for 5.
posted by i_am_a_fiesta at 1:42 PM on February 3, 2015 [3 favorites]

None, assuming it's not un-removable for some other reason (for example, if it's embedded). I know someone who had one in for over nine and a half years with no ill effects. Menstruation started resuming sometime in the eighth year. Feel free to MeMail me if you'd like to know more.
posted by asperity at 1:48 PM on February 3, 2015

I know someone who had one removed a few years later than she should have. It was embedded in the uterine wall and the removal was crazy painful. But no other side effects or damage done.
posted by futureisunwritten at 2:06 PM on February 3, 2015 [2 favorites]

My awesome OB/GYN told me she's left her Mirena in for six years and counting: she said she no longer needs it for BC but is keeping it for the lighted periods, as long as this side effect lasts. In other words, you're probably OK but removal might be free, considering IUDs are generally covered by insurance these days.
posted by smorgasbord at 3:49 PM on February 3, 2015

The most apparent issue with emplaced devices is that the likelihood of physically-mediated events increases over time. That's to say: once you've exhausted the therapeutic effect, it's just a (relatively) inert foreign body in your system. Foreign bodies can have some predictable-if-rare impacts that can be grouped by location, more or less, and so the central concern for an IUD would be in the range of: perforation, embedding, and/or infection (associated with the local tissue impact associated with perforation/embedding/contact issues, or some other issue like and infection associated with a bacterial biofilm on the device). The first two are mentioned in the product safety insert mandated by FDA. The latter is just an awareness from my work in medical device regulation.

The likelihood of any of these things can be presumed to be fairly low, considering the device is approved for marketing by FDA (and, hence, has gone through regulatory safety testing). The unfortunate truth, though, is that those pre-market safety tests aren't fully representative of all possible responses, so the regulatory safety apparatus relies on post-market adverse event reporting to fill in exactly the blanks you're asking about. Now, looking through adverse event reports can be scary, but it can also give you an idea of what kinds of things you might see. I do work with these reports for a living, and they are illuminating.

MAUDE is the medical device adverse events registry. Type "Mirena" in the search box, select "all years," and thumb through the results if you're interested. I haven't done this search, nor am I up to speed on Mirena-specific issues, but here's the two cent medical device wisdom: if you don't need it, take it out.
posted by late afternoon dreaming hotel at 4:24 PM on February 3, 2015 [18 favorites]

If you do remove it, I don't recommend taking it out yourself, and I'm fine taking out my own stitches / changing my own dressings. My IUD removal was simple, but blindingly painful.
posted by momus_window at 5:57 PM on February 3, 2015 [1 favorite]

If you want to keep it in expired and you trust your obgyn, you can ask them to do a scan to check it's still properly positioned and leave it. I and a family relative had bad symptoms at the three year mark, but we had pre-existing medical stuff and these were specific super rare side-effects. Otherwise I would have totally left it in longer.
posted by viggorlijah at 7:12 PM on February 3, 2015

My OB/GYN did mention to me once that Mirena has a significantly (2-4 years?) longer recommended insertion time in Europe than in the US, so you're probably in the clear currently, but much longer, who knows? It's pretty much painless to have removed in my experience, compared to insertion.
posted by padraigin at 7:32 PM on February 3, 2015 [1 favorite]

The mirena is recommended for 5 years in the UK (I imagine the same in the rest of Europe), but they still use copper coils which have a 10 year life. I would try and have it removed in the next year or so. Mine hurt going in, but it didn't hurt coming out.
posted by catspajammies at 10:36 PM on February 3, 2015

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