Mirena: what am I in for?

August 20, 2015 8:31 AM

I'm strongly considering getting an IUD of the Mirena or Skyla variety. I haven't used hormonal birth control in nearly twenty years. What am I in for? Bonus: did Mirena decrease your sex drive or make you moody?

I'm in my mid-thirties and, but for a six-month stint on Loestrin at age 18, I've used a mixture of condoms and lax application of the Fertility Awareness Method for almost twenty years with no "real" pregnancy scares. As I get older, the idea of an unplanned/unwanted pregnancy feels increasingly emotionally complicated; though FAM's been working just fine, I don't want to have to consider an abortion at this point in my life. That said, my sex drive and emotional stability are much more important than the risk of pregnancy for me--I'd consider mood swingy-ness and/or a decreased sex drive absolute deal-breakers, and would almost certainly go back to FAM if the IUD doesn't work out. What am I in for in terms of transitioning to hormonal birth control?

If it makes a difference: I'm in the US and have Kaiser. Nulliparous. My periods are 3-5 days and mostly no big deal with occasional brainfoggy/moody days beforehand. I'm not especially interested in the Paraguard since I really enjoy having fairly mild periods. Also, while I'm mostly not interested in hearing "Have you thought about [xyz non-IUD] birth control method," if you're someone who's avoided hormonal birth control for the majority of your life before finding something (hormonal or otherwise) that worked for you, I'd be totally glad to know more!

posted by tapir-whorf to Health & Fitness (49 answers total)

FWIW, I haven't found Paraguard to make my periods any worse.
posted by hollyholly at 8:33 AM on August 20, 2015 [1 favorite]

I'm on my second Mirena, and have used them since ~ 2009. I was using BCP (yasmin? I think?) prior to then. I love it. I have had none of the global hormonal effects (mood, etc, whatever) that I had with the pills. I've also been lucky enough to have periods go away almost entirely. Honestly, the worst part is the insertion and that's not even that bad.
posted by anthropophagous at 8:44 AM on August 20, 2015 [1 favorite]

I have a Mirena and in your position, I'd try the Paraguard. Either way you're taking a risk, and personally, I found that the Mirena hormones were not 100% consequence-free. If I were going to do it over again (which I'm NOT, because ow) I'd gamble on the Paraguard. One-third of women with the Paraguard have worse periods, one-third have no change, and one-third have lighter periods. So the risk is not that bad.
posted by easter queen at 8:51 AM on August 20, 2015 [2 favorites]

I'm a person who tolerated a no-frills HBC pill well for many years, then switched to a Mirena so I didn't have to think about my uterus every day. I'm a person who, unregulated, has impossibly heavy periods and terrible cramps that leave me bedridden (possible endometriosis), so coming into this my experience isn't the same as yours so keep that in mind.

Even though I felt I did fine mood-wise on the pill, about a month after I switched to the Mirena I started noticing I was a little less weepy about things like dog food commercials and generally felt brighter. I didn't really notice any problems before, and it may just be a coincidence, but emotionally I've felt better since switching.

No effect on sex drive.

Ask for an anesthetic when you get it inserted if you're concerned about pain. I know it's not universal but for about 3 or so days afterwards it felt like I had been Chuck Norris kicked right in the cervix. Docs won't offer, but evidently you can ask for anesthetic if you want.
posted by phunniemee at 8:55 AM on August 20, 2015 [2 favorites]

I was not on hormonal birth control when I got my Mirena, and I had no issue with my mood or sex drive after it was placed. FWIW, when it was time to get it replaced, I switched to Paragard, and my periods are no heavier than my pre-Mirena periods.
posted by amarynth at 8:57 AM on August 20, 2015

Ditto anthropophagous.
posted by wintersweet at 8:59 AM on August 20, 2015

I have the Mirena. I'm also nulliparous and my doctor warned that insertion might be extremely painful. Mine wasn't, but the doc seemed surprised that I found it so easy. Not saying it was pleasant or comfortable, mind you, but I'd file it under no big deal other than some minor cramping for a few days after, which was easily solved by taking some ibuprofen. My pre-IUD periods sound similar to yours, OP. I had random spotting for a few months afterwards, as my doctor said there might be. Again, no big deal.

Oral contraceptives (Tricyclen-Lo and another one I can't remember the name of because I was in my late teens) turned me into a moody, short-tempered she beast. I have had no such side effects with Mirena. Also, my periods are either short and light some months or nonexistent in others. No effect on mood, sex drive, or anything else. It's also worth noting that I have only taken hormonal contraceptives for the last seven years or so. Before that it was strictly condoms.

My Mirena is due to be replaced next year and I will definitely be getting another one. A few of my friends have the Paragard and have no issues with that one either. Both are fine choices.
posted by futureisunwritten at 8:59 AM on August 20, 2015 [1 favorite]

I'm on my second Mirena. I was super sensitive to hormones in other birth control options, and this worked well for me. I got it for the same reason as you -- I don't want pregnancy scares, and this is the most effective form of birth control.

The Mirena is great. It's just there and it works. For the first several months I had bad cramps, but I had bad cramps before that, too. I also had some whacked out bleeding the first few months (happy to MeMail discuss details) but whatever, I'm super sensitive to all side effects of everything.

Now I don't really have a period. It's great and I feel like a cool cyborg (except for when other women ask me for a tampon and then I feel guilty because no, I don't need those anymore). AS FAR AS I KNOW, it had no effect on my mood / sex drive / etc (that said, I've been using this form of BC for the last 7 years).

I guess insertion hurt both times (I only took advil beforehand), but I just went home and drank half a bottle of wine with some advil after each time to calm my system. Idk if this is medically sound, but it worked for me.
posted by aaanastasia at 9:02 AM on August 20, 2015 [5 favorites]

My first IUD was a Paragard specifically because I wanted a hormone-free option, as I'd had terrible experiences with every variation of hormonal birth control. And I went from a light flow/no PMS to a tsunami and having to take sick days each month. After a year and a half, my Ob-gyn convinced me to try a Mirena -- and it's wonderful! I'm currently on my second, and have had no side effects at all except that my period stopped completely after the first month. So my anecdata is that it really does appear to be a negligible amount of hormones.

I think it's important to realize that neither IUD is a "natural" option -- they're both going to affect your body in some way. I do wish I'd realized beforehand that the Paragard works specifically by irritating your uterine lining.
posted by veery at 9:03 AM on August 20, 2015 [1 favorite]

I've talked about this before, but I went from a copper IUD (two years of hell; don't ask me why I waited that long) to a Mirena. I've had the Mirena for three years now, and have had no cramping, no periods, and no babies. Basically, best case scenario.

I had an internal shot of anesthesia during the insertion in my cervix and did not feel a thing.
posted by roomthreeseventeen at 9:03 AM on August 20, 2015 [2 favorites]

I had only used Nuvaring before getting Mirena, so I have little comparison. I chose Mirena due to some family medical history and haven't looked back. I was definitely a person who was a wreck during my period and it was never consistent (which was/is terrifying as a sexually active young adult). I had a Mirena, uhh, installed a few years ago and had the same warnings from my (male) gyno about pain and how it wasn't recommended for women who had not had children. I went for it, experienced a little pain during insertion and cramping afterward, but four years little am thrilled that I have it. My sex drive remained the same, if not better since I wasn't weeping over tampon commercials.
posted by thefang at 9:03 AM on August 20, 2015

I have Mirena and I've noticed no changes in mood/drive (if anything, it's smoothed out some PMS moods). I've also had no periods.
posted by adorap0621 at 9:05 AM on August 20, 2015

Skyla tanked my sex drive and gave me ovarian cysts that burst, sending me to the ER. After removing it, I had a cycle of BV and yeast infections that lasted for about four months. I wouldn't recommend the hormonal IUDs to anyone.

Just my $0.02.
posted by dinnerdance at 9:05 AM on August 20, 2015 [2 favorites]

I just (as in a few days ago), replaced my Mirena with a new one. I was not on hormonal birth control before I got my initial Mirena (though I had been in the past), and I didn't notice any hormonal changes, though I may be a person not particularly susceptible to hormonal birth control. No changes in moodiness or sex drive.

With the Mirena my periods got much shorter (18-36 hours, as opposed to 4-5 days without any birth control) but did not disappear completely. My cycle also reverted back to my "natural" cycle, which is much longer (35 days approximately). I've never had/noticed any PMS or other cycle issues, either with or without birth control, so no changes with that.

I'm also nulliparous, and both times I did the insertion having taken some Ibuprofen. The first time it was not comfortable, and there was some cramping, but I went back to work for the day and went out to dinner that evening. I also had some heavy spotting for a few weeks after the initial insertion. The replacement was more difficult for some reason, and I had pretty bad cramping/pain from the insertion that meant instead of going into the office, I went home and tried to sleep it off. I've since had a bit of cramping, which I expect will go away in a few days. No spotting so far.

I am a huge proponent of IUDs in general and of the Mirena specifically (since that is what I have experience with), and I have a number of friends who feel the same, though the insertion process/pain seems to vary from person to person.
posted by Caz721 at 9:08 AM on August 20, 2015

Response by poster: Dinnerdance: did you have ovarian cysts before, or did they develop out of the blue?
posted by tapir-whorf at 9:09 AM on August 20, 2015

I got my Mirena a couple years ago, and I'm also nulliparous and in my mid 30s. The insertion hurt like hell- for about 10 minutes. Ever since, it's been the best thing ever. I also mostly don't get periods anymore (woo! I did feel a bit weird reading the recent thread on the London Marathon though.. and it also kind of changed my perspective on Connie Willis' short story Even the Queen..) Also bonus, but I get fewer UTIs (dunno why, maybe no more condoms?)

I'd been on a few different forms of bc previously (ortho tri-cyclen, nordette, nuvaring). I am not at all moody with the Mirena, but I definitely have had effects before (I think ortho was the worst for me). For me it's similar to how I felt with Nuvaring (my favorite form until I went for the IUD, which I did because it was covered by my insurance- but which cost less than the 5 years of the ring would have, for me *as well* as for my insurance co. thanks, obama!).

Of course these are anecdata, as you can tell from the varied stories here. Your doctor should have actual statistics available for you on side effects-- they should be able to tell you what percentage of Mirena-havers experience the ones you are worried about.

I expect I'll replace my Mirena with another when the time comes, and when I do, I'll ask for some painkillers before the insertion (even a couple of ibuprofen would have been a good idea).
posted by nat at 9:12 AM on August 20, 2015

My experience has been similar to phunniemee's, plus weird bleeding the first 2-3 months as things settled down. A+++ would insert again.
posted by quaking fajita at 9:12 AM on August 20, 2015 [1 favorite]

I was also very scared of hormonal birth control, never took BC pills, and was pleasantly surprised by the lack of weight gain/moodiness/decrease in sex drive/etc with the Mirena. It's a pretty low dose of hormones that's delivered right where you need it.
posted by Juliet Banana at 9:16 AM on August 20, 2015

phunnimee basically said exactly what I would have said. I love love love my Mirena and it's made a big positive difference in my quality of life. I will keep getting Mirenas as long as I need such a thing. My doc did offer the cervical block anesthetic and I'm very glad I got it - the insertion was still briefly but intensely painful. I would try ibuprofen ahead of time as well, next time.

I've experienced no change in sex drive. Definitely no increase in emotional issues; if anything I think that has improved slightly, although it wasn't a big deal to begin with.

My adjustment period was about 48 hours of an odd feeling in my abdomen area - not discomfort, exactly, just a sense that something was out of place or slightly wrong in that general area. It was weird but not painful. It went away quickly, over the next few months my cycles stayed regular but got lighter and lighter, and within four or five months were all but completely gone.
posted by Stacey at 9:18 AM on August 20, 2015

I had a mirena a few years ago, for slightly less than 6 months. While using it, I experienced fairly constant spotting and random cramping that was among the worst I'd ever experienced. I also developed a very bad itchiness, which my gyn insisted could not be related to the mirena. I also felt sort of brain foggy while using it, but I can't say for sure it was related. I had it removed, and after about a year of steering clear of any hormonal bc, I started using the NuvaRing. I'm in love. Zero side effects, only have to think about it once a month. You can even skip your period by leaving it in an extra week. Highly recommend.
posted by bluloo at 9:18 AM on August 20, 2015 [2 favorites]

I was on hormonal BC for 7-8 years before switching to Mirena. On Mirena I have lighter periods, but no change to length. I have really terrible cramping that I didn't get on the pill, but do remember dealing with before starting any BC. My sex drive increased, which was great. I hadn't realized how much my prior BC had been affecting it. I found the insertion to be one of the most painful things I have experienced.

I don't plan on having children and if not for the cramping I would plan to use Mirena until I don't need BC. The cramping might just be my normal and not caused by the IUD, but next time around I will be getting a tubal.
posted by Shanda at 9:24 AM on August 20, 2015

I got Mirena after I got pregnant while I was on the NuvaRing. I loved the NuvaRing, and had no appreciable sode effects from it. I like Mirena and gave had mine for 14 months. The first 9 months my period was SUPER heavy and I had cramps like never before. The last 4-5 months my periods are significantly lighter and I have some cramps which are still ROUGH but are fewer and farther apart.
posted by slime at 9:25 AM on August 20, 2015

I love my Mirena. I've had two and have to get them inserted under general anaesthetic due to fibroids. Totally worth it and have had no problems whatsoever.
posted by hazyjane at 9:33 AM on August 20, 2015

I am a person who cannot tolerate oral contraceptives at all, and am on my third Mirena. The first two were when I was nulliparous, and the current one was placed post-baby.

The only side effects I have noticed are lack of pregnancy and periods. Mirena has been perfect. When my current one turns five next year I plan to get my fourth.
posted by rabbitrabbit at 9:39 AM on August 20, 2015 [3 favorites]

I am on Mirena #2, will happily get #3. Best decision. HBC started to make me crazyballs, I felt terrible. The local delivery of hormones with Mirena doesn't give me the same crazy feelings/lack of everything/god knows what that I had with HBC. With Mirena I haven't had a period for the best part of 10 years now. It's more or less the best thing I've ever done for myself. Best. Ever.
posted by Medieval Maven at 9:41 AM on August 20, 2015 [1 favorite]

On the topic of insertion pain management:

I did have the gyno I used for my second Mirena write me a script for misoprostol to "soften my cervix" since I'm nulliparous. I was only able to take one of the prescribed pills; it caused really bad cramping. I looked it up, saw that it's used for medicated abortions, and was like "well, I'm definitely not pregnant, but now I know exactly what getting a medicated abortion feels like, this sucks."

She tsk-tsked me for not taking the second round (I had to work, I can't work while curled up and gasping), and the insertion didn't go any worse or better than my previous insertion where I didn't prepare with misoprostol.

I actually got anesthetic without asking, but it's like, a toss up whether having a big scary needle give me a shot in the fucking cervix really made the whole thing less traumatic.
posted by Juliet Banana at 9:42 AM on August 20, 2015 [2 favorites]

I took HBC (Levora, I think?) through my twenties with no major problems, stopped to have a kid, had said kid, then got a Mirena about a year after kid was born. I love the Mirena so much. No side effects, but it took about six months for almost constant spotting to stop (I was still breast-feeding, so I assume I had other weird hormonal things going on). I'm 4 years in now and will definitely get it again when this one expires. Not having to pay into the lady tax of buying tampons/pads every month makes me happy.
posted by banjo_and_the_pork at 9:43 AM on August 20, 2015

Oh, on pain management: I had misoprostol both times (uh, no real side effects for me. I am kind of convinced I don't really have lady parts in there sometimes). Getting the first one OUT was worse than anything else and for the 2nd insertion they injected . .. lidocaine? The biggest thing I noted about that was that it made me VERY FUNNY for about 30 minutes. By which I mean, both extra spacy and extra witty. I made a killer Smurfs joke. YMMV.
posted by Medieval Maven at 9:45 AM on August 20, 2015 [3 favorites]

quaking fajita:

My experience has been similar to phunniemee's, plus weird bleeding the first 2-3 months as things settled down. A+++ would insert again.

This is exactly what I was about to say. I was 27 when I got my Mirena and, spotting aside, have had such an improvement in my periods and in the side effects I'd been getting from the pill. Nulliparous and dreading my next insertion (I nearly fainted a couple of times in the hours afterwards - rest was important!), but so, so worth it for me.
posted by carbide at 9:51 AM on August 20, 2015

I started with the paragard and stuck with it long enough for the initial cramping and spotting to end, but my periods almost tripled in length and intensity and after three years I'd had enough and switched to the mirena. I think because my body was already used to the iud, there was no cramping or spotting. I loved loved loved it. No side effects that I could tell, on sex drive or anything else, except for ending my periods, which was just lovely. (My impression is that the lower dose skyla might be less effective at that).

I think this is one of those things where there's no way to know but to try. The good part is that changing iuds seems a lot easier than starting one, so if hormonal doesn't work out you can more easily switch to non (or vice versa).

I loved the peace of mind and ease of both and I definitely recommend giving it a try.
posted by Salamandrous at 10:02 AM on August 20, 2015

Also I was also nulliparous and the pain was sharp but over so so fast. I definitely recommend finding a doc who has done a ton of insertions.
posted by Salamandrous at 10:05 AM on August 20, 2015

I had a copper coil (paraguard?) and I really liked it, I had one heavy period and then they evened out to normal... Insertion hurt, but more because nobody warned me to take an ibuprofen beforehand.

However- I fell pregnant 2 years into the life of my coil and I am now looking at a bouncing 6 week baby boy.

We were planning on a child just not so soon so it wasn't that big of a deal- but make sure that you're educated on how to check your strings- because I wasn't!
posted by pairofshades at 10:12 AM on August 20, 2015 [1 favorite]

I was 26 when I got my Mirena IUD (~3.5 years ago) and had strictly used condoms for birth control prior to that. I was drawn to the IUD for the simplicity, low maintenance, and high rate of contraceptive success. I've never been highly emotional during my period, but I had horrific cramps that left me bedridden about quarterly from about age 15 (Why did I wait 11 years to get hormonal birth control? Such a good question).

I haven't had any mood swings, and my sex drive remains quite high. I don't experience lighter periods, and I still have a clockwork schedule, every month, but the cramping is worlds better. I heard horror stories about insertion, but it was simple - a sharp pain, then some discomfort and cramping for a few days, but nothing nearly as bad as I'd had with a rough period. I'm totally pleased with the Mirena experience and intend to get a new one when this installment runs out its lifespan.
posted by Catenation at 11:24 AM on August 20, 2015

I do think the Mirena has led to some major mood swings for me. They're not the kind of mood swings that leave me curled up sobbing or anything, but they're also not a huge amount of fun.

That said, the super light period, and the fact that the Mirena did not alter my weight or libido, makes it the best option for birth control I've ever tried.
posted by artemisia at 11:35 AM on August 20, 2015

Before, I was on Jolessa and only had a period four times a year with some spotting in between. I had Skyla put in a year ago almost to the day. For the first six months the cramping and bleeding was so bad I thought it had punctured my uterus. After repeated assurances that the IUD was placed correctly and a prescription for super-ibuprofen, I decided to just wait it out. It got worse. It turns out I had cervicitis from the string irritating my cervix. They gave me some antibiotics and cut the string shorter and the bleeding is much lighter now, though the cramps are still pretty awful. I will probably not get another IUD.
posted by domo at 11:38 AM on August 20, 2015

PS. I should clarify that the bleeding for the first six months was almost constant. I cannot believe that my gyno did not immediately jump to cervicitis as the cause. I was in her office twice a month for the first six months. Now I have a somewhat normal, though long, cycle.
posted by domo at 11:54 AM on August 20, 2015

tapir-whorf: My understanding is that all women produce ovarian cysts as a normal part of their cycle; it is when they get too big that problems arise. With that background: I never had problems with ovarian cysts until Skyla. Diagnosis and checkups required transvaginal ultrasounds, and during my first, I was told my cysts were dangerously large and that the searing (frightening, awful, dropped me to my knees) pain I had experienced was likely one of them bursting.

I don't want to scare you, but I really wish I had been informed about the potential side effects before I went through insertion. My other experience was that some gynos are not well informed about the potential side effects and will not believe you if you tell them you think X, Y, and Z might be related to the IUD. I went through three before I found one who didn't make me feel like I was a crazy person. He told me he saw many, many patients with IUD-related problems, and wouldn't prescribe the Mirena.
posted by dinnerdance at 12:22 PM on August 20, 2015 [1 favorite]

Coda: You may be a person for whom the IUD works well. I have several friends who love theirs. But if you are not, prepare yourself for a bad time.
posted by dinnerdance at 12:26 PM on August 20, 2015 [3 favorites]

I was on different forms of HBC for 10+ years, took a year off, then had a mirena IUD inserted last October. Insertion itself was nothing and I have a high pain tolerance - but the first few months were more crampy and irregular than I had ever experienced before, and for a while I regretted it. I had always had a very regular cycle with moderate bleeding lasting 5-6 days and no PMS to speak of. Now, my flow is much lighter but irregular. I will have light periods lasting
7-9 days, and significant
PMS symptoms. My sex drive is lower now, yes. I still worry about an unwanted pregnancy even though the risk is small, so for me I'm not sure it has been the best choice but I'm also not bothered enough to have it removed and try something else.
posted by sarahnicolesays at 2:48 PM on August 20, 2015

Mirena slightly reduced my sex drive, but vastly reduced my sex life because I spotted constantly. I spotted randomly, I bled every time I had penetrative sex, I got a yeast infection in my cervix, cramps were still horrifying although period was lighter. Mood swings were slightly worse, and also more random. I also have a permanently sensitive cervix that spots/bleeds if it is knocked (sex, defecation, internal exams, transvaginal ultrasounds, and recently any orgasm whatsoever). It was fine prior to the Mirena and with the Mirena in I became very sensitive to physical stuff in the area (I had to stop using my menstrual cup because the shifting around during insertion/removal nearly made me pass out).

However, I do have endometriosis and I think that affected my experience of the Mirena. If I'd gotten it earlier maybe things would have been better but by this stage my uterus and ovaries are both adhered to my intestines and it looks like there's some odd adhesions around the place elsewhere, which may also explain the cervix thing.

Also my partner got stabbed in the junk every time we had sex, regardless of how trimmed the strings were.

So I don't rec the Mirena on my experience, but it is a statistical outlier (Mirena Georges...)
posted by geek anachronism at 3:18 PM on August 20, 2015

I love my mirena. It has totally changed my life for the better. I had really wretched periods and now they're almost gone. I've tried various hormonal BC over the years with some nasty side effects (nonstop bleeding, cystic acne, hair loss...) but nothing bad from the Mirena. I was a little crampy for a few weeks right after insertion, but compared to my usual collapse-to-the-ground-in-agony period cramps, it was nothing.

Also, no pregnancy scares, insertion wasn't painful (nulliparous) and it hasn't gone walkabout in my abdominal cavity or anything of that nature. I plan to keep getting them until menopause, barring sudden appearance of side effects.

This thread definitely emphasizes that everyone is different when it comes to BC though.
posted by ZeroDivides at 3:53 PM on August 20, 2015

My experience with Mirena, in short simple summary:
- Birth control that actual works.
- No period. At all.
- Zero other side effects.
- Serious improvement in sex life, because I wasn't terrified of getting pregnant while on birth control yet AGAIN.
- Serious reduction in stress as a result.

Absolute best thing ever for me.
posted by stormyteal at 4:24 PM on August 20, 2015 [1 favorite]

I'm getting the Mirena next month, so all of this information is so, so useful! Thanks, everyone who shared!
posted by sarcasticah at 4:24 PM on August 20, 2015 [1 favorite]

Mirena! I've mine for 1.5 years, and it's been great. The insertion was a little crampy, but nothing unbearable, and I was in and out of the office in like 15 minutes, including the time my lovely NP spent reading the warning labels to me.

I did have moderate cramps on and off for 3 months and almost constant spotting for about 6 months. I know, it SOUNDS terrible, but my period was unpredictable and painful before I got my Mirena, so these side effects were not a big deal. YMMV. I used my Divacup usually, and Advil for the cramps. Now I get a period every few months, if that.

No negative effect on sex drive, and having worry-free condomless sex (with a clean, monogamous partner, etc) has been amaaaaaazing.

+1 would mirena again
posted by Ragini at 6:29 PM on August 20, 2015

I loved my Mirena but we did not stay friends. I had it removed after 3 years as I suspected it was causing mood swings. Haven't had an inexplicable sad since removal (2 years ago). Everything else about it was great, such a shame!
posted by Ness at 1:33 AM on August 21, 2015

I've had both the Paragard and the Mirena (currently still have it). Nullip. Mirena insertion hurt way more than Paragard--but that could have to do with the person who inserted it. I didn't take any painkillers or receive any lidocaine. I definitely prefer the Mirena--I don't get a period at all.

I don't see any reason to get a Skyla if you're not planning on trying to get pregnant in the next five years. First of all, Skyla has a shorter lifespan, and second of all, most people don't experience shortened periods with it. The one advantage, IMO, is that the inserter is smaller so it's supposedly less painful. (FYI: Studies seem to indicate that there's no real benefit to misoprostol prior to IUD insertion; in fact, it might make cramping worse.)

Something no one else has brought up: Your insurance should 100% cover the device and the insertion. That is the promise of the ACA. (If Kaiser balks, which they might, go here and tell them what happened.) This is all to say that there's virtually nothing stopping you from getting the IUD, and if you don't like it after a few months, having it removed. It's not permanent and your fertility will no be impacted.
posted by cowboy_sally at 9:15 PM on August 21, 2015 [1 favorite]

Response by poster: Thank you all so much for you advice and tales and warnings and for being really super-generous with information. I'm tempted to mark just about everything as a best answer, but will refrain.
posted by tapir-whorf at 9:42 AM on August 22, 2015

I'm also happy to be a cool cyborg on my 3rd Mirena. I'm a nulliparous woman in my mid-thirties. Reduced pain and PMS are great, as is having almost no period (for me it goes away after insertion, and then a few years in I get around a day of very light bleeding per month).
First insertion felt like medium-intensity menstrual cramps: not fun but nbd.
Second insertion: intense pain, and a few days of cramps. Other experiences with that practitioner did not leave me confident that she knew what she was doing though. I wish I'd taken some codeine or something beforehand.
Third insertion: barely a pinch. Also, because I have a tipped uterus, that doc inserted the IUD upside-down, which I think was brilliant and will ask for from whomever inserts my next one.
I didn't notice any effect on my libido--but it's pretty great not to worry about where in my cycle a date night falls!
posted by Edna Million at 12:45 PM on August 22, 2015 [1 favorite]

What I learned is that ACA requires insurance companies to completely cover one form of each mode of birth control. Mirena and Skyla are considered the same mode and my insurance, for reasons unknown to me, only completely covers Skyla. My copay for Mirena would have been $75 plus whatever remained of my deductible, up to the full cost.
posted by Salamandrous at 9:08 AM on August 23, 2015