The levonorgestrel-releasing intrauterine device, commonly known as the Mirena, is a small, T-shaped plastic frame that releases a progestin hormone called levonorgestrel directly into the uterine cavity. Unlike copper IUCDs, hormonal devices work primarily through local actions rather than a foreign body inflammatory response alone.
Midwives in Nigerian clinical practice frequently recommend this method to women seeking highly effective, long-acting reversible contraception that also dramatically reduces heavy menstrual bleeding.
Thorough preparation before inserting a levonorgestrel IUCD safeguards client health and ensures informed choice. Midwives must take a detailed medical, sexual, and menstrual history to rule out absolute contraindications like current pregnancy, unexplained abnormal uterine bleeding, acute pelvic inflammatory disease, or active cervical infections.
Bimanual examination and speculum inspection are mandatory to assess the size, position, and mobility of the uterus, and to check for any signs of sexually transmitted infections. Counselling must cover realistic expectations regarding side effects. Many users experience irregular spotting or light bleeding during the first three to six months, followed by a welcome reduction in menstrual flow or even complete absence of periods, known as amenorrhea. Reassure clients that this absence of bleeding is safe and results from the local thinning of the uterine lining.
Inserting a levonorgestrel IUCD requires strict aseptic technique to prevent ascending infection. The procedure follows a precise clinical sequence:
Once the insertion is complete, allow the client to rest quietly on the examination table for a few minutes, as some women experience mild vasovagal dizziness or cramping. Provide simple analgesics like paracetamol or ibuprofen if cramping is bothersome.
Instruct the client on danger signs that require prompt clinic attendance, encapsulated by warning signs such as severe lower abdominal pain, unusual vaginal discharge, fever, or missing threads. Schedule a routine follow-up visit after the first spontaneous menses or at 4 to 6 weeks post-insertion to confirm the device remains properly placed and check for thread visibility.
Removing a levonorgestrel IUCD is generally straightforward when performed by a trained midwife. Seat the client in the lithotomy position, insert a speculum, and visualize the threads. Gently grasp the threads with sterile ring forceps or toothless forceps and pull outward at a steady, slow pace. The arms of the device fold upward as it passes through the cervical canal, minimizing discomfort.
Be prepared for potential complications: