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Surgical Removal of Mirena IUD

The Mirena intrauterine device (IUD) is a hormonal birth control method that involves inserting a small, T-shaped device into a woman’s uterus. The hormone levonorgestrel is then released into the uterus in a time-controlled manner over the next five years. At this point, Mirena removal is necessary. Women may also choose to have the device removed at an earlier point, or premature removal may be needed due to serious and potentially life-threatening complications of the IUD.

However, in some cases, normal removal of the device is not possible, and the patient must endure surgery. Many women have already filed lawsuits against the manufacturer, Bayer Healthcare, alleging permanent injuries and trauma due to complications that necessitated surgical removal. Given that the FDA has received more than 45,000 adverse event reports associated with the Mirena IUD, it is likely that more complaints will continue to be filed against the manufacturer.

Reasons for non-surgical removal

The Mirena IUD is intended only for insertion and removal by a qualified health care professional, such as a primary care physician or gynecologist. The device should always be removed at the end of the five-year time period, if not beforehand. A patient may decide to have the device removed prematurely if she decides to become pregnant.

She may also decide to switch birth control methods if she experiences troubling side effects related to Mirena, such as:

  • Depression
  • Nervousness
  • Weight increase
  • Decreased sex drive
  • Headache/migraines
  • Anemia
  • High blood pressure
  • Pelvic inflammatory disease (PID)
  • Ovarian cysts

Normal removal of Mirena

Usually, Mirena removal is a routine procedure. The health care professional evaluates the uterus and the position of the strings attached to the IUD. Forceps or clamps are attached to the strings, which are then used to pull the device out. As the IUD is pulled out of the uterus, the flexible arms fold. 

In some cases, the doctor or nurse is unable to remove Mirena normally. This may occur when the strings cannot be located. If the strings are not visible, the health care professional then checks to determine whether the IUD itself is still in the proper uterine position. If so, a minimally invasive procedure may be used to remove the device. If the device has migrated, more extensive surgery may be required.

Potential complications that may necessitate early removal of the IUD include:

  • Mirena migration: Mirena migration is a common reason for surgical removal of IUD. Unfortunately, it’s a complication that is difficult to detect. Most women are unaware that the device has migrated out of its proper uterine position until they go for a routine checkup. In severe cases, the device may migrate far enough to damage internal organs, such as the bladder, resulting in significant pain. Migration of the IUD may lead to Mirena embedment or uterine perforation.
  • IUD embedment: Mirena removal is necessary when the device embeds itself in the uterine wall. It can be difficult to remove the IUD through non-surgical means when this occurs.
  • Perforated uterus: If Mirena embedment isn’t detected promptly, the device can perforate the uterine wall and continue to migrate elsewhere in the body. More extensive surgery may be required to repair the damage.
  • Ectopic pregnancy with Mirena use: Pregnancy has been reported to occur in nearly eight out of every 1,000 women who have used Mirena. According to the Bayer literature for medical professionals, up to half of these pregnancies are ectopic, which means that the fertilized egg has implanted outside the uterus. It is not possible to bear an ectopic pregnancy to term. Termination of the pregnancy and Mirena removal is warranted immediately to save the life of the mother.
  • Intrauterine pregnancy: When an intrauterine pregnancy occurs with Mirena use, patients are strongly advised to remove the device. Although device removal may cause pregnancy loss, failure to remove the device can cause septic shock, septicemia, and death of the mother.

Surgical removal of IUD

There are a few ways in which Mirena removal may be conducted surgically. The first and least invasive involves the use of forceps to take the Mirena out of the uterus. This often requires dilation of the cervical canal and possibly anesthesia.

In the event that the device has perforated the uterine wall and migrated, laparoscopic surgery is necessary. The doctor is likely to run imaging tests on the patient, such as an ultrasound and a computerized tomography (CT) scan to determine the exact position on the device. Then, a series of small incisions is made over the area. The surgeon inserts a laparoscope, which is a small, tube-like device with a light and a camera at the end to allow for visibility. Additional small instruments are used for removal of the device. Laparoscopic surgery is generally preferred because it reduces the risk of surgical complications, offers the patient a shorter recovery time, and is less invasive than open surgery techniques.

If laparoscopic surgery is determined to be a poor choice because of the unique circumstances and condition of the patient, the surgeon may need to use more invasive techniques. The surgeon may need to make a larger incision to allow for the insertion of surgical tools. The open surgery approach requires a much longer recovery time and is associated with increased risks of complications.

Complications following surgery

If an open surgery technique is needed, the patient can expect to suffer from reduced mobility as she recovers. She is likely to miss more time from work and other daily activities, and is likely to experience more significant post-operative pain.

With any type of surgical approach, the patient runs the risk of experiencing certain complications, such as the following:

  • Adverse reactions to the anesthesia
  • Malignant hyperthermia
  • Infection
  • Blood clots
  • Bleeding
  • Delayed healing
  • Difficulty breathing
  • Death

The need for surgical Mirena removal and its associated complications has prompted hundreds of patients to take legal action against Bayer. They often charge the company with failure to warn of Mirena IUD side effects and with manufacturing a defective product. They seek damages to cover medical expenses, lost wages, and ongoing care needs, and to compensate them for pain and suffering.