What should you know about spotting between periods with Mirena?

Mirena releases a progestogen in the uterus and can alter the uterine lining. That change may lead to irregular spotting while your body adjusts. The pattern and associated symptoms matter more than the colour alone.

Spotting is commonly noticed after Mirena is placed and may settle as the lining responds. It can be pink, red or brown. Keep a record of when it occurs, whether it follows sex, and whether the amount is changing.

Bleeding should not automatically be attributed to Mirena. Pregnancy, an infection such as chlamydia, cervical dysplasia, polyps or fibroids can also cause bleeding between periods. Changes involving the cervix or womb need assessment when the pattern is unusual; spotting itself does not establish cancer.

A sudden change after a stable pattern, new pelvic pain, fever, unusual discharge or pain during sex warrants advice. If pregnancy is possible, test and tell the clinician that you have Mirena, because pregnancy with an intrauterine device needs prompt assessment.

Use a diary or phone note to record bleeding days, amount, cramps, discharge, sex, medicines and the date Mirena was inserted. Do not remove Mirena yourself or try to reposition it. If you cannot feel the threads when you normally can, or you feel hard plastic at the cervix, contact a clinician for advice and use backup contraception until checked.

Book a review if spotting continues beyond the adjustment period, returns after settling, or is troublesome. Assessment may include a pregnancy test, pelvic examination, infection testing or an ultrasound, depending on symptoms and examination findings.

Seek urgent help for severe or one-sided pelvic pain, faintness, shoulder-tip pain, fever, heavy bleeding, or a positive pregnancy test with pain or bleeding. These symptoms can signal a problem that should be checked promptly.

Get prompt medical advice for new pain during sex, foul-smelling discharge, pain when urinating, or a sudden change in bleeding after Mirena had been settled. A clinician can check the device position and look for other causes.

Ask: Does my bleeding fit a Mirena-related pattern? Could the device have moved? Should I take a pregnancy or infection test? Do I need an examination or ultrasound? What changes should trigger urgent help?