Mirena can now be used for contraception for up to eight years in Korea.

Contraceptive effectiveness remained above 99% during years six through eight.

At the end of year eight, 98.7% of participants were satisfied with Mirena.

 

Among women who discontinued Mirena to become pregnant, 77.4% conceived within one year.

The eight-year duration applies to contraception; 

replacement after approximately five years may still be recommended when Mirena is used for treatment.

If you have ever considered birth control, you have probably heard of Mirena.

Mirena is a hormonal intrauterine system used not only for contraception 

but also in the management of heavy menstrual bleeding and menstrual pain. 

It has also been used in clinical practice for local progestin delivery 

during estrogen replacement therapy and for conditions such as endometriosis, endometrial polyps, and adenomyosis.

Recently, the approved duration of Mirena for contraception in Korea was extended from five years to eight years. 

Today, I would like to explain what this change means.

Evidence Supporting Eight Years of Use

A 2022 study published in the American Journal of Obstetrics and Gynecology evaluated the extended use of Mirena, 

a 52 mg levonorgestrel-releasing intrauterine system.

The study assessed its contraceptive effectiveness, cumulative failure rate, bleeding patterns, and adverse events during years six through eight.

Of the 362 participants who entered year six, 243 entered year eight and 223 completed the full eight years of use.

The Pearl Index values for years six, seven, and eight were 0.34, 0.40, and 0.00, respectively. 

The three-year Pearl Index was 0.28, and the cumulative contraceptive failure rate was 0.68%.

These results indicate that Mirena maintained a contraceptive effectiveness rate of over 99% beyond the initial five years.

High Satisfaction and Changes in Bleeding

At the end of the eighth year, 98.7% of participants reported being satisfied with Mirena.

The average age of the participants was approximately 29 years. 

As Mirena use continued, bleeding and spotting generally decreased. 

By year eight, approximately one-third of participants experienced amenorrhea, while many others had only infrequent bleeding.

Return to Fertility After Removal

Some participants discontinued Mirena early because they wanted to become pregnant.

Among 31 women included in the return-to-fertility analysis, 24 became pregnant within one year after discontinuation. 

This corresponds to a 12-month return-to-fertility rate of 77.4%.

In other words, fertility generally returns promptly after Mirena is removed.

What the Extended Duration Means in Korea

If Mirena was inserted solely for contraception and not to treat a medical condition, 

the procedure is generally not covered by Korea’s National Health Insurance.

However, the device may now be maintained for up to eight years when it is being used for contraception. 

This may reduce the cost and inconvenience associated with replacing the device after only five years.

I also currently use Mirena myself.

Since I am now 50, I had been wondering whether I would need to have it removed next year or whether I should have another device inserted. With the approved contraceptive duration extended by three years, my current Mirena may become the last one I need.

The longer duration can reduce the financial burden while continuing to decrease menstrual bleeding and provide highly effective contraception.

Contraceptive Use and Therapeutic Use Are Different

It is important to understand that the eight-year duration applies specifically to contraception.

If Mirena was inserted to treat a medical condition—such as heavy menstrual bleeding or adenomyosis—replacement may still need to be considered after approximately five years. The appropriate timing should be determined in consultation with your gynecologist.

Today, we discussed the updated duration of Mirena.

I hope this information is helpful if you have been wondering whether it is already time to remove or replace your device.

However, every patient’s situation is different. The appropriate duration may depend on the reason for insertion, your symptoms, your age, and your overall health. Please continue receiving regular gynecological examinations and consult your doctor before deciding when to remove or replace Mirena.