Before insertion, a complete personal & family medical history should be taken. Re-examine patient 6 wk after insertion & where clinically indicated. Prior to insertion, pregnancy & endometrial pathology should be excluded & genital infection should be successfully treated. Consider removal of the system should any of the following conditions exist or arise for the 1st time during treatment: Migraine w/ aura, unusually severe or unusually frequent headache, jaundice, marked increase in BP, malignancies affecting the blood or leukaemias in remission, use of chronic corticosteroid therapy, past history of symptomatic functional ovarian cysts, active or previous severe arterial disease eg, stroke or MI, severe or multiple risk factors for arterial disease, thrombotic arterial or any current embolic disease, acute venous thromboembolism. Women using hormonal contraception should be encouraged to give up smoking. Caution in postmenopausal women w/ advanced uterine atrophy. Insertion & removal may be associated w/ some pain & bleeding. Perforation of the uterine corpus or cervix may occur, most commonly during insertion. In case of difficult insertion &/or exceptional pain or bleeding during or after insertion, the possibility of perforation should be considered. The procedure may precipitate fainting as a vasovagal reaction, or a seizure in an epileptic patient. Remove Mirena in case of recurrent endometritis or pelvic infections or severe acute infections. Expulsion of the system or lost threads leading to system failure. Increased menstrual flow or unexpected bleeding may be indicative of expulsion. Increased relative likelihood of ectopic pregnancy when a woman becomes pregnant w/ Mirena
in situ. Ovulatory cycles w/ follicular rupture usually occur in women of fertile age. Depressed mood & depression. Low-dose levonorgestrel may affect glucose tolerance; monitor blood glucose conc in diabetic users. Not suitable for use as a post-coital contraceptive. Has not been studied in women w/ renal impairment; women >65 yr. No relevant indications for use before menarche.
Sign Out
