Mirena and Copper IUD : How to insert it?

Photography by Lalocracio/Getty Images; Design by Erica Singleton

The insertion of the IUD as a contraceptive method has been growing a lot in recent years, thanks to its practicality and the demystification of its use.

Nothing better than not having to worry about taking the contraceptive pill every day… Even more with the busy routine experienced by us women, isn’t it? 

Currently there are several options such as the contraceptive patch, intrauterine device, and contraceptive implant , among others.

The placement of  the intrauterine device provides great comfort for women, as it is safe (effective close to tubal ligation), practical, reversible and long-lasting! 

So to start, I separated the main doubts that  women have about the insertion of the Mirena IUD and the Copper IUD, as well as how they work, IUD price, advantages and disadvantages, duration and much more!

What is the IUD?

The IUD is an intrauterine device, that is, a very small device that is placed inside the uterus to prevent pregnancy. 

What types of IUDs?

There are currently 2 types of IUD: the hormonal IUD (Mirena IUD and Kyleena IUD) and the non-hormonal IUD (Copper IUD and Silver IUD).

What are the advantages and disadvantages of copper, silver and hormonal IUDs?

Copper IUD

– Advantages: Its duration varies from 3 to 10 years. It does not interfere with libido or menstrual cycle.

– Disadvantages: It can increase the flow of menstruation.

Silver + Copper IUD

Similar action to copper IUD, but silver reduces its oxidation.

– Advantages: It can decrease the risk of heavy menstruation caused by the copper IUD. Its duration is 5 years. It does not interfere with libido or menstrual cycle.

– Disadvantages: Despite the lower risk, it can also increase the flow of menstruation.

Mirena IUD

Hormonal IUD that contains progesterone in its composition.  

– Advantages: It is a long-term method (5 years). It can be used as a treatment for abnormal uterine bleeding and as endometrial protection in post-menopausal hormone replacement.

– Disadvantages: It can cause irregular menstrual bleeding, especially in the first few months after insertion.

How does the Mirena IUD work? 

The hormonal IUD works by releasing the hormone levonorgestrel (progesterone) in small amounts daily into the uterus for a period of 5 years. 

This hormone will act on the mucus and pH of the uterus, making the uterine environment hostile to sperm, thus preventing fertilization and pregnancy.  

In addition, progesterone will also cause endometrial atrophy (thinning of the inner layer of the uterus). 

As a result, many women do not have a period (amenorrhea) after having a hormonal IUD inserted. 

How does the Copper and Silver IUD work? 

The non-hormonal IUD releases copper ions into the uterus, causing a local inflammatory process that reduces the chance that sperm will survive and find the egg.

In addition, they decrease the motility of the fallopian tubes, making it difficult for the egg to move towards the uterus, preventing fertilization.

It is not an abortifacient method !! Nor is it a definitive method like tubal ligation.

Unlike the hormonal IUD, in these types of IUDs, women continue to ovulate and menstruate normally, as they do not cause endometrial atrophy.

It is the reversible contraceptive method of choice for women with contraindications to the use of hormones (eg, women with breast cancer, history of recent thrombosis). 

Some women may experience increased menstrual flow with the use of copper IUDs, so the copper and silver IUD option has been launched on the market. 

The silver IUD works by stabilizing the oxidation of copper, which can reduce this effect of increasing menstruation . 

How are the Mirena IUD and the copper IUD placed?

IUD insertion is similar between IUD types. The procedure can be performed in the operating room or in the office .

In both cases, the patient will be in the gynecological position and the vaginal speculum (a device used for the gynecological examination in the routine consultation) will be inserted. 

After that, there will be asepsis and cervix clamping for the rectification of the uterus, followed by hysterometry (insertion of a thin cannula to measure the uterus, as if it were a ruler). 

After measuring the uterus, the IUD will be placed and the thread will be cut approximately 1.5-2.0 cm from the cervix. 

When the procedure is performed in the operating room, a hysteroscopy is performed to confirm that the IUD is well positioned.

This video below shows exactly how the IUD is placed! Don’t forget to turn on the subtitles in Portuguese!

How is the IUD removed? 

The IUD is removed during the gynecological examination, by gently pulling its thread with the aid of tweezers. Withdrawal is usually a smooth process, but it can cause mild cramping. 

If the IUD thread is not visible in the gynecological examination, its removal must be done through hysteroscopy. 

How long after IUD insertion can I have intercourse?

The ideal is to wait at least 24 hours after insertion of the IUD before having sexual intercourse. 

However, this period is variable, and the woman should feel comfortable, without cramping or bleeding, to resume sexual activity. 

It is also worth mentioning the importance of associating condoms in relationships until the return to the consultation with the transvaginal ultrasound. 

This is essential to ensure that the IUD is well positioned and thus avoid an unplanned pregnancy. 

How long does the Mirena and Kyleena IUD last? 

The hormonal IUD (Mirena and Kyleena) lasts for  5 years . 

How long does the copper and silver IUD last? 

The copper IUD can last 3, 5 or 10 years, depending on the model and dosage. 

The silver IUD lasts for 5 years . 

What are the side effects of IUDs?

The side effects of the Mirena IUD are: menstrual irregularity with leaks, cramps and headaches – especially in the first few months after insertion.

Side effects of copper IUDs are increased menstrual flow and cramping. 

The silver IUD can also cause cramping, but it tends to interfere less with increased menstrual flow. 

In addition, both hormonal and non-hormonal IUDs do not put on weight ! That’s a myth!

How do you know if the IUD has moved out of place?

When the IUD comes out of place or is expelled, the woman starts to experience cramping and vaginal bleeding . 

In cases of partial expulsion of the IUD, it is even possible to feel its vertical shaft on vaginal touch, a situation that does not occur when it is well positioned. 

IUD expulsion rates are low but higher in the first 30 days of use. Therefore, it is important to perform a new transvaginal ultrasound during this period to confirm its proper position. 

How long after pregnancy can I have the IUD inserted?

The IUD can be inserted right after vaginal delivery or cesarean section (between 10 minutes and 48 hours after delivery) or 6 weeks after delivery. 

How much does it cost to have the IUD inserted? 

The price to insert the IUD depends on the type of IUD (Mirena, Copper or Silver) and the medical value for performing the procedure.

The value of the copper and silver IUDs varies according to the duration and model, ranging from R$ 150 to 450 reais. 

The price of the Mirena IUD and the Kyleena IUD ranges from BRL 900 to BRL 1200.

The insertion of the IUD can be performed both in the office and in the operating room under sedation, with variations in the prices of each procedure.

Therefore, the value of the complete IUD for its insertion (IUD price + medical fees) varies according to each doctor. 

Where to put IUD in São Paulo?

This procedure can be performed in offices, clinics or in the operating room. This varies according to each gynecologist and patient’s desire.

Our focus is always maximum comfort and tranquility for all procedures. 

When the IUD is inserted into the OR under sedation, we also perform hysteroscopy to ensure it is positioned correctly.


In this article, we have gathered the main doubts that women have before having the Mirena and Copper IUD inserted. 

We explain how the copper, silver and Mirena IUDs work, as well as their advantages and disadvantages, the value of the copper IUD and Mirena IUD and other curiosities.

We also show you how the IUD is placed, its duration, side effects, where to place it, and much more! 

I hope you enjoyed it!