There’s a lot of confusion about what happens during menopause when you’ve got a Mirena intrauterine device (IUD) in place. Some people think the IUD masks menopause symptoms (it does hide one of them) or that it makes this change of life easier (maybe a little bit).

Not sure what to expect during this transition when you’ve got an IUD? Keep reading to learn the realities about Mirena and menopause.

Mirena partially suppresses ovulation — the release of an egg from its follicle — to stop you from getting pregnant. Stands to reason that releasing fewer eggs will make the ones you have last longer and make you go into menopause later, right? Wrong.

Even if you don’t ovulate, you steadily lose follicles as you get older. Mirena — or any other type of contraceptive — doesn’t seem to affect the time it takes to get to menopause.

Mirena can improve at least one menopause symptom — heavy bleeding.

In the years leading up to menopause (perimenopause), your estrogen and progesterone levels bounce up and down. These shifting hormone levels can make your periods lighter or heavier than usual.

At least 25 percent of women who are perimenopausal get heavy periods. Your monthly flow may get so heavy that you soak through a pad or tampon every couple of hours. Mirena should lighten your periods and put you into a more normal flow pattern.

Hormonal IUDs like Mirena can make periods lighter. Some women with IUDs stop getting a period altogether. If your periods do stop, it can be hard to tell whether you’re in menopause.

Mirena can also cause a few symptoms that look a lot like menopause, including mood swings and irregular periods.

But an IUD shouldn’t affect other menopause symptoms. It only releases progesterone, not estrogen. As your estrogen level naturally drops, you can still expect to have menopause symptoms like hot flashes, trouble sleeping, and flushed skin.

A few other symptoms can pop up that make you wonder whether you’re going through menopause — or second puberty.

These symptoms can be due to the hormone progesterone in Mirena:

  • tender breasts
  • headache
  • cramps or pelvic pain

You usually don’t need tests to diagnose menopause. When your period stops for a full 12 months, you’re in it.

But since the IUD stops your periods, you need a backup plan. Your doctor can do a blood test to check levels of follicle-stimulating hormone (FSH) and estrogen. FSH helps regulate your menstrual cycle and egg production.

During menopause, FSH levels rise while estrogen levels drop. A blood test can look for these level changes.

Your FSH levels can rise and fall throughout your cycle, so your doctor might need to take a couple of blood tests over time. They’ll also look for symptoms like hot flashes to determine whether you’re in menopause.

Mirena can lighten your monthly bleeding, but it doesn’t relieve other menopause symptoms. For that, you might turn to hormone replacement therapy (HRT).

HRT pills, patches, and injections help with menopause symptoms like:

HRT comes in two forms:

  • estrogen-only therapy for women who’ve had a hysterectomy
  • estrogen plus progesterone for women who have a uterus

HRT isn’t perfect. It’s been linked to increased risk of stroke, blood clots, and breast cancer, and more. That’s why experts recommend taking the lowest effective dose for the shortest length of time needed to relieve your symptoms.

Your doctor can help you decide whether HRT is the best option for you.

HRT contains estrogen and progesterone. Birth control pills contain estrogen and progesterone. Both should prevent pregnancy, right? Nope.

Each type of pill works in different ways. Birth control prevents pregnancy by overriding your body’s hormone release to stop you from ovulating. HRT replaces some or all of the estrogen your body used to make, but it won’t stop you from ovulating.

So if you’re not fully in menopause, you can still get pregnant while on HRT.

To prevent pregnancy, you have two options:

  1. Use a birth control pill to manage your menopause symptoms.
  2. Take HRT, but use a condom or other barrier method until you’re fully in menopause.

Even though fertility declines in your 40s, you can still get pregnant until you’re in menopause. To avoid an unplanned pregnancy, leave your IUD in until you’re past the average age for menopause — around 51 years.

If you still get periods, wait for at least one year after they stop to remove the IUD. Or switch to another birth control method like condoms or the pill.

If you’re not sure whether the IUD has made your periods stop, see your doctor. The doctor can confirm with a blood test whether you’re actually in menopause.

It’s fine to leave your IUD in until it expires if you’re not sure whether you’re in menopause. Copper IUDs last for 10 years. Mirena and other progesterone-based IUDs should come out after 5 years.

Although the feeling is similar, the removal process is typically easier than insertion.

Here’s what to expect:

  1. You lay back on the table with your feet in the stirrups.
  2. Your doctor uses a speculum to slowly open your vaginal canal.
  3. After locating the IUD, your doctor gently pulls on the string.
  4. The arms of the IUD fold up, and the device slips out through your vagina.
  5. If the IUD doesn’t come out on the first try, your doctor then uses an instrument to remove it.

You might feel some cramping for a minute or so after the IUD is removed.

An IUD can lighten or even stop your periods, making it hard to tell whether you’re in menopause. Check with your doctor if you’ve reached your 50s and you still aren’t sure whether you’ve crossed over into menopause.

You should also see your doctor if you experience symptoms that are unusual for you. This may include:

But be aware that periods that don’t end at the typical time or are irregular may not be a cause for concern — every woman goes through menopause in their own unique way.