After Mirena administration, which of the following adverse effects may occur?

• A. Hearing loss and tinnitus
• B. Increased appetite and weight gain
• C. Hair color changes
• D. Changes in bleeding, cramping, ovarian cysts, ectopic pregnancies, PID

Answer: (D)

Mirena releases levonorgestrel directly into the uterus, creating local progestin effects that alter the endometrium and cervical mucus. The adverse effects most likely to appear relate to these endometrial and pelvic changes. Changes in bleeding patterns are the hallmark: many users experience irregular spotting, lighter menses, or even amenorrhea, often with cramping as the uterus adjusts. Functional ovarian cysts can occur with hormonal IUDs as part of normal ovarian activity, but they tend to be self-limiting. If pregnancy does occur with an IUD in place, the risk that the pregnancy is ectopic is higher than in pregnancies without an IUD, though overall pregnancies with Mirena are uncommon. There is also a small risk of pelvic inflammatory disease, particularly around the time of insertion, due to infection risk.

Hearing loss and tinnitus, increased appetite and weight gain, or hair color changes are not typical adverse effects associated with Mirena.