During Mirena administration, which of the following are potential immediate side effects?

• A. Weight gain and hypertension
• B. Dizziness, pain, risk of expulsion
• C. Hair loss and vision changes
• D. Nausea only

Answer: (B)

Immediate effects during Mirena insertion are best understood as acute responses to the procedure and the device sitting in the uterus. The levonorgestrel-releasing system can cause cramping and pelvic pain right after placement, and some patients feel dizzy or lightheaded during or soon after the insertion. There is also a real concern about expulsion or displacement of the device in the early period. These are the classic immediate concerns clinicians watch for.

Weight gain and hypertension are not typical immediate effects of Mirena insertion; they’re more associated with longer-term hormonal changes or other conditions, not the acute placement experience. Hair loss and vision changes aren’t commonly seen right after placement with this device, since systemic hormone exposure is relatively limited. Nausea can occur with some hormonal methods, but it doesn’t capture the common immediate symptoms as clearly as dizziness, pain, and the risk of expulsion do.