Which of the following could occur if Mirena experiences expulsion?

• A. Expulsion can occur leading to potential pregnancy risk
• B. It causes immediate blindness
• C. It guarantees contraception for life
• D. It has no risk of expulsion

Answer: (A)

Expulsion removes the contraceptive protection Mirena provides, so the risk of pregnancy becomes real. Mirena releases levonorgestrel and stays in the uterus to keep the cervix thick, the endometrium thin, and ovulation suppressed in some cycles; if it is expelled, the hormone isn’t delivered in the uterus, and intercourse may lead to fertilization with little or no contraceptive effect. Expulsion can be partial or complete and may happen after childbirth, with certain uterine factors, or if placement isn’t ideal. If expulsion is suspected, it’s important to check for the device’s presence, confirm location with an exam or ultrasound, replace it if appropriate, and use backup contraception until a new device is placed. The other statements aren’t correct: there’s no link to immediate blindness, Mirena isn’t lifetime contraception, and there is a real risk of expulsion.