How is the levonorgestrel-releasing intrauterine system (Mirena and Skyla) inserted?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

The packaging is opened by an assistant, taking care to maintain the sterility of the package contents. Care is taken to ensure the arms of the IUD are in a horizontal position (see the image below).

Ensuring horizontal positioning of IUD arms. Ensuring horizontal positioning of IUD arms.

The threads on the handle of the IUD insertion device are then released from the groove in the handle of the insertion device. While pushing the slider toward the insertion tubing, the strings at the base of the IUD handle should be pulled, which will retract the IUD arms into the insertion tubing. See the image below.

Loading the levonorgestrel-releasing intrauterine Loading the levonorgestrel-releasing intrauterine system into insertion tubing with correct orientation of knobs at the end of the arms.

The threads are then secured in the thread cleft, as shown in the image below.

Securing threads on the handle of the insertion de Securing threads on the handle of the insertion device.

The flange on the insertion device is then set at the level to which the uterus sounds. This is accomplished by sliding the flange over the marked increments on the IUD insertion tube, as shown in the image below.

Set the flange at the level to which the uterus so Set the flange at the level to which the uterus sounds.

One hand is then used to provide gentle downward traction on the tenaculum. While continued upward pressure is applied to the green slider on the IUD handle, the insertion tubing is placed into the vagina at the level of the external cervical os. The insertion tubing is then gently advanced until the flange is approximately 1.5-2 cm from the external cervical os. See the image below.

Advancing the insertion tubing to 1.5 cm from the Advancing the insertion tubing to 1.5 cm from the external cervical os.

Next, the slider on the handle is pulled backward to the level of the raised mark on the insertion handle, expelling the IUD arms from the insertion tubing (see the image below), and wait 10 seconds to allow the arms to open completely.

Retracting slider and expelling the IUD from inser Retracting slider and expelling the IUD from insertion device.

The insertion tubing is then advanced until the flange is at the external cervical os, thereby advancing the IUD to the level of the uterine fundus (see the image below).

Advancing the insertion tubing until the flange is Advancing the insertion tubing until the flange is at the level of the external os.

While holding the insertion device steady, the slider is pulled all the way down to release the IUD. The IUD handle and insertion tubing are then gently retracted from the uterus and cervix. The strings will remain in place. See the image below.

Pulling the slider down completely to release the Pulling the slider down completely to release the IUD.

Following removal of the insertion device, the IUD strings will be readily visualized in vagina. Using long-handled scissor, the strings are then trimmed so that approximately 3 cm are visible, extending from the external cervical os. [52] See the image below.

Trimming the IUD strings to 3-4 cm. Trimming the IUD strings to 3-4 cm.

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