Prevalence of Mastalgia and the complications attributed to it following Mirena intrauterine device insertion: A prospective cohort study

Document Type : Original Article


1 Department of Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Department of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran


Background: In recent decades, the surge in global population has prompted the adoption of family planning policies. While an intrauterine device (IUD) is among the most effective contraception methods, it may result in complications and issues that necessitate its removal. The aim of this study is to examine mastalgia and related complications stemming from the use of Mirena IUD among women who seek medical care in Yazd, Iran.
Objectives: The objective of this study is to assess the prevalence of mastalgia and associated complications following the use of Mirena IUD among women visiting medical centers in Yazd, Iran.
Methods: In this prospective cohort study, a total of 201 women who were using Mirena IUD and visited the gynecology ward of two hospitals (one public and one private) in Yazd province, Iran were followed up for 6 months (from November 2021 to June 2022). The study data were collected using a questionnaire that included information on age, parity, duration of IUD usage, and any complications arising from the use of IUD.
Results: The study found that after IUD insertion, 36.9% of women (48) reported mild mastalgia, while 3.5% (7) and 6% (12) reported moderate and severe mastalgia, respectively. After 6 months, 37.9% of participants (54) experienced mild mastalgia, while 5% (10) and 6% (12) reported moderate and severe mastalgia, respectively. Menstrual spotting was the most prevalent IUD consequence (57.2%), followed by pelvic discomfort (28.9%), dyspareunia (27.9%), and nausea (17.4%).
Conclusion: This study highlighted mastalgia as the second most frequent complication associated with IUD usage after abnormal uterine bleeding. Interestingly, the age and parity of the participants did not appear to be related to mastalgia. Furthermore, breast complications associated with IUD usage were found to be relatively common, underscoring the need for further investigation into these complications.


Main Subjects

  1. Peipert JF, Zhao Q, Schreiber CA, Teal S, Turok DK, Natavio M, et al. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol. 2021; 225 (2):157-9. doi:10.1016/j.ajog.2021.03.011 PMid:33716075
  2. Wheeler LJ, Desanto K, Teal SB, Sheeder J, Guntupalli SR. Intrauterine device use and ovarian cancer risk: a systematic review and meta-analysis. Obstet Gynecol. 2019; 134 (4): 791-800. doi:10.1097/AOG.0000000000003463 PMid:31503144
  3. Averbach SH, Ermias Y, Jeng G, Curtis KM, Whiteman MK, Berry-Bibee E, et al. Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: a systematic review and meta-analysis. Am J Obstet Gynecol. 2020;223(2):177-88. doi:10.1016/j.ajog.2020.02.045 PMid:32142826 PMCid:PMC7395881
  4. Ti AJ, Roe AH, Whitehouse KC, Smith RA, Gaffield ME, Curtis KM. Effectiveness and safety of extending intrauterine device duration: a systematic review. Am J Obstet Gynecol. 2020;223(1): 24-35. doi:10.1016/j.ajog.2020.01.014 PMid:31954154
  5. Yüksel İT, Erdem B, Çetin BA, Köroğlu ND, Dansuk R. Effect of the Levonorgestrel-Releasing Intrauterine System on the Uterine Artery, Uterine Volume, and Endometrium in Endometrial Hyperplasia without Atypia. J Acad Res Med. 2019 ;9(Special Issue):15. doi:10.5152/jarem.2019.2470
  6. Achilles SL, Chen BA, Lee JK, Gariepy AM, Creinin MD. Acceptability of randomization to levonorgestrel versus copper intrauterine device among women requesting IUD insertion for contraception. Contraception. 2015;92(6):572-4. doi:10.1016/j.contraception.2015.08.009 PMid:26297203 PMCid:PMC4654647
  7. Bilgehan F, Dilbaz B, Karadag B, Deveci CD. Comparison of copper intrauterine device with levonorgestrel‐bearing intrauterine system for post‐abortion contraception. J Obstet Gynecol Res. 2015;41(9):1426-32. doi:10.1111/jog.12747 PMid:26180028
  8. Miranda MT, Simó PA. Ethical Aspects of the Use of Mirena (r) Iud in the Treatment of Heavy Menstrual Bleeding. Cuadernos de bioetica: revista oficial de la Asociacion Espanola de Bioetica y Etica Medica. 2018;29(96):159-76.
  9. Goldstuck ND, Cheung TS. The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update. Int J Women's Health. 2019;11:471. doi:10.2147/IJWH.S213815 PMid:31686919 PMCid:PMC6709799
  10. Hubacher D, Schreiber CA, Turok DK, Jensen JT, Creinin MD, Nanda K, et al. Continuation rates of two different-sized copper intrauterine devices among nulliparous women: Interim 12-month results of a single-blind, randomised, multicentre trial. E Clin Med. 2022; 51:1-12. doi:10.1016/j.eclinm.2022.101554 PMid:35865736 PMCid:PMC9294241
  11. Wemrell M, Gunnarsson L. Claims in the clinic: Tensions in healthcare communication about perceived side effects of the copper IUD. InFutures Ahead-Translations and collaborations between medicine, social science and the humanities, Linköping, Sweden, June 15-17, 2022 2022 (pp. 97-98). Linköping University.
  12. Bahamondes L, Brache V, Meirik O, Ali M, Habib N, Landoulsi S, et al. A 3-year multicentre randomized controlled trial of etonogestrel-and levonorgestrel-releasing contraceptive implants, with non-randomized matched copper-intrauterine device controls. Hum Reprod. 2015;30(11):2527-38. doi:10.1093/humrep/dev221 PMid:26409014
  13. Moray KV, Chaurasia H, Sachin O, Joshi B. A systematic review on clinical effectiveness, side-effect profile and meta-analysis on continuation rate of etonogestrel contraceptive implant. Reprod Health. 2021;18(1):1-24. doi:10.1186/s12978-020-01054-y PMid:33407632 PMCid:PMC7788930
  14. Makins A, Taghinejadi N, Sethi M, Machiyama K, Munganyizi P, Odongo E, et al. FIGO postpartum intrauterine device initiative: Complication rates across six countries. Int J Obstet Gynecol. 2018;143:20-7. doi:10.1002/ijgo.12600 PMid:30225873
  15. Pfitzer A, Mackenzie D, Blanchard H, Hyjazi Y, Kumar S, Lisanework Kassa S, et al. A facility birth can be the time to start family planning: postpartum intrauterine device experiences from six countries. Int J Gynecol Obstet. 2015;130:S54-S61. doi:10.1016/j.ijgo.2015.03.008 PMid:26115859
  16. López-Farfan JA, Hernandez-Gonzalez A, Vélez-Machorro IJ, Vázquez-Estrada LA. A comparative, randomized study of levonorgestrel intrauterine system (LNG-IUS) vs Copper T 380 A intrauterine device applied during cesarean section. Open J Obstet Gynecol. 2012;2(2):151-5. doi:10.4236/ojog.2012.22029
  17. Sakinci M, Ercan CM, Olgan S, Coksuer H, Karasahin KE, Kuru O. Comparative analysis of copper intrauterine device impact on female sexual dysfunction subtypes. Taiwan J Obstet Gynecol. 2016; 55(1):30-4. doi:10.1016/j.tjog.2014.12.011 PMid:26927244