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Pregnant on Mirena
sarycarr posted:

I've had Mirena for about 9 months now (had it placed at my 6 week pp visit) and I've never been very happy with it. I've had off-and-on spotting for almost the whole time that I've had it, and plenty of dull cramping. I've had 2 ultrasounds to determine if it's in the correct place, and both times I was assured that it is and to give my body some time to regulate. The side-effects were definitely bothersome, but I put up with them because, well, I really didn't want to get pregnant. Both of my children were conceived while I was on the pill, and my doctor told me that Mirena would be the best option for me to avoid another unplanned pregnancy.

On to my main point- the last few weeks have been different. I had spotting about a month ago and since then I've had nothing. I'd be really happy about that, but I've had some suspicious symptoms. My breasts have all the sudden grown a noticeable amount and I''ve been getting lightheaded and have had some nausea. I'd be able to ignore those issues, but I've also had some intense fatigue- which has always been my number one symptom in early pregnancy. I've taken a home pregnancy test several times this week and they were all negative, but I feel pregnant.

I'm not sure what to do. I think I might be pregnant. I know that pregnancy with an IUD is rare, but I've gotten pregnant on hormonal birth control twice before, so maybe my body just doesn't respond well to birth control? I know pregnancy with an IUD is also dangerous, but should I go and seek medical attention without getting a positive result? If I am pregnant, is it possible that the Mirena could be giving me a false negative? Also, if the pregnancy were to be ectopic, would I still get a positive home result?

Any advice or input is appreciated.
Jane Harrison Hohner, RN, RNP responded:
Dear sarycarr: Thanks for awaiting a reply. The easy question first. There is nothing in the Mirena which would cause you to have an incorrect urine HCG pregnancy test result. However, if one has an ectopic/tubal pregnancy HCG levels will rise more slowly. With an early uterine pregnancy which is proceeding normally blood HCG levels double every 48 hours. So it can take slightly longer for a urine test to show positive on an ectopic. For example, a test a the first day of missed flow would likely not be accurate for an ectopic, but one a week later should show positive.

In your specific case, because you wouldn't be having predictable flows with the Mirena, it would be more difficult to time a home HCG test. Given all this I would urge you to see your GYN or clinic so they can order a blood HCG if indicated. If it is negative then the cause of your current "pregnancy" symptoms can be investigated. Some possible alternative explanations might include: GI virus, missed ovulation causing continued elevation of estrogen linked breast tenderness.

Bottom line, get that test from your GYN ASAP. No MD wants to overlook an ectopic. I would wager that they would be happy to rule out the very distant risk for pregnancy for you.