The Mirena IUD: Gender Affirming, Not Just Birth Control
- Raine Lovebright
- Nov 2
- 6 min read
As a nurse, I’ve worked with many transmasculine and non-binary patients who have cervixes and choose the Mirena to reduce or completely stop their periods. Let’s be honest, periods can really suck. For our trans masc and non-binary pals, it’s more than just a practical choice. It can be a powerful act of self-affirmation. Not bleeding every month can bring huge relief and help ease gender dysphoria, making their body feel more like home.
What is the Mirena, really?
The Mirena (levonorgestrel) is a small T-shaped device that sits inside the uterus and slowly releases a low dose of progestogen (a hormone similar to progesterone). It’s one of the most effective long-acting contraceptives out there. In Australia, it’s approved for use for up to 8 years as contraception, and up to 5 years for hormonal control (such as reducing periods or managing endometrial conditions) (Therapeutic Goods Administration, 2025). It can be removed anytime if you want to stop using it or try another option.
But beyond pregnancy prevention, Mirena can also significantly lighten or stop periods completely. Research shows that amenorrhoea (no periods) develops in approximately 18–20 % of users by 1 year of use, and up to about 23 % by 5 years (Sexual Health Victoria, 2022). Other studies show that the proportion of users experiencing amenorrhoea (no bleeding or spotting for at least 90 days) rises from about 0.2% in the first 90 days, to 8.1% by days 91‑180, and around 18%‑20% during the first year of use (Sivin et al., 2015).
For trans masc and non‑binary people dealing with menstruation‑linked dysphoria, being in that approximately 20% who stop bleeding (or significantly reduce it) can be truly life‑changing.
Why some trans masc people choose the Mirena
Menstruation can be a huge source of distress for people who don’t identify with having periods. The Mirena can:
Reduce or stop bleeding - many users stop having periods after a few months.
Reduce cramping and PMS - which can ease physical and emotional discomfort.
Avoid daily hormones - it’s low-maintenance and doesn’t require taking pills or injections.
Play nicely with testosterone - it’s safe to use alongside T and can help manage breakthrough bleeding during the early stages of hormone therapy.
For some, getting a Mirena isn’t about “birth control” at all. It’s about taking control of how their body functions and reducing one more source of dysphoria. On that note: this can be an appropriate option for our trans ace pals who might not be concerned with pregnancy but still want relief from periods.
Is it gender affirming? Absolutely.
Gender affirmation isn’t just about surgeries or hormones. It’s about anything that helps you feel more at home in your body. For a trans masc person, choosing the Mirena can be as affirming as choosing top surgery, binding, or cutting your the way you really like it for the first time.
The not-so-fun bits
The Mirena is inserted through the cervix into the uterus, usually by a doctor or nurse. For some people, that can be physically uncomfortable or emotionally triggering, especially if you have a history of trauma, dysphoria, or painful pelvic exams.
If that is a concern, ask for:
Trauma-informed care, let the provider know what helps you feel safe.
Local anaesthetic or sedation options, pain management should always be offered.
A support person, bring a friend, partner, or peer worker.
For more on what to expect during an awake IUD insertion, and tips to help make it easier, check out our article on What to expect when you’re expecting an IUD (awake).
Tips for a more affirming experience
Ask for a clinician experienced in trans care, many sexual health clinics and family planning services have them.
Use your name and pronouns early in the booking process to avoid awkwardness on the day.
Plan self-care afterwards, cramping or emotional reactions can happen, so be gentle with yourself.
Some FAQs I get asked:
Can I still use the Mirena if I’m on testosterone?
Yes! The Mirena works perfectly fine alongside testosterone. Studies show that T doesn’t stop ovulation or protect against pregnancy on its own (Asseler et al., 2024). Say it with me: "T is NOT an effective form of birth control". Soooo a Mirena can actually help with both bleeding control and contraception.
Will it make me more “feminine” or mess with my T levels?
Nope. The Mirena’s hormone acts mostly inside the uterus, not throughout your whole body. It doesn’t raise estrogen or lower testosterone which is pretty great. It’s super low-dose and won’t undo your transition effects.
Can I get one if I don’t call myself female or don’t want to be in a “women’s clinic”?
Absolutely. You don’t need to identify as a woman to access reproductive care. Many sexual health clinics and family planning services are inclusive and experienced with trans and non-binary patients. You deserve care that matches you.
What if pelvic exams freak me out?
That’s completely valid. You can ask for a trauma-informed provider, explain what helps you feel grounded, and even bring someone you trust. Some clinics offer sedation options. You should never be made to “just deal with it.” Another reminder to check out this article I wrote on getting an IUD (while awake) for some tips on advocating for yourself.
Can I still have sex, use toys, or bottom after getting a Mirena?
Totally! Once the initial healing and cramping settle (usually a few days to a week), you can get back to whatever feels good. Just keep in mind the small threads attached to the IUD. You usually can’t feel them, but your partner might notice them if you’re having receptive vaginal sex. They can be trimmed shorter if needed.
What if I don’t have periods but still get dysphoria from having a uterus?
You’re not alone. The Mirena can help by stopping visible bleeding, but it won’t change how you feel about having internal anatomy. For some people, it’s one step toward body comfort while considering other options like hysterectomy later down the track, or it’s enough on its own.
What if my periods don't go away or stop?
This can happen. As research shows, not everyone with an IUD will experience reduced or completely stopped bleeding. Remember, this doesn’t reflect on you or your identity. If the dysphoria it causes feels overwhelming, please reach out to your healthcare provider. There are other options available. These might include starting testosterone, pursuing affirming surgeries, or connecting with a therapist or counsellor who specialises in supporting queer folks as they work through the idea that having a period doesn’t always mean being female. And for some people, being a dude bro with a period is empowering in its own way.
In short
For trans masc and non-binary people who want to stop periods, manage bleeding on testosterone, or just feel more in control of their bodies, the Mirena can be a quiet but powerful form of gender affirmation.
References
Asseler, J. D., del Valle, J. S., Chuva de Sousa Lopes, S. M., Verhoeven, M. O., Goddijn, M., Huirne, J. A. F., & van Mello, N. M. (2024). One-third of AMENORRHEIC transmasculine people on testosterone ovulate. Cell Reports Medicine, 5(3), 101440. https://doi.org/10.1016/j.xcrm.2024.101440
Dhamangaonkar, P., Anuradha, K., & Saxena, A. (2015). Levonorgestrel Intrauterine System (MIRENA): An emerging tool for conservative treatment of abnormal uterine bleeding. Journal of Mid-Life Health, 6(1), 26. https://doi.org/10.4103/0976-7800.153615
Mayo Clinic. (2025, September 11). Gynecological care for trans men. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/gynecological-care-for-trans-men/art-20473719
Sexual Health Victoria. (2022, February). Hormonal IUDs available in Australia: Comparison chart for prescribers and IUD inserters [PDF]. https://shvic.org.au/assets/img/content/Hormonal-IUDs-available-in-Australia-comparison-chart-for-prescribers-and-IUD-inserters-TOOLS.pdf
Sivin, I., Stern, J. E., & Elger, W. (2015). The levonorgestrel intrauterine system: Reasons for contraceptive failure and the role of bleeding patterns. Contraception, 92(5), 435–443. https://doi.org/10.1016/j.contraception.2015.07.010
Therapeutic Goods Administration. (2025, November 1). Australian product information: MIRENA® (levonorgestrel) intrauterine drug-delivery system (CP-2009-PI-01235-3) [PDF]. Commonwealth of Australia. https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2009-PI-01235-3&d=20251101172310101
The information provided in this blog post is intended for general educational purposes only and does not constitute professional medical advice, diagnosis, or treatment. While I am a registered health practitioner, this content is not a substitute for consultation with a qualified healthcare professional who can consider your individual circumstances.
This blog reflects my personal views and professional experiences and does not represent the views of my employer or any affiliated organisations.
In line with AHPRA guidelines, no testimonials are included, and this blog post is not intended to advertise or promote specific services or treatments.
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