Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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When to insert Mirena postpartum

22/01/2013

Question:

Hi, I am almost 6 weeks postpartum and am looking into getting the Mirena IUD. I know that it is possible to have spotting for up to 6 months, and that some types of spotting would not make me niddah.

If I have only just begun my 7 nekiim or have not started them yet, then how do these spotting incidents affect me? Will they ruin my chance of being able to go to the mikvah? Is there anything that I can do to try to prevent the spotting or make sure that it will be less?

Thank you so much for your help.


Answer:

Mazal tov on the recent birth of your baby!

If possible, we strongly recommend waiting until after you immerse to have the Mirena inserted. Irregular staining is common, as is bleeding due to the insertion, and both could cause difficulty completing the clean days.

If you have the Mirena inserted after you immerse, any bleeding that takes place within the first few days after the insertion may be attributed to trauma and would not render you niddah. Additionally, you may take precautions against becoming niddah from further staining by wearing colored underwear or pantyliners and waiting 15 seconds after urinating before wiping.

In order to delay insertion of the Mirena until after mikveh, you can discuss with your physician using a barrier method of contraception for a short period of time. If you are exclusively breastfeeding, your chances of pregnancy at this point are quite low and the combination of this decreased fertility and spermicide is reasonable protection. Alternatively, you can immerse to allow physical contact but avoid having marital relations until the Mirena is inserted.

If you do have the Mirena inserted before you immerse, there are a number of suggestions we can offer to try to help you successfully complete the clean days. You should change your white underwear more frequently to prevent stains from accumulating to the size of a gris. This way stains smaller than a gris on your underwear may be disregarded and do not invalidate your clean days. Additionally, you may reduce the number of bedikot required to the hefsek taharah and one bedikah per day throughout the clean days. If even that is difficult due to consistent staining, you may reduce further to the hefsek taharah and one bedikah each on days 1, 7, and one additional intermediate clean day. You should also take care to wait 15 seconds after urinating before wiping. This way you may disregard stains found on the toilet paper or in the toilet.

While there may be little you can do to prevent the staining associated with the Mirena, you can try to manage the situation using the suggestions and leniencies described above. Nevertheless, you should be prepared for the possibility of a difficult beginning as your body adjusts to the Mirena.

Please feel free to get back to us with any further questions.

B'Hatzlacha!


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