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

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Replace Mirena or tubal ligation?

11 November, 2018


I am 42. I have 3 girls and 2 boys. I have had a Mirena for over 4 years. I spotted for a few months and now my period is mostly gone with an occasional stain.

1. I do not want more children. I am struggling to do a good job with the ones I have.
2. The IUD string is lost and I need to have a procedure to remove it.

I need a new method. I was never able to get a diaphragm in…I think I have short fingers.

Hormones make me feel bad. Is there any opening to consider tubal ligation? I am reluctant to get another IUD since my husband always felt it before the string got lost.


Tubal ligation is a form of sterilization, and as such is forbidden barring extreme situations (i.e., it would be life-threatening for the woman to get pregnant), and all other forms of contraception have been ruled out.

Based on what you have written, given your circumstances, tubal ligation would not be permissible. If there are additional circumstances you have not mentioned, then feel free to ask the question again or to discuss with a rabbi who knows you and your circumstances personally.

While we understand your hesitation to have another IUD inserted, it does seem to be your best option at this point. The Mirena is meant to be replaced every 5 years, so you would have had to have it replaced within the coming year anyway. If you were basically happy with the Mirena we recommend having a new one inserted. You can speak to your physician about cutting the strings a bit shorter to make it less likely for you husband to feel them.

See our article on choosing a contraceptive method and speak to your doctor to discuss the different options.

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


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