The Mirena is intended to initially release a daily dose of 20 micrograms levonorgestrel (a progestin). No single mechanism accounts for the effectiveness of the IUS in preventing pregnancy; it has several effects on the reproductive system:
Frequency of ovulation is reduced.[8]
Cervical mucus is changed to obstruct passage of sperm through the cervix.[9]
The presence of a foreign body in the uterus prompts the release of leukocytes and prostaglandins by the endometrium, substances that are hostile to both sperm and eggs.[10] Some physicians believe these substances are also hostile to very early embryos.[11]
The endometrium is thinned.[9] It has been suggested that this inhibits implantation of embryos, though no experiment has yet confirmed or disproved this theory. Because many pro-life individuals and organizations define fertilization as the beginning of pregnancy, this possible secondary mechanism of action has led some pro-life individuals and organizations to label the IUS an abortifacient.
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