How is the birthcontrol mirena (levonorgestrel) removed and how much does it hurt?

Office exam: Mirena (levonorgestrel) is removed by inserting a speculum into the vagina much like for a regular pap smear. Then the "string" is found and pulled until the entire device is removed. The procedure takes less than a minute and may cause mild cramping for a few minutes.

It is pulled out: The strings are grasped after seeing them on a speculum exam. The strings are then pulled and the iud pops out. It rarely causes much more than a mild short lasting cramp.