Steps:

1. Obtain consent (verbal or written).
2. May premedicate with misoprostol 200mcg, 2 tabs pv the night before the procedure and/or Toradol or other NSAID po 30 minutes prior to procedure to prevent cramping.
3. Perform a bimanual examination to dertermine the position of the uterus.
4. Insert a vaginal speculum, and visualize the cervix.
5. Cleanse the cervix with Betadine swabs.
6. Sound the uterus to determine its size (usually between 6-8 cm).
7. Open the Mirena package enough to reveal the shaft of the inserter.
8. Wearing sterile gloves make sure that the slider is in the furthermost position away from you.
9. Ensure that the arms of the system are in a horizontal position (if not, align them on sterile surface of packaging).
10. Pull on the threads to place the system in the insertion tube and fix the threads in the cleft at the end of the shaft.
11. Set the upper edge of the flange to the uterine sound measurement taken previously.
12. Move the inserter gently into the uterus until the flange is about 2 cm from the cervix.
13. Release the arms of the system by pulling the slider back until it reaches the raised mark on the shaft.
14. Push the inserter gently inwards until the flange touches the cervix.
15. Release the system by pulling the slider back all the way; threads will release automatically.
16. Remove the inserter from the uterus. Cut the threads to have about 2 inches visible outside the cervix.