The Mannuelle Ring is a localized drug ring that releases levonorgestrel, which can counteract estrogen in women, making the uterine lining thinner, so patients with the Mannuelle Ring can experience low menstrual flow or even amenorrhea. If a woman develops amenorrhea after wearing the MMT, it usually occurs after three months of wearing the IUD. Within the first three months of wearing the IUD, patients may also experience periodic small amounts of vaginal bleeding. Some patients experience spotting vaginal bleeding within the first three months of wearing the IUD, which are some of the normal signs of wearing the IUD. However, there are some patients who will not experience low menstrual periods or amenorrhea after the IUD. Instead, they will experience heavy menstrual periods or even persistent irregular vaginal bleeding. If this causes anemia or infection in the patient, the Mannix Ring needs to be removed, proving that the patient may have a subluxation of the birth control ring or that the patient is not suitable for the birth control ring.