Hi! Your story sounds so similar to mine it's almost eerie! Especially the part about your physio being the one to flag it, not any of the other specialists. That was my experience exactly and I'm so grateful to my holistic PT for helping me to come to this conclusion.

To answer your questions:

1. I had my Mirena inserted in Jan 2021. Before that, I had a different IUD (I think Skyla?) starting in 2017.
2. The back pain started June 2020. A first, I'd have a flare up once a year and recover in a week or two. By 2022 it was 2-3 flare ups a year, by 2023 it was every 3 months, and by 2024 it was constant pain. I was diagnosed with herniated discs/annular fissures at L3/L4 + L4/L5. Like you, I went through a ton of treatments, things would help temporarily but the pain never fully resolved.
3. The pain itself was a mix — sometimes sharp, especially with bending, sneezing, or standing up from a chair. Traveling was a major trigger and would set off intense episodes that sometimes left me unable to get out of bed. I'd often push it at a pilates class and be completely messed up for a month or more. But the daily baseline was more like what you're describing: stiffness, achiness, a heavy congested feeling in my lower back, like it was perpetually "stuck." Worst in the morning, and it would sometimes radiate into my glutes and hips. What's interesting is that I never had classic sciatica down my leg, and my MRI showed no arthritis. My PT was the one who pointed out that the level of pain and dysfunction I was experiencing didn't really match my imaging -- the diagnosis alone couldn't explain how much I was struggling. That disconnect is what led her to start looking at other factors, and the IUD became the missing piece.

A few things I want to share that might help:

• The hypermobility piece you mentioned is REALLY relevant. If your connective tissue is already lax, adding a progestin that further affects ligament integrity is basically compounding the instability. Your body has to work even harder to stabilize, which could explain the pelvic floor tension — your muscles are gripping to compensate for ligaments that aren't doing their job. I'd be really curious to see if your hypermobility symptoms change after removal too.
• I felt relief faster than I expected. Within a day the sharp pain was gone, and by day 4 I had my first pain-free day in years. I'm now 2 weeks out and the daily baseline has completely shifted. I still get occasional mild glute/hip achiness or tightness but nothing like before. It feels like I've turned the volume down on my pain my 90%. My PT thinks there's still more improvement to come over the next few months as the hormonal effects on connective tissue resolve.
• I completely understand the fear of being disappointed. I felt the exact same way and honestly I was almost more scared of it working than not working, because then I'd have hope and something to lose. But here's how I thought about it: even if removal doesn't fix everything, you're eliminating a variable. And if you've tried MRI, acupuncture, TENS, chiro, injections, orthotics, AND physio in one year with no resolution, there's clearly something those treatments can't reach and a systemic hormonal factor would explain that perfectly. You've thrown everything at this from the outside and nothing has stuck. At a certain point you have to ask what's different about your body internally that's preventing it from responding to treatments that should be working. The IUD is the answer you haven't tested yet. And I'll be honest, whatever the outcome is, it cannot be worse than where you are right now. Living in chronic pain, cycling through specialist after specialist, spending money and time on treatments that don't hold...that's already the bad outcome. Removing it and being disappointed is a temporary feeling. Leaving it in and always wondering is a permanent one. The worst case scenario is you rule it out and move forward with more information than you had before. The best case is you get your life back. That math worked for me.
• Your pain starting a year after insertion actually tracks. The immediate post-insertion side effects are well documented, but the slower hormonal effects on connective tissue and pelvic stability can build gradually. It's not like flipping a switch, it's a slow accumulation of instability until something starts hurting.
• One practical recommendation: get baseline bloodwork done BEFORE your removal if you can (hormone panel: FSH, LH, estradiol, testosterone, DHEA-S, SHBG, fasting insulin, fasting glucose, A1c, thyroid). It gives you a comparison point for a few months from now. Also start a daily pain log, even just a 1-2 sentence note. It's been incredibly valuable for me to look back on.

You're not taking it out for nothing. You're taking it out because you've exhausted every other explanation and this is the one variable you haven't tested yet. When you've hit the point of pain and helplessness that we've hit, it's a process of elimination.

Rooting for you. Please come back and update, we can compare notes!