MIRENA: A Game Changer?

There were times when cases of unsuccessful medical treatment of menorrhagia (heavy bleeding during periods) were offered surgical removal of uterus, but now times have changed. There are  many new treatments, alternative to surgery, among one of them is progesterone loaded intrauterine system MIRENA, it is a contraceptive device but it’s non-contraceptive uses have given promising results in gynecologic problems.

What is Mirena?
It’s a flexible and soft, plastic T-shaped device, loaded with progesterone hormone (52 mg levonorgestrel) which is slowly released in the uterus for 5 years.

What are the indications of Mirena insertion?
It can be used for:

• Contraception
• Patients of heavy bleeding during periods, menorrhagia
• Progesterone Hormone therapy
• Endometriosis or adenomyosis (uterine lining cells in uterus muscle and outside uterus)
• Treatment for thick uterine lining (endometrial hyperplasia)

What you should tell your doctor before insertion?
You should always inform about the history of:

• High blood pressure
• Uncontrolled diabetes mellitus
• Cardiac diseases, heart attack, stroke
• Bleeding disorders
• Migraine
• Sexually transmitted infections
• Uterine surgeries or Caesarean sections
• Use of any herbal medicines

How it is inserted?
It should be inserted by a trained health care provider, as its insertion is different from a copper T intrauterine contraceptive device.

How long does it take for insertion?
The insertion usually takes a few minutes.

Is insertion painful?
Usually it’s not painful, some women feel cramps like periods which disappears after few hours.

How often is the follow-up after insertion?
First follow-up is 6 weeks after insertion, then there are yearly follow-ups. But if you have irregular bleeding, pain or persistent discomfort then come earlier.

What are chances of its spontaneous expulsion?
There are certain factors which are correlated to spontaneous expulsion of Mirena:

• Age less than 20 years
• Recent  delivery of a baby
• Previous history of spontaneous expulsion of IUCD or Mirena
• History of crampy painful periods

Are there any drug interactions of Mirena?
There are certain drugs which can cause problems so Always Ask Your Doctor before taking Anticonvulsant medicines:

• Barbiturates like benzodiazepines
• Herbal medicines

Does it protect against sexually transmitted infections?
No, Mirena does not protect against any sexually transmitted infection.

Will it increase the weight?
It does not increase the weight, there is no significant difference in gaining weight among users and non-user women.

How it reduces the heavy blood loss during periods?
When there is hormone imbalance of estrogen and progesterone, the lining of uterus becomes very thick and this results in heavy menstrual bleed. Mirena releases progesterone and makes the lining of uterus very thin, causing light and short periods.

Could periods stop while using Mirena?
There is marked reduction of blood loss after 3 months of usage but in one fifth of women periods stop. Since the hormone levels are normal as once Mirena is removed, periods return.

How it’s an effective contraceptive device?
It’s a safe contraceptive device as it makes the lining of uterus very thin, increases thickness of cervical secretions and prevents sperm and egg contact.

Does it affect fertility after its removal?
No, usually fertility returns to as before, once its removed.

What are the side effects?
Some patients experience pelvic pain, cramping and backache, excessive vaginal discharge, irregular spotting off and on, but it settles in few weeks. Since there are very low levels of progesterone in blood, there are occasional cases of headache, mood changes, depression, breast pain and tenderness, very few women can have oily skin or acne.

When it should be removed?
If side effects persist in spite of treatment then it should be removed.

What are its contra-indications?

• History of irregular/ undiagnosed bleeding
• Fibroids distorting cavity of uterus
• Recently delivered a baby or breast feeding
• Liver disease
• Untreated pelvic infections
• Abnormal papsmear
• Malignancy of breast, uterus or ovary
• Immunocompromised states, leukemia, drug abuse, AIDS

Remember, careful patient evaluation on the basis of history, examination, investigations and considering all pros and cons, helps in selecting the right candidate for Mirena insertion.

Dr. Ayesha Azam Khan