Mirena IUD contraceptive has a lot going for it

The Mirena is a popular alternative contraceptive to the pill.

 "I have horrible painful periods, and now I am in my 40s they seem to be getting worse. My doctor can't find any underlying cause for this, and has suggested I have a Mirena inserted. Could you tell me more about this, and whether it is something you would recommend?" Mary

Over the last decade or so, Mirena has become almost a household name. It is actually a brand name for the Intrauterine System (IUS), but as it is the only type of IUS available here the terms tend to be used interchangeably. It has led to something of a contraception mini-revolution, especially for women who experience unpleasant, heavy or painful periods, and is being used more and more by younger patients, wanting alternatives to the contraceptive pill.

It is a type of intrauterine device (IUD) or coil, but differs from the traditional IUDs as it contains a synthetic progesterone hormone known as levenorgestrel. This hormone is very gradually released into the womb over a five-year period, causing very few systemic (or body-wide) effects. The main benefits of Mirena include:
* Contraception – as a long-term contraceptive, Mirena is hugely effective. It provides 99.9 per cent cover for up to five years, but can be removed earlier if you want to conceive. There are very few patients who can't trial a Mirena, although it certainly won't suit everyone. It is great if you don't like taking a pill every day, or can't use other forms of contraception for medical reasons. Unlike the combined contraceptive pill, it is safe to use while breast feeding. Once you remove the Mirena, your natural cycle will return quickly, and there is no long-term effect on fertility.

* Period control – over the first few months of having a Mirena, most patients will find that their periods reduce in intensity, becoming lighter and shorter. The majority of women will have very minimal bleeding or no periods at all by the end of the first year – this is not only safe, but extremely welcome in most cases! If your periods don't reduce as expected, you may find that the irregularity and unpredictability of your bleeding is too hard, and decide to have the Mirena removed.

READ MORE: Long-term contraceptives for all teens in NZ? It's working in Colorado
* Endometriosis – Mirena is now one of the treatments of choice for endometriosis. As the Mirena "overrides" your normal cycle, it can very successfully reduce the pain and bleeding associated with endometriosis.

* Cancer protection – the Mirena causes a thinning of the womb lining, and thus offers some protection against uterine cancer. It is used as a treatment for people with a pre-cancerous condition known as endometrial hyperplasia.

As with any medical treatment, there are potential side effects. These are usually mild and resolve after the first few months. The commonest include headache, skin changes, breast tenderness, abdominal bloating and cramps, irregular bleeding, mood changes, and weight gain. More serious but much rarer side-effects relate to the actual insertion of the Mirena. Your doctor will talk you through these before they carry out the procedure.

The procedure itself is relatively simple, and doesn't require any form of anaesthetic or sedation. Mirenas should only by fitted by doctors who have been specially trained to do so, and precautions will be taken to minimise any infection or other complication. The whole process takes less than half an hour, but you should expect some bleeding and cramps for a few days afterwards. I usually recommend to my patients that they take simple pain relief, such as paracetamol or ibuprofen, before the procedure, just to make it more comfortable. It is also important to avoid sex, swimming pools, baths and tampon use for a week after, in order to minimise the infection risk.

In terms of a recommendation, I would hesitate to advise you Mary without knowing more about your history. However, in my experience most patients who decide to have a Mirena are extremely happy with it. There are a few people who shouldn't have a Mirena, so it would pay to check that you don't fall into any of the following groups:

* Previous breast,uterine or cervical cancer
* Current active liver disease
* Unexplained abnormal vaginal bleeding
* Fibroids or other lumps in the womb that may make insertion difficult
* Current or recent pelvic infection.

The only other issue to consider when making your decision is the cost. Mirena is funded for anyone who has periods heavy enough to make them iron deficient or anaemic. Your doctor can check a blood test to see if this is the case for you, but if you don't reach the criteria, it will cost around $400. This cost is not extreme if you consider that it gives you contraceptive cover for five years, but can certainly be a barrier for some people. The other option is to ask your doctor for a referral to your local gynaecologist – if they feel your periods warrant this as a treatment, they will be able to fit a funded Mirena in their clinic. 
Source : stuff


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