Mirena Iud - An Alternative To The Pill?

[iheartcats]

My gynecologist has suggested Mirena since she's so worried about my blood pressure fluctuations and being on medicines that can increase blood pressure. I agree this is a fair concern.

Mirena is shown to reduce and even stop periods. I am on Seasonique now as I cannot tolerate a monthly period with POTS. At all. I don't think I could work full/almost full-time any longer.

What are your thoughts on this? I don't think I'd be able to do it for about 3 months (time off - they say a day or two but I know how my body works and that equals a week off + monetary reasons. I've already spent $150 on BCP through May and both of those reasons are why I can't really get it done any earlier). I'll talk to my gynecologist and see if that's realistic (but I am afraid it may be to go off of or reduce Midodrine until then).

Any experience you've had with IUDs would be appreciated. I don't want to go with Depo as it's not removable. Worst case the IUD is.

[mkoven]

I have a friend without pots who likes it. But she's had two kids. I've heard iuds can be painful on insertion if you've never given birth. Are the hormones in mirena supposed to be safer than the pill?

[EarthMother]

I did the Mirena for five years. The last four with no period. At the time I had it implanted it was very new and I did not realize it was still systemic (i.e. you are still getting daily hormones at a dose close to the pill). At the end of the five years I started having more thyroid problems and other health issues ... I didn't know what to attrib it to so I had the IUD removed (it was almost time anyway.) Looking back, I can't say the Mirena was the problem. One of my co-workers who had the Mirena about the same time as I did, ended up having to have it surgically removed after her five years was up, because it had implanted itself in the uterine wall.

At this point, my cardio has insisted I be off hormones (I am 46) ...

Good luck finding the right solution for you.

[iheartcats]

Thanks for the info - my gynecologist says it has the hormone that won't 'hurt' (progesterone)?

At least, unlike Depo, it COULD be removed. My cycles are too horrible without any type of control...so I'm being optimistic that Mirena would be better than nothing.

I know it hurts. They've warned me. I guess I'll have to suck it up and hope it lasts five years. :/

[mkoven]

anyone know if it's safe for migraine with aura? I've been told no estrogen...

[EarthMother]

anyone know if it's safe for migraine with aura? I've been told no estrogen...

Not estrogen per say, Mirena contains levonorgestrel, a hormone commonly used in birth control pills.

[flop]

There are two types of hormonal birth control cocktails.

The most common ones are combined (oestrogen + progeserone) which are they type of pill (or patch) that you have a break and have a bleed during that break. Combined pills are the ones associated with slight increased risk of blood clots and can raise BP (may not be suitable for high-risk people; certain migranes, diabetes, high BP, overweight, smokers, in the UK if you are older than 35 and either smoke or are obese you are not allowed combined contraceptives).

The other sort are progesterone only methods. There are several ways of getting the progesterone: pills (mini-pill), injection (depo-provera), implant (implanon) and IUS (Mirena).

An IUS is a bit like a copper IUD but it has a preparation of slow-release progesterone on it instead of copper. Mirena has a much much lower dose of progesterone than the other progesterone methods as it acts directly on the lining of the womb but a little will be systemically absorbed. I believe that having an IUS put in is not a walk in the park but that taking simple analgesics (paracetamol and ibuprofen) before it is fitted can help and a hotwater bottle at home afterwards.

When my periods were playing up last year I was planning on having one fitted. For one reason and another the appointment kept getting delayed and now my body has settled down so I don't need one at the moment.

Flop

[iheartcats]

Flop -

My doctor said they are widely used in Europe...so I'm thinking I may go with the Mirena method. I see her soon and will discuss getting an appointment for later this spring.

Thanks for your input, I'll ask about the analgesics too so I don't have to tolerate any more pain than I must.

[flop]

Cat Lady, yes they are widely used in Europe. If you see a gynae about heavy/painful periods one of the first things they suggest is a Mirena. I have older friends who in previous times would have been offered hysterectomies for heavy bleeding and they are now trying Mirena, a much less drastic option.

I have a whole bunch of leaflets from the family planning clinic. The Mirena leaflet says to take painkillers an hour before your appointment. It also says that they sometimes use lidocaine gel on the cervix.

Flop

[iheartcats]

Cat Lady, yes they are widely used in Europe. If you see a gynae about heavy/painful periods one of the first things they suggest is a Mirena. I have older friends who in previous times would have been offered hysterectomies for heavy bleeding and they are now trying Mirena, a much less drastic option.

I have a whole bunch of leaflets from the family planning clinic. The Mirena leaflet says to take painkillers an hour before your appointment. It also says that they sometimes use lidocaine gel on the cervix.

Flop

That's very helpful. Sometimes, in the States, BC isn't talked about very openly. It's unfortunate. I do have heavy, painful periods (since my teens) so I've been on BCP for about 14 years! I'd love an alternative, so I will mention all this to my doctor and especially the lidocaine since I've never had children. Thank you so much!

[Guest brianala]

I have migraine with aura, and a family history of stroke so I opted to get a Paragard (copper IUD, no hormones).

I've had it since last summer and I absolutely love it.

I'm 28, never had kids and the insertion was painful but I would do it again in a heartbeat. I took the day off and spent the afternoon on the couch with the heating pad. The first few periods with it were heavier and longer, but things have settled down since then. I had to pay for mine in full since my insurance doesn't cover it but considering what I was paying every month for pills/nuvaring, etc. I'll easily make up the money.

I've noticed a drastic decrease in my migraines since getting it. I used to get menstrual migraines either the week before or the week of my period, pretty much every single month. I've only had two since getting my IUD.

I would highly recommend it to anyone here looking for a safe, reliable form of birth control.

[EarthMother]

I have migraine with aura, and a family history of stroke so I opted to get a Paragard (copper IUD, no hormones).

I've had it since last summer and I absolutely love it.

I'm 28, never had kids and the insertion was painful but I would do it again in a heartbeat. I took the day off and spent the afternoon on the couch with the heating pad. The first few periods with it were heavier and longer, but things have settled down since then. I had to pay for mine in full since my insurance doesn't cover it but considering what I was paying every month for pills/nuvaring, etc. I'll easily make up the money.

I've noticed a drastic decrease in my migraines since getting it. I used to get menstrual migraines either the week before or the week of my period, pretty much every single month. I've only had two since getting my IUD.

I would highly recommend it to anyone here looking for a safe, reliable form of birth control.

I'm glad to hear something positive about the copper one. I wouldn't consider hormones again at my age, and I am a bit concerned about even HEAVIER periods. But from other things I've read that doesn't seem to last with the Paragard. I may mention this as well to my GYN.

When I had my Mirena put in years back it was the first one my GYN had inserted and he actually had to stop in the middle (while I had a heavy clamp attached to my insides and walk across the room to go and RE-READ the manual! I said, EXCUSE me but this really hurts! He said, "I know". And I corrected him and said "NO YOU DON'T KNOW because you don't have a clamp attached to ...." Well you get the picture. If I wasn't making a joke I would have been crying out in pain. Ahh, laughter ... best medicine yet.

~EM

[mkoven]

Interesting! Since I also get migraines with aura, I'm intrigued. If there are no hormones, can I ask how it stops migraines and changes your period?

[flop]

Copper IUDs have no hormones but in general can cause heavier/more painful peroids than usual (not in everyone though).

Mirena IUSs have low-dose progesterone (no oestrogen) and in general cause lighter/shorter/less painful periods and in a lot of women periods stop altogether.

Both are suitable for migrane sufferers.

Flop

[Guest brianala]

Interesting! Since I also get migraines with aura, I'm intrigued. If there are no hormones, can I ask how it stops migraines and changes your period?

From what I understand, menstrual migraines are caused by the change in hormone levels before/during/after your period. Hormonal birth control exacerbates this, since there's a sharp drop from one week to the next on the hormone-free week. Going back to your body's natural cycle results in a more even cycle of hormones and can reduce the amount of menstrual migraines. Also, women who experience migraine with aura are at a significantly increased risk of stroke if they take hormonal birth control, although I don't know the exact mechanism.

Copper IUDs can cause heavier periods, but it's really a matter of perspective. Your period is going to go back to whatever your natural cycle is. For most women that will be heavier than what they experienced while on hormonal birth control.

[iheartcats]

I've made my appointment for Mirena. The more I've read about it (and the significantly lower stroke risk - I am on Midodrine and my Gyno worries about BCP and a blood pressure raising medicine) the more I think it's worth a try.

My Gyno said the worst case scenario I try to give it a few months to work, if it doesn't, it can come out. But I think since I handle Seasonique ok, this shouldn't throw me off too much. Fingers crossed!

[flop]

All the best for your appointment, I hope the Mirena works well for you.

Flop

[iheartcats]

I got it today. It hurt. Now I'm cramping, but a nurse I know said I could cramp for a day so take the next day off and relax.

I hope it works well. My Gyno and EP prefer me to be off the pill now...it's just one more medicine in my regimen of meds and personally the blood pressure/stroke/blood clot issues with the pill scare me a bit.

I'll let you know how things go a couple weeks in. I know there have to be a lot of women interested in this and glad we have a place to share info here.

[Stace915]

I saw my gyn a few weeks ago to talk about BC options. I was on the pill for years but because of a blood clot I am not allowed to take it anymore. My only options are methods that are progesterone only. I turn 30 in about 2 weeks and I discussed getting my tubes tied and learned that there is another method of sterilization, Essure... I do want to have children, in fact everytime I see a baby I get upset and teary eyed, but based on my health I have made the decision not to have children. Not an easy decision but beyond even passing POTS and EDS onto another person, I still have many days (like today) where I am bed-ridden and there is no way I could take care of another person etc etc... All of that being said, I started to do some research on Essure because I have issues with anesthesia so getting my tubes tied is not really an option and I got really upset everytime I read about it, I guess even though I have made the decision not to have children actually doing to something so permanent is a scary and very real decision... My doctor said that what ever I decide is ok but she would feel more comfortable with me doing something that is long term but not permanent. She told me that I am not a candidate for the copper IUD because only women who have had children can get it (which is interesting because a few people on here mentioned having it and not having kids), so that really leaves Mirena and Inplanon as my options.

My doctor said that she has about 30 patients currently who have Mirena and none of them have gained weight or had any issues, then I read all of this horrible stuff online about people gaining 30lbs from it, getting severe depression, debilitating fatigue etc.. My doctor said that was all veyr rare and did not seem concerned... I am not ok with gaining weight from BC and I can not handle anymore fatigue so I am nervous about Mirena... hoping someone with POTS can share a good experience with me... the other option, Inplanon, is implanted in your arm for 3 years. My doctor said she has less than 10 patients who have this, but again said none of them have any problems, no weight gain etc.. and of course online I found a ton of horror stories.

I would really like to make a decision as soon as possible, if anyone has experience good or bad with Mirena, or Implanon please let me know... and if anyone has gone through the Essure procedure I would like to hear about that too.

Thanks!

[flop]

Hi Stace,

I haven't had either implanon or mirena myself but I did do extensive research about them 18 months ago when I was considering having a mirena fitted.

Firstly your doctor's advice that only women who have had children can have a copper IUD is (in the UK anyway) considered to be out of date. It is easier to fit an IUD in someone who has given birth naturally but it is perfectly possible to fit them in other women too. In fact in the UK the copper IUD is offered as a form of emergency contraception up to 5 days after unprotected intercourse even to girls in their early teens.

Implanon vs Mirena. The obvious difference is the location - implant in the arm (local anaesthetic, tiny incision, pressure dressing on upper arm) or fitted inside the uterus. Implanon lasts 3 years vs Mirena 5 years, but both can be removed at any time if you get side-effects or decide that you want a child. Hormone dose - Implanon hormones travel from your arm throughout the whole body via the blood, Mirena hormones work directly on the lining of the womb so a much smaller dose of hormone is needed (but some does still travel through your body). Because of the lower dose of hormones the side-effects are much less common with Mirena than with Implanon. I know that family planning clinics in the UK use hundreds of both systems and most people are satisfied and come back to have a new implant or IUS when theirs is running out, very few people have side-effects so severely that they want them removed early.

Hope you find something that works well for you,

Flop

[cnm1]

Wow, something I can offer some advice on I do ALOT of IUDs. In fact, I inserted 2 today - 1 paragard, 1 Mirena. Both never had children. It is like everything some like them, some don't. It certainly hurts going in but it only takes a couple of minutes. Most women are ready to go back to work afterwards but I expect with POTS; probably not. The research indicates little systemic absorbtion with the Mirena but I do have pts who complain of "hormonal" issues. I expect that there are exceptions for everything and some might absorb more hormones than others. My clinic does 50-60 iuds/year!!! Many in women with no children. There is a increase chance of expulsion if you've never had children but not greatly. Things like perforation - rare with an experience clinician. Imbeded - rare too. Geez- I can't think of any IUD in 15 years that wouldn't come out if I could see the strings

I do suggest inserting an IUC on your period if you have never had children but they can be inserted at anytime if there is no chance of pregnancy. Some clinicians will use misoprostol before an IUC to ease insertion - I am not impressed so far.(taken either 12 or 1 hr before insertion: it can soften the cervix.

Stacie

You could also take a progesterone only pill (POP) like micornor/nora b. FOr some reason alot of clinicians forget about them. WHile not as effective as estrogen/progestin pills, they are still highly effective (95%). My former clinic did essure - for most it is a pretty simple proceed with severe cramping for a 1hr or so afterwards. To be honest, from what you have told me, I would suggest a progestin only pill while you consider your options.

Louise

[Elfie]

When my gyn talked to me about Mirena she said that their office frequently uses a local when inserting on women that have never been pregnant and most women only experience period-like cramping afterwords. However, she cautioned me that many women that haven't been pregnant have vasovagal episodes during insertion (not related to pain). She thought this might have a higher likelihood because of POTS.

[Stace915]

cnm- thanks for all of that info, I didn't realize that there was a pill that I was able to take. My doctor said that if I decide I want Mirena I have to come in first for some kind of test to make sure that it will fit, that sometimes when a woman has not had a baby they are not able to get it in. Do you know much about Implanon or patients experiences with it? At this point just based on everything I have read I am leaning towards the Implanon because it sounds less painful and I do not have to have a test before the insertion, and from all of the horror stories I have read online, the Implanon sounds like the lesser of the two evils. I know it probably sounds stupid to some of you, but the weight gain is truly my biggest concern.

It is really interesting that my doctor will not use a copper IUD on someone who has not been pregnant before, it sounds like that is a very old-school way practice. As much as my decision to not have children is made, I do think that if I do either the IUD or Implanon that in another 3-5 years I will be more accepting of my decision and at that point ready to do something permanent.

I will probably have someone drive me to the procedure (which ever one I decide) and take the day off from work just to be safe, if non-POTSY's get dizzy and crampy I assume I will feel pretty bad after the insertion.

[cnm1]

I have no idea what they mean about a test!! The health care organization I work for does 100s of IUDs each year. I suspect they try sounding 1st but I see no point in that at a separate visit. That is done at time of insertion. If you can not sound then; then no insertion is done. (sounding is using a narrow device to see if you can enter the uterus far enough to place an IUD). Doing that at a spearate visit before hand only increase cost and pain. I don't think this doc does many IUDs. Trust me experience helps with insertion!!!

I don't see a big demand for implanon. For those who want it, I suggest a trial of Depo 1st, similiar side effects and no incisions involved. EMAIL me and where you live; I may be able to offer you another place for a second opinion. I really recommend a second opinion. No offense but I am not impressed with the options your MD is offering and his education on these issues.

Print out someting on POP and call you doc. He should be able to start you on that immediately. Geez I can't believe how complicated some docs make this stuff. I have to say lots of docs in private practice send their pts to us for IUDS because of our experience with them (using we do them cheaper too since we get a volume discount.

Louise

[sandymbme]

Mirena was one of the options I considered prior to having my endometrial ablation/tubal ligation. For me, ( I was 33 at the time and newly divorced) I had come to a point where having biological children seemed highly unlikely, and frankly dangerous. My periods were complicating all of my health issues, from the horrific effect all the ibuprofen was having on my stomach lining to the wildly unmanageable migraines. Since having my ablation, I no longer have periods at all. For which I am profoundly grateful! The recovery was not too terribly bad, I only really used the painkillers for a day or two. Not much worse than my periods, frankly! If child-bearing isn't a concern, I highly recommend this option!

Sandy