Holy Hormones Journal: I was delighted to see Dr. Jen Gunter’s blog post come out over the weekend with information on the Mirena IUD. She is so right when she sates that there is a price to pay for unexplained bleeding with the use of long acting reversible contraceptives. The Mirena IUD is no exception. Women need to know that there is no such thing as a regular or irregular period when on an synthetic contraceptives. These are ‘chemical bleeds’. It is also recommended that women are nutrated when they use these devices. An IUD sets up a minor infection in the uterus – so the immune system needs to be supported. It is also know that synthetic hormones rob the body of vital nutrients – along with daily stressors and aging.
Although I am not a proponent of synthetic hormone use – I am a proponent of women have the information and education they need to make informed choices about what type of contraception works for them.
Bleeding after a Mirena IUD insertion, what to expect
Dr. Jen Gunter
WIELDING THE LASSO OF TRUTH
May 25, 2013
The levonorgestrel intrauterine system (Mirena IUS) is a popular IUD. It contains the hormone levonorgestrel and over time many women gets lighter periods or even lose their periods altogether. This is a desirable side effect. The only problem is the promise of very light or no periods and combined with long acting reversible contraception comes with a price – many women have an initial bout of irregular spotting and/or bleeding. Unfortunately, many women are not adequately counseled about this possibility and as a result most women who get their Mirena removed for reasons other than wanting to get pregnant do so in the first 6 months and the most common reason cited is irregular bleeding.
Preventing early removal of the Mirena is important for the following reasons:
- Contain costs. IUDs themselves are expensive and there is often a co-payment for insertion as well.
- Prevent unplanned pregnancies. Long acting reversible contraception (LARC) is the most effective form of contraception because there is no user error, and so with the IUD out the next method chosen is likely to be less effective when considering real world experience. Not everyone has a plan for their post IUD contraception and that time of considering what to use next is very high risk for an unplanned pregnancy.
- Reduce the burden of complications. While significant complications with IUD insertion are very low (less than 1%), they are all associated with the insertion. If you have an IUD inserted and pulled out 3 months later you have assumed that risk for nothing.
The best way to prevent dissatisfaction related to a known side effect (irregular bleeding) is to be adequately counseled about that side effect. So how common is irregular bleeding after a Mirena IUS?
There are a couple of high quality studies to consider. These studies followed women after the insertion and they completed daily diaries to record bleeding, so the data is prospective (these were typically studies looking at ways to reduce post Mirena insertion irregular bleeding).