MIRENA COIL FOR HEAVY PERIODS

MIRENA COIL FOR HEAVY PERIODSThis page and its c ontentsare Copyright 201 0t he British Fibroid TrustQuestions & Answers for PatientsDr Nicki On, PhD, MRPharmS. PharmacistDr Rajesh Varma, MA, PhD, MRCOG. Consultant Obstetrician & Gynaecologist.Website address: www.britishfibroidtrust.org.ukWhat is the Mirena® IUS?1. An IUS (intrauterine system), commonly knowas a coil, is a small T-shaped plastic devicewhich slowly releases a progestogen hormone.This is similar to the natural progesteroneyour ovaries produce.2. In UK, the IUS is available as Mirena. In fact,Mirena contains 52 milligrams oflevonorgestrel, a hormone used in manycontraceptive pills. The hormone is housedwithin a substance calledpolydimethylsiloxane. This is surrounded by amembrane (skin) also made ofpolydimethylsiloxane. Levonorgestrel isreleased from IUS at an initial rate of 20mcg/day.3. The T-shaped frame also contains bariumsulphate so that it can be seen on x-rays.4. There are two fine threads, made of iron oxideand polyethylene, attached to the bottom ofthe frame. The fine threads allow easy removaland allow you or your gynaecologist to checkthat the IUS is in place.What is the Mirena IUS used for?It has three main licensed uses:• Contraception: This is the main use, which isan effective, long term and reversible methodof contraception. Once Mirena coil is placedinside the womb, it slowly releases thehormone levonorgestrel over a period of 5years or until it is removed.• Heavy menstrual bleeding (Menorrhagia): Itreduces the menstrual blood flow.• Protects the uterine (womb) lining fromoverstimulation in women who have a uterus(womb) and wish to use Oestrogen replacementtherapy HRTMirena has also been shown to be effective inmanaging symptoms of other gynaecologicalconditions, such as fibroids, endometriosis,adenomyosis, endometrial hyperplasia andpremenstrual syndrome. However, Mirena ispresently not licensed to be used as a treatmentfor these conditionsHow does Mirena work?• The hormone in the Mirena coil reducesheavy menstrual bleeding by controlling themonthly development of the lining of yourwomb, making it thinner.• The hormone in the coil prevents pregnancyby the following actions:oooPicture of a Mirena CoilIt makes the lining of your wombthinner and in doing so it makes theuterus lining less likely to accept afertilised egg.It also thickens the mucus from yourcervix, which makes it difficult for thesperm to reach the egg.In some cases, it stops ovulation andas the result your periods stop andthere are no eggs for fertilisation.Date of preparation: 12 September 2010

Page 2Mirena for HMB Q&AHow effective is Mirena for heavybleeding?There is strong scientific evidence showing thatit reduces the monthly blood loss in 90% ofwomen who use the system. In 20% of womenfitted with Mirena, periods may stop altogetherwith the reduction in blood loss being gradualover a period of time.Generally, you see reduction in blood loss in 3 to6 months after insertion. There is evidenceshowing about 86% reduction in blood flow at 3months and 97% reduction at 12 months afterfitting. You may have an increase in bleeding.however, usually in the first 2-3months, before areduction in blood loss is achieved. If asignificant reduction in blood loss in notachieved after 3-6 months, alternativetreatments should be considered.Many gynaecologists now believe that Mirena isan important alternative to a hysterectomy andother surgical treatments.What are the benefits of having aMirena for heavy bleeding?It is very effective in reducing menstrual bloodloss therefore preventing anaemia.Once fitted, it lasts 5 years. Women who are intheir forties will require one or two Mirena IUSbefore their menopause.Menopause brings about anatural cure for the heavymenstrual bleedingproblem, and decreases theneed for a hysterectomy.You get the benefit ofcontraception in addition totreating heavy menstrualbleeding.“Be warned, ifcontraception isnot what you wantor unacceptablethen Mirena coil isNOT for you”Will Mirena affect my period pain?Typically, about half of the women who sufferwith heavy bleeding also complain of painfulperiods. Experience shows that Mirenasignificantly improves period pains in over 96%of users, in addition to reducing the monthlyblood loss.What are the side-effects effects or risks ofMirena?• Acne (usually less common after 3 months oftreatment, and may improve if acne alreadyexists).• Breast pain, tenderness or swelling.• Headaches or migraines (although headachesmay lessen in many users; in others, theymay increase in number or become worse).• Dizziness.• Depression. If you have a history ofemotional disturbances, it may be more likelyfor you to have a recurrence while using theMirena device• Weight gain.• Loss of fertility.• Some develop small fluid-filled cysts on theovaries. Often, these cysts do not causesymptoms but some women experiencepelvic pains. These cysts are not dangerousand usually do not need to be treated anddisappear without treatment. Women usingthe Mirena coil are more likely to developbenign ‘simple’ ovarian cysts. The mostcommon symptom of a simple cyst isabdominal pain that does not resolve withsimple painkillers. Such cysts usuallydisappear without treatment in 2–3 months• Pelvic infection. The Mirena coil is designedto minimise the risk of infection, but there isstill a slight risk of developing a pelvicinfection while using the coil, particularly inthe first 3 weeks after fitting. Such infectionsare usually related to sexually transmitteddiseases, and you are more likely to developan infection if you or your partner has severalsexual partners. Overall, about 1.5% ofwomen will develop an infection with 5 yearsuse of the coil. You can reduce your risk ofdeveloping an infection by using a condomwhen having sex with anybody other thanyour long-term sexual partner.• Embedment of Mirena in the myometriummay occur. When this happens the Mirenashould be removed. Embedment can result indifficult removal and, in some cases surgicalremoval may be necessary.Date of preparation: 12 September 2010

Mirena for HMB Q&APage 3Side Effects (Continued)• Decreased libido (sex drive). This is notofficially reported but was raised by a numberof women on health's forum.What situations prevent me fromhaving Mirena IUS?You can not have an IUS if you have or in thepast had the following:• Cancer of or presence of abnormal cellsin the womb, cervix, ovary or breast.• Active liver disease or a liver tumour.• Unexpected bleeding from your vaginabetween periods or after sex.• Blood clot problems (e.g. thrombosis,DVT or PE) or leukaemia or othercancers affecting the blood.• A heart attack or stroke or infection ofthe heart valves.• Pelvic infection or untreated sexuallytransmitted disease.• Inflammation of the lining of the wombor cervix.I am diabetic, am I not suitable forMirena coil for my heavy menstrualbleeding symptom?Levonorgestrel may affect glucose tolerance, andthe blood glucose concentration should bemonitored in diabetic users of Mirena.Can I change my mind once I havehad Mirena fitted?Mirena can be removed at any time. Ideally itshould be removed during the time of a period,or another reliable form of contraception usedfor seven days leading up to the time of theMirena removal. This ensures that there is norisk of an unplanned pregnancy.What are the risks associated withthe procedure of inserting theMirena coil?• During 20 days after fitting, there is a smallchance of getting an infection. It is advisableto make sure there is no existing infectionbefore fitting.• The IUS can be expelled (pushed) out by yourwomb or can move. This is more likely tohappen soon after fitting, You may not beaware of it. It is important you learn how tocheck your IUS threads every month.• While fitting, there is low risk of perforation(puncture) of your womb or cervix. The riskof perforation may be increased in lactatingwomen, in women with fixed retroverteduteri, and during the postpartum period. Therisk is low when the coil is fitted by anexperienced gynaecologist or gynaecologypractice nurse. Perforation can cause painbut often you get no symptoms. Ifperforation occurs, the IUS has to beremoved by surgery.• There is a small risk of ectopic pregnancy ifyou fall pregnant while you are on the IUS.What are the alternatives to Mirenafor heavy menstrual bleedingcaused by fibroids?There are alternative medical or surgical options.The common medical options include:oooThe combined oral contraceptive pill.Tranexamic acid.Prostaglandin synthetase inhibiotrs(NSAIDs) such as Mefenamic acid oribuprofen.Surgical options include:ooooEndometrial ablation.Myomectomy of sub-mucosal fibroids.UAE/UFE.Hysterectomy to remove the fibroids andwomb.Date of preparation: 12 September 2010