Heavy Periods. What treatments for heavy periods are there for a young woman?

Figure 14.1 Mirena IUS in a uterus.

Although primarily a method of birth control, the Mirena has found a place in the management of heavy periods, PMS, HRT and endometriosis. The Mirena had been available for routine clinical use in Scandinavia for five years before it was licensed in the UK in May 1995.

How does the Mirena work?

Although the Mirena is physically similar to other IUCDs, its main mode of action is similar to progestogen-only pills. The mucus in the neck of the womb remains thick and hostile to sperm throughout the menstrual cycle; this thick mucus prevents sperm reaching the eggs and fertilisation is therefore unlikely to occur. Furthermore, the lining of the uterus is kept thin by the Mirena so that even if an egg should be fertilised, a pregnancy cannot be supported. For some, the question of how the IUCD prevents pregnancy is critical. As IUCDs are effective partly after fertilisation, they may not be acceptable in some cultures. The Mirena functions almost entirely to prevent fertilisation.

How is the Mirena introduced into the uterus?

Like other intrauterine devices, a Mirena is best introduced at the end of or just after a period. It has a slightly larger diameter (5mm) than most other devices so the neck of the womb may have to be stretched a little (dilated). This can usually be accomplished with a local anaesthetic injection. If there is an indication to perform a D and C operation - (heavy periods, for example), the Mirena can be introduced under the same anaesthetic.

Prostaglandins provide a medical means to open the cervix. Some gynaecologists prescribe Misoprostol 2 x 200 mg introduced deep into the vagina three hours before planned introduction may assist. Ibuprofen 400 mg one hour before insertion provides very effective pain relief and may be repeated a few hours later. Erythromax capsule (erythromycin 250mg) is sometimes used about an hour before insertion to reduce the chance of infection.

How quickly will a Mirena work?

Provided the Mirena is introduced at the correct time, it is effective immediately. It can be introduced at any time if you are currently taking the pill. Generally, we recommend waiting until the first check, which is usually scheduled about six weeks after fitting.

For How long will my Mirena work?

The Mirena is licensed for five years although there is some evidence that it may be effective for at least eight years.

How failsafe is the Mirena?

The Mirena is associated with only 0.2 pregnancies/100 woman years (Pearl Index). This is less than combined pills, progesterone only pills, other IUDs, and even female sterilisation (0.4/100 women years).

What side effects can occur with the Mirena?

Spotting for the first two or three months after insertion is a relatively frequent side-effect.  As with other intrauterine devices, a Mirena could be expelled from the womb - it should be checked about six weeks after insertion. Very rarely, the device can go through the uterus (perforation).

There is no evidence that the Mirena increases body weight.⁰⁶⁰¹

How would a Mirena affect my fertility?

When the Mirena is removed from your uterus, fertility will be restored immediately.

Could the Mirena have a place in the management of endometriosis?

Retrograde menstruation (retrograde menstruation) is a significant cause of endometriosis. From a theoretical point of view, as the Mirena is associated with reduced menstrual flow, the retrograde menstruation should be reduced, perhaps reducing the endometriosis. Further research is required in this exciting area.⁰⁷⁰¹

Intrauterine progestogen (Mirena-LNG-IUS) is effective in symptom control throughout the 3 years on the device, and discontinuation is greatest between 3 and 6 months. For those patients with improvement in symptoms, it is an acceptable long-term alternative.⁰⁵⁰³ TheMirena is effective in symptom control throughout the 3 years on the device, and discontinuation is greatest between 3 and 6 months. For those patients with improvement in symptoms, it is an acceptable long-term alternative. The levonorgestrel intrauterine system is an effective hormonal option for treating symptomatic endometriosis (minimal to moderate). It also alters the American Fertility Society staging of disease. With a continuation rate of 68% after 6 months, it has the potential for providing long-term therapy in a substantial number of sufferers, although this would require further study and verification.⁰⁴⁰¹ The Mirena greatly reduces pain associated with endometriosis and adenomyosis and delays disease recurrence. Irregular bleeding and spotting is the main side effects. Administration of GnRHa in advance does not improve the bleeding symptoms.⁰⁶⁰³

 

Related Medical Abstracts - Click on the paper title:-

• Subject and clinician experience with the levonorgestrel-releasing intrauterine system (Mirena).
• A levonorgestrel-containing IUD (Mirena) for the treatment of endometriosis.
• Weight variation in users of the levonorgestrel-releasing intrauterine system (Mirena), of the copper IUD and of medroxyprogesterone acetate in Brazil

Could the Mirena have a place in the management of endometrial hyperplasia?

The Mirena has been shown to be effective in the management of endometrial hyperplasia.⁰⁸⁰¹

Please click on the required question.

• 1 Are heavy periods a common problem?
• 2 What is in my menstrual flow?
• 3 What range of menstrual cycle length is considered to be normal?
• 4 How can menstrual blood loss be measured?
• 5 How can I tell if my periods are abnormally heavy?
• 6 What could be the cause of my very heavy menstrual periods?
• 7 I have been sterilised. Could this be the cause of my heavy periods?
• 8 Should I have tests to find the reason for my heavy periods?
• 9 How will my heavy period problems be investigated?
• 10 What is meant by anaemia due to heavy periods?
• 11 What is intermenstrual bleeding?
• 12 What is a hysteroscopy and D and C?
• 13 What is cervical cautery?
• 14 What happens after the D and C?
• 15 What treatments are available for my heavy periods?
• 16 What are the medical treatments available for heavy periods?
• 17 How do the various medical treatments for heavy periods work?
• 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
• 19 What is a hysterectomy?
• 20 What are the indications for hysterectomy?
• 21 What are the risks (complications) of hysterectomy?
• 22 What is vault granulation?
• 23 What are the different types of hysterectomy?
• 24 Is it essential to remove the neck of the womb at hysterectomy?
• 25 Should my ovaries be removed or conserved during hysterectomy?
• 26 How long will I be in hospital when I have my hysterectomy?
• 27 I have had a hysterectomy. Do I still need to have smear tests?
• 28 What are the other surgical alternatives to hysterectomy?
• 29 How do endometrial ablation and hysterectomy compare?
• 30 Are there any psychological effects following hysterectomy?
• 31 How do we decide the best treatment for my period problems?
• 32 Could I have some recommended hysterectomy support groups?
• 33 Are there any support groups?
• Intermenstrual Bleeding - Bleeding between periods.

 

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.