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The IUD and Perimenopause

Greetings, Divas!

I am 40, married, NP, perimenopausal, and considering an IUD. My first choice would be sterilization, which I started asking for when I was 16, but now that I'm finally "old enough to make that decision," (thank you, medical profession, for infantalizing me all these years!) I have lousy insurance (catastrophic care only, $20,000 deductible, sterilization explicitly excluded) and can't afford it ($5000 for Essure and $8-10,000 for a tubal are the best self-pay prices I've gotten where I live)...so, next best thing, right? Or not...I have a few concerns and hesitations.


.1.) I have hormone issues, and wasn't great on the pill when younger, mostly mood-related (the "uni-mood" and depression) and mild immune system issues (got sick easily). Never had any acne, hair problems (growing or losing), or BTB. Lately, I've been having what I consider to be more perimenopausal symptoms: insane anxiety, a bit of weight gain/redistribution, occasional yeast infections, more PMS,  no sex drive, and slightly erratic periods...natural progesterone and supplements help somewhat. So, I decided maybe Mirena wasn't the best bet...synthetic hormones scare me, always have. I dig that the Mirena hormones are mostly confined to the uterus, and even went so far as to compare published blood serum concentrations of LNG between Mirena and LevLite (which I've taken, and was probably the worst of the low-dose pills for me, the best being LoEstrin 1/20), and it's a dramatic difference, as far as I trust serum hormone measurements. I am just a bit nervous about Levonorgestrel.

2.) When younger, I had heavy, very crampy, clotty periods, mostly 8 days or more. In my 30's, they really backed off to 1-2 heavy, crampy days and 3-4 moderate days, then a spotty couple of days. But lately, the old patterns have been making an occasional reappearance...every few months, I'll have one of those periods where the cramps are so bad you're looking around on the floor for your uterus (magnesium is my best friend). So, I decided maybe Paragard might not be the best bet, either...they say to look at your mother and your early menstrual patterns to see what menopause might look like...my mother suddenly (and for the first time) had killer periods, much like my early ones (she actually apologized to me for not being more sympathetic when I was a teenager). So if that's the way things might trend for me in the future, I might not do well with increased bleeding and cramps. I spend a lot of time working on construction sites with only crappy porta-sans and big, burly guys who are totally not interested in "lady problems," so utterly gushing periods would not be great for me.

3.) I am a gynecological wimp, I think. Intellectually, I know it's nuts, but I am severely squicked out by the idea of jamming something inside my uterus. I don't even like tampons because they somehow block me emotionally...as bad as my periods have been in the past, it's always been a stress-release for me, and tampons just stuff a sock in it (so to speak). On the other hand...I don't even understand the idea of a "painful" Pap smear...honestly, I don't even feel it, so maybe I'm not as much of a wimp as I thought. But knowing that I can't take NSAID's (one aleve or ibuprofen and I am puking my guts out) makes me apprehensive about insertion...the NP I talked to at PP said "Oh, we'll give you whatever you need," but I am skeptical. I've had my cervix dilated before (with percocet and valium for my mental state) and it kinda sucked, but wasn't excrutiating or anything, if that gives you any ideas of how I respond to cervical manipulation. At my last exam, the NP said my cervix looked nice and soft and like it would not pose huge problems at insertion. My biggest fear is that I will never be able to forget the IUD is there, and will be intensely aware of it ALL THE TIME...anyone have that fear going in, and did it resolve or go away?

 

Sooo...my main questions are: any perimenopausal women using an IUD of either kind? The NP was really pushing the Mirena at me like a cure for all my menopause problems...I remain unconvinced, and there are not a lot of NP 40+ year olds with IUD's running around to give advice. Would the Mirena help or exacerbate this hormonal process I'm in? I've read all the horror stories, but there aren't a lot of older women saying much. Also, I do a fair amoung of very awkward heavy lifting at work...will that be an issue, expulsion-wise? And finally, I am completely and utterly paranoid about pregnancy...I know that's just my twonky brain at work, but any advice on how you dealt with that issue? Is it just a gradual process of getting used to the idea of IUD protection? I'm just afaid I'd be checking the strings 327 times a day, and using condoms and spermicide "just to be sure."

Sorry to be so long-winded, but when you're poor and on the hook for all your medical expenses, you tend to be a little paranoid about making the wrong choice. So if I do this, I want to make sure I do it right, because I definitely can't afford a mistake. Y'all got a great little community here; I've been reading online forums for years, and can tell quality at a glance...you ladies are quality!

Comments

( 17 comments — Leave a comment )
denisecmt
Sep. 30th, 2008 11:20 pm (UTC)
I'm 45 and got my Paragard in June. I have had a really good experience with mine, including a painless insertion. I have never had difficult periods, i.e, no cramps and about 4 days long. I have not had any period cramps with the IUD. My first several periods were much heavier than usual but lasted the same amount of time. They are now returning to what I would consider a normal flow for me.

I've gone this long without using hormonal birth control and don't want to start now, even tho' I understand the Mirena hormone amount is super super low. (By the way, I have not started to have any peri- menopausal symptoms.)

In terms of pregnancy fears, I think it's within the range of normal to want to check the strings all the time. I was so afraid of expulsion that even if I sneezed I got nervous. But over time that diminished to the point I really don't think about it at all. After the first year, they say that the effectiveness of the IUD is as good as sterilization (meaning, if it doesn't expel).

I wish I had gotten my IUD years ago! I love it.
red1964
Oct. 1st, 2008 12:32 am (UTC)
Hi - I am 43 and am happy to share my Mirena experience with you. Prior to the Mirena, which I had installed in Sept 07, I had normal periods, not too long, not too heavy, almost always 28-30 days apart. No big cramps or anything like that. I have, one two occasions since I hit 40, skipped a period and was given Aygestin to bring on the cycle. Bad stuff for me....made me want to shoot myself, the headache pain was so bad.

Anyway, I get the Mirena as my Doctor of many many years tells me that this is a good option for me because the progestin is so low (knowing my sensitivity to it). It's a bit painful going in but I went back to work right afterwards. Random cramping but a lot of bloating, which didn't go away the entire time I had it.

A few weeks down the line, I started with the headaches....daily....and then the cystic acne arrived...the sort of thing that would wake me up at night if I rolled over on it (I NEVER had acne before in my life)...crushing fatigue....insomnia....heart palpitations....serious brain fog....libido in the toilet. I lasted 5 months. Had it removed at my annual and my Dr said that while he was initially a fan of Mirena, not so much anymore because he had been hearing a LOT of issues like mine. Literally as I was walking to the car, the fog began to lift. Bloating down in 2 days (hey - there's my waist!!)....acne cleared in 2 weeks...it was amazing. After a while I realized, "Hey, I haven't had to buy any Advil lately"...because I no longer had that dull headache every day.

So....that was Feb of this year...in April, I started having hot flashes. My Dr does bloodwork and I am post-menopausal....NOT perimenopausal....but POST...as in DONE. At 43???? Repeat the bloodwork in 6 weeks....same thing and estrogen level even lower, almost undetectable. Shocking.

So I am now on HRT for a few years as I need the estrogen to protect my heart and my bones. I am still stunned that this could happen so quickly. I did more research and found studies in the British Journal of Medicine that showed that in fact, the progestin in the Mirena DOES get into the blood (as my tests confirmed) and that it is the equiv of taking two POP each day!

Some women do great on the Mirena....I was not one of them. Too sensitive to the progestin. And yes, I did always feel that it was "there"....and even during sex, there were some positions that had to be avoided. I can't tell you how much it contributed to preventing pregnancy seeing as I am no longer fertile! I do believe that it interferes with the natural balance of hormones in your body....maybe for those of us that are a little older, our balance is already precarious.

I would have tried the Paragard if I still needed birth control. Some people have heavy periods but then again, many have reported that they settle down after the initial adjustment. My female relatives in Europe have use copper IUDs w/o issue for many years.

Good luck with your decision. Feel free to email me if there is anything else I can share with you. Take care.
skepticalcat
Oct. 1st, 2008 02:04 am (UTC)
I'm sorry it didn't work out for you...my mother went on HRT at 40, came off it at just shy of 45 and was post-menopausal at that time, so it's definitely not unheard of. She was actually a great role model and thus I am really looking forward to the whole process of menopause.

I actually have seen that reference to the British study...however, the reference is in the form of a letter, but it doesn't add up to me. The abstract of the article it references (Xiao et al, Fertility and Sterility, April 2003, regarding the use of LNg IUD's in the treatment of idiopathic menorrhagia) states a sustained average levonorgestrel serum concentration of 511 pmol/L, which doesn't seem high compared to other forms of levonorgestrel contraceptives (COC's and implants specifically, were the numbers I was crunching this afternoon...there are no levonorgestrel POP's used in the US, as far as I know, I think there is one in the UK, though). Without shelling out $$ for the full article, that was as far as I could follow that particular reference.

Yeah, I overthink these things sometimes.
red1964
Oct. 1st, 2008 02:44 am (UTC)
The article I was talking about is a bit more current....maybe you can look it up...BJOG volume 114, Issue 10, pages 1307-1308, Oct 2007 "Mirena - the other side of the story".

My Dr told me that at 43 I was not considered "prematurely" in menopause but that I was on the left side of the bell curve of "early". No one but no one in my family started before age 48 so couple that with a super fast transition and you can understand that I was shocked!! Now I am concerned about my bones and my heart and keeping them healthy.

Good luck....and take care.
skepticalcat
Oct. 1st, 2008 03:05 am (UTC)
Yep...that's the initial reference that cites the earlier Xiao article. I went and looked up all the sources cited in "The Other Side of the Story," Xiao just happened to be the one that discussed LNg serum concentration. Like I said, it just didn't add up for me.

I personally think that women are starting to experience hormone imbalance and perimenopause much earlier nowadays because of hormone exposure and environmental/life factors...but I also come from a VERY matriarchal family where women tend to "crone" early and become very strong elders (read as: "pushy old broads,") so my viewpoint is a bit skewed.

skepticalcat
Oct. 1st, 2008 02:32 am (UTC)
The funny thing is that I found a link here to a place where you can buy pregnancy tests in bulk...I'd probably be running one of the dang things every month.

It's funny, but some part of me is saying "Yeah...no periods would be cool," which is totally NOT my normal mindset. Probably just the part of my brain that is sick of being part of the "cycle of nature" thing and can't wait to be post-menopausal.
kickballer
Oct. 1st, 2008 12:33 am (UTC)
Unfortunately I don't have much to offer in regards to this <
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Unfortunately I don't have much to offer in regards to this <<except support!>> and wanted to bring up payment options like CareCredit. I use it to pay for my braces (which comes out to over $10K, insurance only covers $1500/lifetime for orthodontia) and it's worked out really well for me. I don't know if PlannedParenthood or your regular OB/GYN would accept it but it might be something worth looking into, re: tubal or Essure.

I can definitely appreciate your concerns and while others might be able to offer ways to manage pain while getting the IUD (I have Paragard, loving it!) or advice about hormones/menopause, I thought it might help you to know there are options out there to help you manage your payments.

Good luck to you! And if you decide to get an IUD, I think you'll be pleasantly surprised. Breathing exercises and meditation helped me (31, NP) through mine, I didn't even flinch while it was being put in.

Oh, and I really hope I am not breaking any site rules by mentioning the payment plan. If I am, my apologies!
skepticalcat
Oct. 1st, 2008 02:12 am (UTC)
I actually HAD CareCredit at one time...the interest rate was insane (as I recall), but it was my only choice at the time. I mean, I COULD easily tap into credit lines I already have...but I just can't justify spending that much on medical care short of major illness or bones/intestines sticking out of my body. Heck, I've actually given my husband stitches because we're too poor (or cheap) to go to the ER. I appreciate the thought, though. One of the more expensive doctors would have accepted it, but they will only do Essure under general anesthesia and it was in the neighborhood of $8000...gak!)

tanukisuit
Oct. 1st, 2008 02:48 am (UTC)
why doesn't your husband get a vasectomy?
skepticalcat
Oct. 1st, 2008 03:13 am (UTC)
Heh...two reasons: he's opposed to non-essential medical procedures (and I would assume a bit protective of his man-bits...which is understandable)...but mostly because of the two of us, I am the one who is *vehemently* childfree; if anything were to happen to me, he might possibly want to reproduce with another woman (he doubts it, but isn't 100% sure). IMO, no one should get sterilized who isn't 110% sure about it, and he's only at 99%. I've known since I was 8 that I wasn't having kids, so I have no doubt whatsoever about it...therefore, if someone's gonna get snipped, it should be me.
tanukisuit
Oct. 1st, 2008 03:22 am (UTC)
That makes sense.
jinxleah
Oct. 1st, 2008 01:16 am (UTC)
Well...I'm 39, but I am perimenopausal. I got an IUD mainly because I am absolutely paranoid about getting pregnant. My mother was 43 and on the pill when she had me, and my grandmother was over 40 when she had her last three of five children. I do not wish to continue that trend. Even though I am in a committed relationship with only one person, and he's snipped, I do not want to get pregnant. I have mild periods, but as far as PMS, it is horrible. I've thought of getting snipped or a hysterectomy just to get rid of my PMS. But I do not want to go through surgery. Also, my periods were 1 or 2 days of very light bleeding, with 2 days of moderate bleeding, and 1 or 2 more days of light bleeding, so nothing too bad.

I've had my Mirena in since May. I love it, and wish I could have gotten it done years ago. My most recent period, just this weekend, was 2 days of very light spotting. It was so light that they only reason that I used a pad at all was because I was going to be away from a bathroom for an extended period of time. My moods have evened out, and I have calmed down considerately. My changed mood was one of the first things my hubby mentioned.

Get one, you will love it! Again, I wish I'd gotten one years ago!
skepticalcat
Oct. 1st, 2008 02:28 am (UTC)
Did you have any perimenopausal-type symptoms when you got the Mirena? Just wondering if you had any symptoms that were helped or made worse...was your PMS more recent or was it something you'd always had to deal with? I've always had mild PMS, nothing major, but it's gotten worse over the last few years...specifically the anxiety (not panic, just anxiety)...which strikes me as generally being a lack-of-progesterone kind of symptom (upheld by the fact that natural progesterone seemed to help it in a short-term trial). That said, my fear is that synthetic progestin may actually exacerbate symptoms like that...I know that on low-dose COC's, I actually didn't get enough estrogen and ended up having hot flashes, so I'm a bit concerned that Mirena could do the same thing to my progesterone levels. I wonder if it can be used in combination with natural progesterone if needed?
linny21
Oct. 1st, 2008 02:28 pm (UTC)
I must be the oldest Diva here. I had a Mirena fitted two months ago at the grand old age of 55 as the progesterone part of my HRT. My doctor recommended it after the no bleed HRT I was on was giving me constant spotting.
The insertion was a bit long winded as my cervix refused to dilate, I have two children and used to have a copper coil. I had very minor spotting for a couple of weeks but I am now all clear. I receive my oestrogen by patch.
I did not get on very well with HBC but HRT suits me just fine and my present combo is the best yet. I live in the UK and the mirena is getting very popular here for menopausal ladies.
skepticalcat
Oct. 2nd, 2008 08:14 pm (UTC)
Thanks for that comment...I was actually intrigued when Mirena was first approved for use in the US, thinking that it might be used as the progestin arm of HRT. The NP actually suggested that if I did start having estrogen-deficiency symptoms down the road, that I would already have half the HRT covered with Mirena (though deep down, I am hoping to avoid HRT altogether if at all possible...will cross that bridge when I get to it, though!)
(Deleted comment)
skepticalcat
Oct. 2nd, 2008 08:10 pm (UTC)
Re: How about this..
I know that the 2 clinics in this state don't do sterilizations...even PP (which doesn't do abortions here) has no resources on this; I'm in New England, so just about anywhere within that area might be doable, if they will accept out-of-state patients self-pay. The main problem I keep running into is that because I don't have kids, I'm not eligible for much in the way of low-income programs. But thanks for the offer of help!
(Deleted comment)
skepticalcat
Oct. 2nd, 2008 10:41 pm (UTC)
Re: Options I have found for you =)
Thank you!!! For some reason, I had completely forgotten NYC existed (duh!), but my best gay boyfriend lives there and I could stay with him for a few days...that just might work. PP in Boston does Essure, but they said they wouldn't even talk to me about it unless I had insurance (?!?!)

I have an IUD consult at PP tomorrow, and will make a few phone calls on that list; given how unstable the economy is, I really should consider an IUD for now, if PP's sliding fee is at all reasonable. Given my age, it may be a more cost-effective choice...and I can line up some ideas for sterilization, start saving especially for it, and if I decide I love the IUD, I can just use that money for a romantic weekend instead. Win-win.

I am spending tonight putting together my list of questions and concerns for the consult...I have a feeling I'm going in there with several pages of monographs, clinical studies, and handwritten notes. Every NP's nightmare.

( 17 comments — Leave a comment )

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