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Mirena: clear, informative review article

I was looking for sources about the Mirena's effectiveness over 7 years, and found this review article from 2009 that neatly lays out common concerns. It doesn't do any empirical research, but pulls from myriad sources to summarize the state of research.

Things you probably already know:

* The Mirena prevents ovulation 5-15% of the time
* "Plasma estradiol (E2) and progesterone measurements are comparable to those of normally ovulating women."
* Mirena is effective at thinning the endometrium for 7 years, but the cervical mucous starts being less protective at 5 years. It's still 99% effective for 7 years, though.
* PID risk is as low or lower than women without IUDs.
* Ectopic pregnancies too--the "more likely to be an ectopic" belief is a quirk of statistics.
* Perforation estimate: 0 to 1.3 per 1000 insertions
* "The US LNG-IUS labeling was revised in 2008. 10 Under indications and usage, it states that “Mirena is recommended for women who have had at least one child.” However, nulliparity is not listed as a contraindication to use of the LNG-IUS in the package insert," and the WHO says NP women can use it.
* Inserting halfway through the cycle actually is correlated with easier settling-in.
* "Amenorrhea occurs in 15% to 20% of LNG-IUS users during the first year of use, and increases to 30% to 40% with longer durations of use."

There are also interesting conclusions about insertion techniques, off-label usage, bleeding changes, post-removal fertility and a bunch more.

Quick poll: Who was told their Mirena lasted 7 years? What year and country did you get yours? I got mine in June 2010 from a USA PP, and was told 5 years, but a friend got hers in August from a secular hospital (also in Portland, OR) and was told 7.

Also, if anyone knows of a study on Mirena 7 year effectiveness that was entirely conducted in the late 90s/2000s, I'd love to read it. The ones discussed in this paper date back to older studies, which may have used a prototype of the Mirena with slightly more LNG.

My undergraduate degree is in evolutionary biology, so while I can read a scholarly scientific paper, medical ones are usually above my head and beyond my patience. But this one is pretty easy to read!

Comments

( 14 comments — Leave a comment )
onlyforever10
Mar. 28th, 2011 09:03 am (UTC)
Thank so much for posting this! I'm a year and a half into my first Mirena and I'm crossing my fingers that it gets approved in the US for 7 years before my five years is up (I was told five years by my doctor...I'm in California if it makes any difference). I might consider just leaving it in for the 7 years if there was enough information that pointed to it still being effective. I heard maybe in somewhere in Europe was where it was effective for 7 years?
knittinggoddess
Mar. 28th, 2011 09:31 am (UTC)
Sure!

I wanna say that it's approved for seven years in whatever Western European country where it was developed, but it's also 2:30 and my brain isn't as quick on the draw as it was earlier. Or able to Google, apparently. The Mirena has been approved in Europe for way longer than it's been approved here, and we're still behind the times. (USA: Behind Europe in SO MANY WAYS.)

I'm tempted to keep mine in for seven years. I suppose it depends on my insurance, finances and relationship status/gender of partner in 2015.
onlyforever10
Mar. 28th, 2011 09:45 am (UTC)
I knew we had a much lower percentage of IUD usage than Europe...but less than 2% of Americans use IUDs?? Honestly, I stumbled upon this community a couple years ago when I was sick of all sorts of problems from my birth control and I'd never heard of an IUD before. So sad that it's not more known here. When I tell people about it now they either look confused or start spouting off misinformation that seems to run rampant (it aborts babies! You'll become infertile!!!)...ugh.

When I went for my 6 week checkup at the end of 2009, my gyno told me that the Mirena had went up in price 45%. I'm lucky my insurance paid for all but around $100 of mine, but if I can keep it in two more years, that would be AWESOME. Either way it beats the $50 I was paying PER MONTH for the pill.

Plus my SO and I are at that point where we're fairly sure we don't want kids, but aren't quite ready for the vasectomy...2 extra years will put me at 30 years old which I figure is a good age to make the permanent decision on that.
knittinggoddess
Mar. 28th, 2011 06:37 pm (UTC)
Oh, more than 2%, according to Guttmacher, 5.5% of contraceptive using women in 2006-08 used iuds. That's five times more than Implanon, the Patch and Lunelle, combined. (Wow, I didn't realize the Patch was so rarely used.)

I wonder why. Just holdover from the Dalkon Shield? Our inability to market birth control as anything other than period control? Our inability to talk about sex ever OMG?
onlyforever10
Mar. 28th, 2011 06:52 pm (UTC)
Oh ok. I was just using info from the link in the original post...according to it: "Estimated use is considerably lower in the United States, at only 1.8% of women."

That must be an older statistic. I'm glad it's going up!

I think a lot of it does have to do with the Dalkon Shield. I know my mom (who grew up in the 70's) was really worried about me getting an IUD because of that. Even when I showed her all the information about the Mirena, she's still concerned. But I definitely agree that there is also a lot of misinformation and just refusing to talk about BC that has a lot to do with it.
knittinggoddess
Mar. 28th, 2011 06:57 pm (UTC)
Oh, yeah. Again, review article, pulling from different dates.

My mom was extremely concerned about me getting a Mirena, and she swore it had nothing to do with the Dalkon Shield, but entirely due to her own experience with an older LNG IUD. That one had three times the LNG that Mirena does (and only lasted a year), and she had an awful adjustment period. She swore up and down it was the SAME THING TOTALLY, got Dr Google to back her up and proceeded to send me emails about horror stories. She also has a bicornuate uterus, which is totally a contraindication for an IUD, and my uterus is normal shaped. Now she either trusts me in this regard or has given up.
frolicnaked
Mar. 29th, 2011 03:39 am (UTC)
Also, with these particular stats and sources, I wonder if part of the discrepancy might be the difference between "contraceptive using women" and [all?] "women." There's bound to be a certain subset of women, even limited to women between menarche and menopause, who aren't contraceptive-using for various reasons (celibate, involved in a same sex relationship, trying to conceive, etc.).
onlyforever10
Mar. 29th, 2011 03:42 am (UTC)
VERY good point.
xxabscisinxx
Mar. 28th, 2011 12:05 pm (UTC)
My doctor told me that it's FDA approved for 5 years, but in other parts of the world they use it for 7 years.

6 years from now I wouldn't mind getting pregnant, but I'm afraid of miscarriages with this thing in. :/ So I'll probably get it out within 5.5 years unless the FDA changes its mind.
xxabscisinxx
Mar. 28th, 2011 12:08 pm (UTC)
**by 5.5 years I would decide if it's time to have children for me and my partner or if I want to move on to another/continue this form of birth control.
mahasin
Mar. 28th, 2011 01:05 pm (UTC)
You always post such good information, thank you so much!
jadeejf
Mar. 28th, 2011 03:45 pm (UTC)
My doc told me 5 years, but good to know about the other factoids!
haikucatlady
Mar. 30th, 2011 05:10 am (UTC)
I got Mirena in August 2010

I got it at Hospital La Catolica in San Jose, Costa Rica. I live in the US but since I am NP nobody I talked to here was willing to insert a Mirena for me. Thankfully they weren't so prudish in Costa Rica and they are more widely used there, so the doctor who did mine was apparently a Mirena insertion expert.

I was told it lasts 5 years.
knobody
Apr. 5th, 2012 03:39 pm (UTC)
i went to have mine replaced recently as it had been in place for five years and my midwife told me that while it's only FDA approved for five years here, in europe it is approved for seven. after discovering that insurance won't cover it ("it is subject to your deductible, which you haven't met yet") and it would cost over $1000 to have the old one removed and the new one put in (five years ago it cost me $300something), i've decided to go with the seven year plan. hopefully in the intervening years our health insurance will decide that it's cheaper to pay for my IUD than a baby. it was a bit of a nervous decision, but i feel more comfortable knowing that there are other practitioners out there suggesting that seven years is just fine. thanks for the information.
( 14 comments — Leave a comment )

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