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Why am I spotting now?!

25 year old np with a Mirena (trans male will be on hormones soon).

So this morning I have discovered why been so frisky and clingy lately. Apparently I am menstruating. Hard. I have had Mirena for now 4 years. It should be good for another year so I don't know why I am bleeding. Mind you it's not blood but dark red fluid that smells just like period blood. My strings are still there so I didn't expel. I haven't had a period since I was implanted so I don't understand this at all.

EDIT: I did call my GP and relayed a message.



( 10 comments — Leave a comment )
Feb. 22nd, 2012 10:03 pm (UTC)
This is opinion is completely unfounded by science (at this point) but here's my 2 cents - I think some women absorb the hormones out of their Mirena faster than other women. Some women have no trouble with their Mirena after 5 yrs (some studies suggest that a Mirena can be good up to 7 yrs) and other women have trouble with the Mirena and it lacking enough hormones to suppress menstruation after only 3 - 4 yrs. I think some women have more local ie uterine hormone receptors and absorb the hormones from it faster and other women have less local hormone receptors so they absorb the hormones at a slower rate. (This theory has been formed from anecdotal evidence at the birthing center I work at. We midwives talk a lot about contraception since most women get a contraception pep talk at their 6 week postpartum well visit.)

Maybe you have absorb the hormones in your Mirena at a faster rate and now the IUD has so little hormones to give that you are now menstruating. I wouldn't worry about you getting pregnant though (if that is a worry for you, I dunno) an inert plastic IUD still causes localized inflammation which still has a contraceptive effect. But if you are bummed out about this, I would have another Mirena inserted to suppress menstruation.

Good luck.
Feb. 22nd, 2012 10:14 pm (UTC)
The fact I won't get pregnant is reassuring, but the idea that I have absorbed all the hormones from the device is kinda upsetting. The thing is that I am gonna get it removed soon to start T, but I want to be reassured that my device will still prevent pregnancy. I can deal with the menstruation to some degree however it is causing some dysphoria but I will manage.
Feb. 23rd, 2012 04:31 am (UTC)
More thoughts:

* If you have a Mirena for treating endo, the general recommendation is that the IUD gets replaced every four years. (I've also read three years.) This tells me that the hormones drop off enough at year four that if menstruation suppression is REALLY important to you, you should probably plan on replacing it early.
* It's common to experience changes in your bleeding behavior across the lifetime of the IUD. (see long term updates, though finding an article to back this up is incredibly difficult.)
* The amount of hormone does decline from day 1. Check out this graph from Mirena's website.
* From this article: Mirena is effective at thinning the endometrium for 7 years, but the cervical mucous starts being less protective at 5 years. From this, I take that the hormone levels aren't enough to do every little thing it used to in the beginning, and as the levels drop off, you will experience gradual changes in how your uterus behaves.
Feb. 23rd, 2012 04:42 am (UTC)
I am not treating endo, so I am not worried about menstrual suppression. I am just concerned that it won't keep me from getting pregnant.
Feb. 23rd, 2012 04:53 am (UTC)
It didn't sound like you were worried about endo, but in your subject, you were curious about why you were spotting. I agree with divineoubilette's hypothesis, and just wanted to give more information in support of that.

That last link I gave discussed how the Mirena is still extremely effective even at year 7 (when the cervical mucus is gone, though they didn't say anything about breakthrough bleeding being more common): In 1991, in a randomized multicenter study that was conducted in 2244 women, the cumulative pregnancy rate after 7 years of use was 1.1% for the levonorgestrel IUD and 1.4% for the copper T380A device. They go on to explain two more studies with the same results supporting efficacy past the 5 years.

What does this have to do with you? It's evidence that even though menstrual suppression, cervical mucus, and LNG levels in general drop off, the IUD still remains very effective.
Feb. 23rd, 2012 04:55 am (UTC)
OK that is very comforting to hear. So this is just break through bleeding, Thanks for this, this helps with my anxiety.
Feb. 23rd, 2012 04:54 am (UTC)
I wish I had comment editing. Pretend I said this in my first point:
This tells me that the hormones drop off enough at year four that if menstruation suppression is REALLY important to you, you should probably plan on replacing it early regardless of medical background.
Feb. 23rd, 2012 04:57 am (UTC)
I don't know if I can afford to replace it right now regardless. I am on insurance now, but they are PRICEY and mom helped me pay for my first one. Because I am gonna go on T (hopefully soon) it doesn't seem like a good idea for me to replace it when It's gonna be gone anyway.
Feb. 23rd, 2012 06:18 am (UTC)
Well, hopefully starting on T will have the dual effect of stopping your period and relieving more general dysphoria.

Related: I found this blog post via vaginapagina's twitter on contraception for trans guys. You might find it useful if it's not old news!
Feb. 24th, 2012 09:21 pm (UTC)
I thought about not posting this comment because the OP didn't complain, but in the future, could you please consider phrasing your comments about all people using IUDs not in terms of "women"? The people you're talking about with Mirenas and uterine hormone receptors and contraceptive needs aren't all women, as evidenced by this very post! It seems inappropriate and totally goes against the discussion the comm had a while back about how to be inclusive.
( 10 comments — Leave a comment )

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