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Thinking of switching to Mirena for PMS

I generally avoid hormonal contraception. I had three shots of Depo seven years ago and had a rotten time on it, including depression, hair loss, and various symptoms more commonly seen with the menopause such as wild temperature fluctuation. So I'm a copper IUD girl and very happy with it. The thing is, I get PMS from hell and it's way past the point where it can be improved by diet, positive thinking or anything like that. The gynae has put me on Cerazette (desogestrel), a third-generation progestogen-only pill which is meant to be be pretty good for PMS. I've been on it three and a half weeks so far, I started it around ovulation last cycle so it's too early to tell if it'll stop my periods and what it'll do for the PMS, although I didn't get depression or breast pain last month. My boyfriend says I seem chirpier since I've been on it, though I've had a few days with worrying levels of moodiness (I'm under quite a bit of stress right now, makes it hard to judge what's causing what) and I think it may be knocking my sex drive back. My body temperature is developing a habit of varying quite a bit, going speedily from being roasting hot to shivering for hours, and I suspect the Cerazette could be behind that, especially since I got that on Depo. The spotting, the main side-effect Cerazette is known for, is starting to calm down, and anyway that could be the cervical polyp I am currently hosting.

Anyway, if it does turn out to work, I'm wondering about switching to Mirena a few months down the line. I'd rather keep the hormone dosage as low as possible, and taking pills is a hassle. I'm in the UK where contraception is free and the gynae I'm seeing is one of the best IUD inserters around, so swapping IUDs shouldn't be difficult. There's the minor issue of having to go through the settling down period all over again, possibly twice if I end up going back to a copper IUD. Is that less if you're moving from one IUD to another, is part of it your uterus reacting to the shock of having something in there? Also, if I move from the mini-pill to Mirena, will my body already be used to having progestogen and not make such a fuss over the Mirena? If I was already amenorrhoeic, for instance (which is pretty likely to happen, my periods are light and stopped instantly on Depo, I think about half of women on Cerazette end up without periods), would that just continue with a Mirena, or would spotting and such start up again?

The main thing, however, is how I'd react to the hormones. Both are forms of progestogen and both stop ovulation, but they're different progestogens, different dosage levels and different routes of entry, so to speak. So could anyone here who has been on Mirena or a mini-pill, especially if it's Cerazette, please tell me how you got on with it? If you tried both, how did they compare? Does the Mirena have fewer side-effects than the mini-pill? In particular, I'm very interested in hearing from anyone who has experienced PMS, whether it was before or during they were on hormones, and how the hormones affected it.


( 20 comments — Leave a comment )
Apr. 26th, 2007 05:44 pm (UTC)
I never had a problem with PMS until I started taking combined pills, and even after I stopped taking them it stuck around and it's been pretty bad. Since I've had the mirena I haven't had any issues, and the best part is that there hasn't been any of that annoying breast soreness since I've had it in. Sorry I can't help with the mini-pill related questions, though overall the side effects should be less since it's a smaller dosage.
Apr. 26th, 2007 05:54 pm (UTC)
Interesting. So you had PMS just before you got a Mirena, but not once it was in? I'm not entirely surprised that the combined pill set it off, I've heard of that happening before. Did you get premenstrual depression?

Off-topic for this post, but I'm currently looking up Mirena and Cerazette and related stuff, and came across this bloody site, which claims that IUDs are more likely to fail if the couple isn't married!
Apr. 26th, 2007 05:58 pm (UTC)
hahahahaha, jerks.
Apr. 26th, 2007 06:05 pm (UTC)
I think it cheated and used the stats for general contraceptive efficacy according to social groupings. I'd imagine that failure rates are generally lower amongst married couples, as they're likely to be older than average and thus less fertile, and also more experienced with using the contraceptive than your average fifteen year old or someone who's not been using contraception for long. However, that's mostly going to be where user error is a factor (I doubt the relative fertility rates are the most important point), and user error isn't a factor with IUDs. Ach. It was a weird site.
Apr. 26th, 2007 06:01 pm (UTC)
Wow, I've never heard of that before, it's nice to know I'm not alone. Not sure about the depression, I think I'd just get more moody and depressive issues were more related to other factors. And while on the pill I was depressed all the time so who knows. But yeah, now it's wonderful. I haven't really had a real period since the month after it was put in, and I haven't had any signs that my body was trying to either, so yay for that.

And wow, crazy people. I better lie to my IUD and tell it that i'm married so it works ;)
Apr. 26th, 2007 06:10 pm (UTC)
Premenstrual depression tends to be bloody obvious, at least for me: you suddenly feel completely suicidal and paranoid, completely out of the blue, and a few days later your period starts and the depression vanishes. Evidently your body wasn't happy with the hormonal level the Pill produced, were you on a monophasic one by any chance?

Personally, I'd far rather have my periods, I feel weird being without my cycles, but when I get PMS to that degree my priorities change.
Apr. 26th, 2007 06:49 pm (UTC)
Apparently my marriage license reduces the chances of me having an unplanned pregnancy. Who knew!
Apr. 26th, 2007 08:51 pm (UTC)
::is rolling on the floor::

Wow, that site is ridiculous. The first paragraph alone makes me twitch:

-No, insertion does not involve local anesthetic. It can, but more often than not it doesn't.
-There is no U in ParaGard. Sorry.
-The copper IUD does not remain effective for as long as it's left in place, if it's in for more than 10-12 years.

That entire paragraph about effectiveness was a joke. It's sad that some people would actually believe that your birth control knows whether or not you have a signed piece of paper from the court, but sadly due to sites like this, I'm afraid a few too many do.
Apr. 26th, 2007 09:25 pm (UTC)
Admittedly, the "Paraguard" misspelling is very common, but you'd expect a site on contraception to know better. The bit that really cracks me up is the "information on contraception", purportedly "the truth about birth control" (I somehow doubt that there are people using elective abortion as their primary method of birth control, as that site claims, as least deliberately), having this quotation to the left:

'Jesus said, "Let the little children come to me, and do not hinder them, for the kingdom of heaven belongs to such as these."'

So they destroy any method they remotely can as an abortifacient, regardless of actual research, and then just hint that you should't really be using contraception anyway. I ask you.
Apr. 26th, 2007 09:31 pm (UTC)
I enjoy the "Which Birth Control Method is Right For Me?" page.

(Hint: The first method recommended is "Prayer.")
Apr. 27th, 2007 06:21 pm (UTC)
If I dropped to my knees and started praying in the manner recommended by that site, my boyfriend would probably take a step back, especially since I'm Jewish, but knowing him he'd probably jump me anyway.
Apr. 26th, 2007 10:45 pm (UTC)
Do you take an active pill of Cerazette every day? I would think that as long as you had a week of placebo pills (as with most BCPs) you would still get a period.

I got a Paragard (no U in there! ha) in October, and I have noticed more PMS than I seem to remember on the pill. But I dunno. It's not TOO bad and I'd rather be ME even if ME is PMSy than rely on hormones to control me. But that's just me.

If you can switch em out for free, I'd say might as well try...
Apr. 27th, 2007 01:09 pm (UTC)
My PMS is so bad I get suicidal for several days a month, it's completely incapacitating and actively dangerous. If it was just a bit of moodiness and headache, I'd rather be me, but I can't put up with this level of illness.

Cerazette isn't a combined pill, and progestogen-only pills are monophasic, you take exactly the same amount of hormone every day. They also work completely differently from combined pills. I've never actually been on the combined pill, I've always been suspicious of hormonal contraception, and between knowing a woman who died from the combined pill (two strokes, two heart attacks, dead at 29) and having a dire time on Depo, I've mostly stayed away from anything hormonal.
Apr. 27th, 2007 01:22 pm (UTC)
Huh. I didn't realize that about the progesterone only pills.

And yeah - I definitely hear ya. I remember before I ever went on the pill getting really moody around my period, like, crying at stupid stuff, and then that pretty much went away on the combined pill, so I sort of forgot about it. Now with the Paragard, it's back to that, but it's not the end of the world.

But I KNOW that different types of BC can do different things, because I tried the NuvaRing for two months and oh god that was awful. For the week before my period, I was SERIOUSLY crying NONSTOP. Like, every couple of hours at work, I'd have to go into the bathroom and just start crying about NOTHING. And then I'd feel bad that I was crying and get even more upset. It was awful. I mean, I wasn't suicidal or anything, but I can CERTAINLY see how that could happen.
Apr. 27th, 2007 04:37 pm (UTC)
I remember someone describing PMS as crying because she couldn't get her shoes on, does that sound familiar to you too?! I've heard that the combined pill can trigger bad PMS, though some people do really well on it, so I'm not wildly surprised to hear that about NuvaRing, though isn't that meant to be low-dose because it's localised?

Contraception doesn't actually use progesterone, it uses progestogen (also called progestin). This is an artificial form of progesterone, it's not 100% identical to the hormone in the body and some people think that the differences matter more than others. There was a fashion for using progesterone for PMS for a while, but the research didn't bear it out so it's not done any more.
Apr. 27th, 2007 07:56 pm (UTC)
Oh yes - I remember crying because I bought the wrong flavor of ice cream, crying because I meant to grab a pencil but I grabbed a pen, crying because my boyfriend pushed the "yes" button when it asked if he wanted a reciept at the gas station...

But most of the time, I found myself crying because... I WAS CRYING. That was seriously the reason. I'd start crying about something ridiculous, realize it was ridiculous, and then start crying even more BECAUSE I was crying about something ridiculous. It sucked.
Apr. 27th, 2007 10:40 am (UTC)
If it's at all possible, try a levornogestrel (sp?) mini-pill. The different kinds of progestins are where a lot of the differences in side effects come out (as a gyn once explained to me).

I've taken combined pills with both desogestrel and levornogestrel, as luck may have it. My side effects were VERY different on each, so I'd try to recommend trying out LNG if you possibly can. In my experience, levornogestrel dealt better with PMS than desogestrel, but everyone's differnt, ymmv, etc etc....although my PMS was quite mild to begin with (some moodiness was the only part that wasn't nice, and the LNG dealt better with my moods in general--but it made my hair fall out too).

Apr. 27th, 2007 01:40 pm (UTC)
Aha, so I'm not the only one getting hair loss on progestogens? My hair is long enough to sit on, so it was really noticeable with Depo.

I've just checked, and the FPC lists Norgeston, which contains 30 mcg of levonogestrel (Mirena has 20 mcg). So if I do want to try Mirena, I have something I can test out first that's the same progestogen. Thanks for pointing that out. I'm trying to work out if it's truly worth doing, since cost isn't a factor but time is. One of the infuriating things about PMS is that every treatment has to be tried for at least three months, and I'd rather not lose time trying a progestogen on a higher dose than I'll be using if I could go straight to Mirena. This is presuming that chopping and changing IUDs wouldn't cause any trouble, of course, but I'm hoping it wouldn't. If I got Mirena after at least three months of a POP, hopefully my uterine lining will already be thinned down and the spotting over. If I switch back to a copper IUD after Mirena, I'm guessing that the initial heavier bleeding wouldn't be as bad as before due to having a thinned-down endometrium. Anyway, it wasn't that big a deal, the main thing that's been annoying me is the spotting and that's probably from the polyp.

Interesting that you did better with the levonogestrel one, though if it's in a combined pill it's going to be a totally different animal. I think Cerazette is the only one they're keen on for treating PMS right now. The combined pill isn't generally recommended for PMS sufferers right now, and it's never been recommended for migraine sufferers.

On reading up further about progestogens and PMS, apparently they don't have a good track record and frequently make PMS worse. Some gynaecologists prefer to treat PMS with oestrogens, by which they don't mean the combined pill, they use patches and so forth. Although they then often prefer to add back a bit of progestogen to stop things building up, Mirena seems popular for that. I've just found this, for instance:

The LNG-IUS does not reliably suppress ovulation and is not recommended for treatment of premenstrual syndrome by itself but may form a component of treatment whereby it is used in conjunction with transdermal oestrogen (Brechin and Owen, 2003).

Why I'm being treated with progestogen when the research seems to be saying that oestrogen is the way to go is slightly beyond me, but it could be because Cerazette works quite differently from the other POPs, for instance by suppressing ovulation, and having a high affinity for progesterone receptors and a low affinity for androgen receptors.

Which form of contraception are you using now?
Apr. 27th, 2007 02:55 pm (UTC)
I'm on the combined pill, Femodette, which is gestodene, and a lower amount of estrogen than usually. I was put on this when I came to the UK because the pill I took before wasn't available here: a lower-estrogen pill with levornogestrel (Levlite). I took Levlite for several years, and Desogen (with the desogestrel). The problem with Desogen for me personally was how it affected my mood, it basically made me quite depressive in tendency. Levlite was very good for my mood and general energy and overall side effects were fine, except for a slight thinning of hair (which in the end I decided I could live with, but now the Femodette is fine). In general I have actually enjoyed the pill, which seems to be a minority opinion, but also over the years I have tried a lot of brands and found good ones and learned to recognise which ones weren't for me fairly quickly.

I'm planning on getting a copper IUD in June (after a month long trip, which is why I have to wait so long!). I'm 30 and have been on various forms of HBC (all combined pills, which I have mostly liked) for about 10 years, and it's time for a rest from the hormones! I am open to considering the Mirena though, and because I have a history of bad ovarian cysts my doctor may talk me into it.

(sorry about the ramblyness)
Apr. 28th, 2007 01:14 am (UTC)
Can you take antidepressants? My friend is currently treating her PMS from hell (she also gets suicidal) with antidepressants and she is really satisfied with the treatment.
If for whatever reason you can't/don't want to take antidepressants, perhaps you could try that pill with the same progestogen as mirena before deciding to switch. You could even try halving the pills, if they aren't bloody tiny, to see how would you do with a lower dose.
( 20 comments — Leave a comment )