What is the Mirena IUD?
The Mirena was approved for contraceptive use by the U.S. Food & Drug Administration (FDA) in 2000. (Fatemeh et al., 2012, p. 1). The device is described as “small, plastic and t-shaped containing the hormone levonorgestrel. It is inserted by a healthcare provider past the cervix and into the uterus, where it may remain for up to 5 years” (Fatemeh et al., 2012, p. 1). It is a progestin-only device, and the theory is that the hormone remains localized in the womb versus being released systemically, throughout the entire body.
“Worldwide, intrauterine devices (IUDs) are the most widely used and effective reversible contraceptive. Second only to female sterilization as the most prevalent method of family planning” (Sroddard et al., 2011, p. 1). There is a stark difference between the use of the device in developed and developing nations. Researchers argue that the disparity exists due to the Dalkon Shield experience from the 1970s. The Dalkon Shield was an IUD used in the early 70s and 80s. Professionals discovered that the Dalkon Shield caused an array of severe injuries, including pelvic infection, infertility, unintended pregnancy, and death. Providers and researchers argue that the effect of this device continues to deter folx from using a modern IUD.
However, there have been a growing number of lawsuits associated with the modern IUD. In 2009, “the FDA cited Bayer for its Mirena promotions, stating they were misleading and downplayed risks associated with the device. Since being approved, there have been thousands of serious adverse complications reported to the FDA.” (Sroddard et al., 2011, p. 1).
Some of the reported injuries include “perforation of the uterine wall, embedment to the uterine wall, and migration of the IUD” (p. 1 article). Other side effects of the Mirena IUD include “higher rates of spotting and bleeding at 1, 3 and 6 months and higher rates of headache and breast tenderness at 3 and 6 months” (Fatemeh et al., 2012, p. 143).
My goal with this article is to provide my experience with the device, and, to the best of my ability, provide an unbiased summary of its use.
***Content Warning - IUD insertion experience
Lack of Informed Choice
In the winter of 2014/2015, I was employed at a medical laboratory in the microbiology department. Up until this point, my experience with hormonal birth control had been short and consisted only of taking “the pill.” As a teenager, the physician I saw required a birth control prescription with the yearly pap, since I was sexually active. Talk about informed choice... At the time, my partner and I planned to travel to Turks & Caicos for three weeks in the coming month. My cohort in the lab had been chatting lots about having an IUD inserted, and she also mentioned the primary benefit being amenorrhea—no more periods! As a young adult who would be traveling to a tropical destination where I would be scuba diving and spending lots of time in the ocean, how would this not appeal to me?
I went to my family doctor to chat about having an IUD placed. She highly suggested it and talked about all the benefits, including no more periods in most cases AND no longer having to worry about an unintended pregnancy for up to five years. There was no discussion of the risks, nor was there a discussion about the placement procedure itself. She recommended that I have the device placed while I was menstruating so that my cervix would be “slightly open” and the device would be easier to place. As I was now on a time crunch before the trip, it was recommended that on the day I begun bleeding I was to call the office and schedule an appointment.
Try as I might over the course of my four-day bleed, they were unable to squeeze me in for the insertion and, therefore, submitted an urgent referral request for a gynecologist who was new to town and accepting patients. I was told that he was more experienced to insert the device, even if I wasn't menstruating. I quickly heard back from the office and made an appointment for the coming week.
The instructions I received from the medical assistant at the office were to take extra strength ibuprofen prior to the appointment—that was all. I found it odd that I wasn't given a prescription for a cervical dilator called Misoprostol, but I figured I would be supplied with pain relief in office.
When I arrived late in the day, I was soon ushered into the office. The OB was a nice man who reviewed my medical history. We then went into the procedure room with his assistant, and I was given instructions on what to expect...still no mention of pain relief.
The two of them left and came back when I was ready. I was chatting with the assistant, and the OB prepared for the procedure. The idea of pain control had now completely slipped my mind until the doctor paused and said, “I am just about to insert the device. I forgot to offer you freezing. I can stop and apply the freezing and we can then restart.” Now, imagine this, a young adult in a position where she is about to have an IUD inserted in an already uncomfortable position. I said, “No, let's just get it done.” Seconds later, the doctor inserted the device, and I literally thought my uterus was going to crawl out of my body. I believe that I am someone who has a high pain tolerance, but this was no joke.
The gynecologist gave me a few minutes afterwards, then I re-entered the office. He recommended Tylenol and Advil as needed over the following days. He advised me to make an appointment in about a month to confirm that the device was well positioned in my uterus. He chatted about the strings that were inside my vagina from the IUD and how they were tucked behind my cervix. If I had any concerns with them, I should call the clinic. He instructed that I check them on a regular basis to ensure the device hadn't been expelled. Expulsion—why was this was the first I had heard of this?!
I arrived home and spent the evening convincing myself that the pain I was experiencing wasn't that bad. I attempted to complete a workout, and I remember curling up in child's pose. I thought if I rolled up tight enough, the pain would subside and the device wouldn’t fall out of my uterus. Over the following days, the pain lessened, and I was excited that the device was starting to sort itself out. My body was adjusting. It was at that time that the mid-cycle spotting began.
The spotting continued for several weeks, along with cramping. In hindsight, I should have realized that I was experiencing side effects as a result of the IUD. As I normally do, I pushed forward and continued to wait for my body to adjust to this foreign object.
Sex was out of the question. My vulva, vagina, and uterus constantly ached! I absolutely could not fathom the thought of intercourse.
As our trip neared, I contacted the OB/GYN office regarding the cramping and spotting. The doctor advised me that it would subside over time, and that it could take several months for my body to become accustomed to the Mirena. I was informed that this was normal and to ensure that I booked a follow-up ultrasound upon my arrival home.
To be continued in Part 2...
Fatemeh Ramazanzadeh, Toktam Tavakolianfar, Mamak Shariat, & Iman Eftekharzadeh Mashhadi. (2012). Short-term complications of the Mirena® IUS vs the copper IUD in Muslim women. The Journal of Family Planning and Reproductive Health Care, 38(2), 143–. https://doi.org/10.1136/jfprhc-2011-100210
Stoddard, A., McNicholas, C., & Peipert, J. (2011). Efficacy and Safety of Long-Acting Reversible Contraception. Drugs (New York, N.Y.), 71(8), 969–980. https://doi.org/10.2165/11591290-000000000-00000
Mirena IUD lead to growing number of lawsuits. (2013). Women’s Health Weekly, 108–.
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