I also HATE using tampons, pads leak, and menstrual cups freak me out with an IUD

August 5, 2012 1:45 PM

Oh wise Metafilter IUD users, please tell me your experiences switching from a Paragard to a Mirena.

I work in family planning and (like everyone in fp, it feels) have an IUD--specifically, a Paragard that I got five years ago. I love it, I love not worrying about a method, I really appreciate the no-hormones side of it, I have awesome sex/sex drive with little fear of pregnancy. Hormonal birth control (pills and Nuvaring) seemed to make me very emotional when I took them, but I was also a teenager and, like many teenagers, kind of an emotional mess regardless.

However, I get wicked periods and PMS: this is one of very few months in 5 years that I haven't thrown up or needed/wanted to spend all day in bed with cramps. Most obnoxious to me is the PMS: I feel the urge to cry recreationally, I get depressed and/or very irritable (to a point where I can't focus @ work or need to go home "sick") at least one day a month, my energy sinks precipitously before and throughout my period. I will start to feel these symptoms sometimes a week before my actual period. I'm trying to figure out if switching to a Mirena will help regulate my hormones and knock out some of the days that I spend mildly incapacitated by hormones/cramps/bleeding, but I also don't want to screw up a good thing by taking out my Paragard if it's not going to help or will make things worse.

I'm looking for anecdata: how did your switch from Mirena to Paragard go? Were you successful with hormonal bc before that? How did switching to Mirena affect your periods/PMS/energy levels/sex drive? I know the downsides of adding artificial hormones, to expect irregular bleeding, etc.

If folks have other ideas for moderating crazymaking and painmaking hormones, I'd welcome that too. Acupuncture worked once, it's just a hassle to arrange for me.

posted by c'mon sea legs to Health & Fitness (12 answers total)

I am not a doctor, although my dad is a very progressive OB/GYN who made sure to educate the daylights about of me and my sister about birth control from a young age.

Before you remove the Paragard, you might want to try taking Seasonale for a few cycles. It uses the same progesterone as Mirena (all BCPs use the same estrogen--what varies is the type of progesterone they use, which is why you might have a good experience with one but feel depressed and gain weight with another). If you feel good on Seasonale, you'll probably feel OK on Mirena. If Seasonale makes you feel crazy, you'll know Mirena is probably not a good choice for you.

After seeing how much better I felt after stopping hormonal birth control, I hear you on the desire to find other ways to manage PMS. Yoga helps me, as does exercise. Also, just acknowledging that I have PMS helps, as does giving myself permission to cave in to the cravings and tiredness. I found a lot of what made my period unpleasant was that I tried to power through it when I didn't really need to. Put your period on your calendar, try to under-commit during those days, and be kind to yourself.

For cramps, those Thermacare heat wraps are the bomb.
posted by elizeh at 3:02 PM on August 5, 2012 [1 favorite]

I would recommend against what Elizeh says. My doctor was quite clear to me that, even though there are hormones Mirena, they are localized to the uterus, unlike BCP which obviously are not. I switched from the Nuva Ring, and it is even more local than that was. My doctor told me to expect to be back at my emotional baseline, but that my periods would likely be very light or even non-existent. It's been over a month since my installation, and I've been emotionally stable and no signs of PMS. Also, no cramps since a few days after install. Feel free to memail me for more info!
posted by two lights above the sea at 4:16 PM on August 5, 2012

I am currently about 30 days post-swap (Paragard --> Mirena). My reasoning for the initial choice of Paragard and subsequent switch to Mirena are very similar to yours -- I didn't want the hormones because of difficulties with hormonal bc in the past, but became increasingly frustrated with the heavy periods and terrible cramps that accompanied the Paragard.

Because so little time has passed since the swap, I unfortunately do not have much anecdata to share (and am looking forward to hearing others' experiences). My first period post-swap has come with cramps -- but only 1.5 days instead of 3-4 -- and the flow has been very light so far. That said, the hormones have not stabilized yet. Although this is nothing like the crazy experiences I went through on hormonal bc, I did have noticeable (to me) mood swings immediately prior to bleeding.
posted by milagu at 4:39 PM on August 5, 2012

I also just made this switch, less than a week ago. I had to have my paragard removed because it had gotten out of place. I am extremely sensitive to hormones and was really worried about switching to the Mirena. I, particular, I had awful experiences on the NuvaRing. However, my doc said he really doesn't think I am going to have a problem. The amount of hormone that winds up in your bloodstream (not all of it stays localized) is about 150/200 pg/ml (basically 150 trillionths of a gram) in every milliliter of blood. For comparison, the Nuvaring, a "low" hormone contraceptive releases about 1374 pg/ml into your bloodstream.

So basically, the systemic hormonal effects should be seriously minimized. I have only had mine for a very short time, but so far everything is good. I was very very worried about hormones but after doing a bit of research, I felt comfortable with the decision. Good luck!
posted by Katine at 5:09 PM on August 5, 2012

I've never had the Paragard, but I've had a Mirena IUD for almost 8 years now. I'm on my second. I have virtually no periods, and it is lovely! I was worried about the hormones as well. I'd been on birth control pills for years, then had to stop after a weird vision-losing migraine b/c of the estrogen (maybe). I was told I could use progesterone-only BCPs, but chose not to. So I used a diaphragm. Then I switched to the Mirena and never looked back. I even used it while breast-feeding, as my OB-GYN said the localized hormones would not cause my daughter problems. This seemed iffy to me, but I chose to believe! I still have some of the emotional fall out of pre-period moodiness, and sometimes breast tenderness -- things I had without the IUD--but almost no bleeding.
posted by bluespark25 at 5:28 PM on August 5, 2012

Not using an IUD, but I've found that since switching to a paleo diet my cramps have disappeared. They were never awful before, but still: gone.
posted by hishtafel at 5:57 PM on August 5, 2012 [1 favorite]

Still had wicked PMS (emotional mostly) on Mirena, unfortunately -- just without the periods to give me a clue about what was going on. Needed to do careful calendaring to figure it out. Even so, I gladly got another after my son was born: it definitely didn't make my PMSworse, and hey, no periods! YMMV, of course.
posted by wyzewoman at 6:21 PM on August 5, 2012

I had a Paragard for about a year, and even though I didn't have problems with hormonal BCP, I had pulmonary emboli in 2006 so I had to stop using my beloved Tri-Levlen pills. I switched to Mirena last fall because my periods were horrible with the Paragard, so much so that it was interfering with exercising. Also, I had ovarian cysts while on Paragard. Suffice to say, I LOVE MY MIRENA and frequently bond with other women that love theirs too. No more problems with ovarian cysts (with the Paragard, I had ovarian cysts that lead to bleeding that made it seem like I had 2 periods a month--GRRR!) and yes, I'm one of those women that stopped having any periods at all, very quickly after my Mirena insertion--maybe 1 month?

Like you, I was nervous about taking such a plunge but luckily I have good insurance and, surprisingly, switching between the IUDs hurt less than the initial insertion of the Paragard--it went lightning fast, too! YMMV but my experience has been great! I haven't noticed mood changes...I have experienced those on previous BCP's until I found my old favorite. So I know what to look for.
posted by leemleem at 7:51 PM on August 5, 2012

I'm getting my 2nd Mirena next week, but I've never used a Paragard. I had awful side effects through 7 years of hormonal birth control use before I got my Mirena. Migranes, crazy mood swings, zero libido, yeast infections, random discharge, you name it. My periods have always been heavy and I've had bad cramps my entire life, even though they were milder with most birth control pills.

It took about 4 months post-insertion for my periods to stop completely, and that is the ONLY noticeable side effect I've had with 5 years of Mirena. I've been on birth control since I was 15 and it was a revelation to suddenly have a high libido and no mood swings for the first time in years. I'm highly sensitive to hormones added to my system, but I have had no issues with the hormones in my IUD. I can't recommend it highly enough. Did I mention I haven't had to buy tampons, pads, or any kind of liner in almost 5 years?
posted by evilbeck at 10:03 PM on August 5, 2012

I had a horrible experience with Paragard- incredibly heavy bleeding and cramps and hellish mood swings. I had it taken out after 8 months to avoid homicide. I never had cramps in my life before. I can't take BCP because I have migraines but I was cleared for a Mirena. After dithering for a while I got it and haven't had a period in a couple years! I do get a bit of PMS despite the absence of periods but it's so minor I often just think I'm a bit tired or something and only later realize that it's PMS. I did have the mystery leg pain for a while, which freaked me out but seems to be common and has abated for the most part, and I did gain 10 pounds after a year of having it but that might or might not be the Mirena. Not having a period is incredible freeing though so I'm willing to eat better and run more to combat the weight gain and have managed to reach detente.

Most of all the Mirena hasn't affected my energy levels or focus and, um, intelligence the way that BCP did. I was a tired, grumpy procastinating mess on Depo and Ortho. I'm pretty much normal me on the Mirena.
posted by fshgrl at 10:32 PM on August 5, 2012

I had an awful experience with Paraguard giving me heavy bleeding and cramps. About a year after having it removed, I got a Mirena, and it's great. I've had it about a year and have very light periods. Because of this, my hematocrit is higher, and I'm no longer borderline anemic, so I have more energy. I still get cramps, but they're close to baseline levels, and much better than when I had Paraguard. I only lasted three months on BC pills because they made me weepy, but the hormones in Mirena haven't noticeably affected my moods.

Mirena is an approved treatment for endometriosis, which speaks to its potential to mitigate awful period symptoms.
posted by momus_window at 9:05 AM on August 6, 2012

I loved my Mirena for about 4 1/2 years (no periods, no mood swings, no undesirable side effects) until...

I. Got. Pregnant!

YMMV with a Mirena, as with any form of birth control. The downside to not having a period with a Mirena is that I didn't have a clue that I was pregnant until I was into my 2nd trimester.
Depending where you live, if you become pregnant and don't know about it until your 2nd trimester, you may not be able to opt for an abortion at that point, even if you wanted one. This is worth consideration, if you're one to lose your period completely with the Mirena.

If you become pregnant with an IUD (and the odds are against that happening), your OBGYN may want to remove it immediately (mine did), which, for me, meant waiting on pins and needles for 3 days to see if I would miscarry (I didn't), and waiting for an ultrasound to determine whether the pregnancy was viable (as ectopic pregnancy risk is slightly higher with IUD use). As it turned out, the baby didn't miscarry and it was not an ectopic pregnancy. If I had known that Mirena + Pregnancy = me getting to freak out, for days, over the possibility of miscarriage or needing emergency surgery, I may have opted for a different birth control method altogether. But! The odds were astronomically against me getting pregnant (Mirena + condom = ...baby?) so I never considered those things.

(BTW, I had a healthy baby boy in May, opted for an Open Adoption, and now, a wonderful couple got to see their baby wish come true, after waiting for years for a birth family to choose them. Win-win!)
posted by erasorhed at 12:43 PM on August 6, 2012 [3 favorites]