Reluctantly giving up my HBC pills -- have questions about the Mirena
June 18, 2013 8:08 AM   Subscribe

I'm a 29-year-old female who's been on birth control pills for 13 years, with one six-month break in the middle. Due to a recent medical diagnosis, my PCP is concerned about my continued use of this medication and has suggested I consider a Mirena IUD. I have questions.

The recommendation is based on the heavy, *heavy* periods that preceded my HBC prescription and reoccurred during the break. I have an appointment scheduled for early July to discuss options with an OB-GYN but in the meantime, I'm in a bit of a panic.

The other threads about IUDs and the Mirena have been very helpful. I understand that different people have had very different experiences, and that some have been very unpleasant. My questions are:
  • If something is going to go wrong after insertion -- whether it's bleeding, mood irregularity, or change in skin condition -- what is the expected timeline for identifying the problem? I'm going back to school in the fall and am concerned about encountering side effects during this stressful time, during which my medical insurance and PCP will also change.
  • What specific questions should I ask at my initial appointment?
  • For those who tried/considered and rejected the Mirena, what alternate method (that isn't birth control pills) did you choose and why? I'm particularly interested in methods that limit monthly bleeding.
posted by anonymous to Health & Fitness (26 answers total) 5 users marked this as a favorite
Would you be able to get a second opinion? I'm not sure why heavy periods when you are not on the pill would lead to a recommendation to stop taking the pill.
posted by WeekendJen at 8:12 AM on June 18, 2013 [1 favorite]

I agree with weekendjen. If the pill is working for you, switching during a stressful time seems like borrowing trouble.

I experienced mild weight gain in the first month and have had persistent spotting for a few months now. Everything I've read implies strongly that the first six months or so are the worst in terms of side effects.
posted by the young rope-rider at 8:22 AM on June 18, 2013

I will just address one part of your question: I moved cross-country and changed insurance soon (~ one month) after having a Mirena inserted and would have to say that I wouldn't recommend it. It didn't work out for me and, while getting it removed was easy enough once I managed to see a doctor, if I had to do it over again, I would prefer to have better continuity of care and not have the extra stress of dealing with a new insurance situation.
posted by mustard seeds at 8:26 AM on June 18, 2013

I think that things are most likely to go wrong soon after insertion. I'm making up numbers here but if you get through the first month without problems, you're probably 95% good and maybe 99% if you get through the first six months. I don't think it's the kind of thing where the first six months would be great and then it falls apart, for most people, anyway. And if you have a problem, you could go to the student health center or a Planned Parenthood. It's not something exotic.

I have an IUD (I think Mirena?), never did HBC, tried Nuvaring for a month and didn't like it. My periods have always been regular and the first two days would be really heavy. Since getting the IUD, the first two days of my period have still been the heaviest but now they are so much lighter and my periods are shorter.

The one IUD horror story I know of involves a cousin who got pregnant with an IUD and had to have surgery to have it removed. But she was crazy fertile, had a kid already, was married, and eventually had another kid after the one who she got pregnant with while she had her IUD. They suggest feeling for the strings on an occasional basis. I don't know if mine were cut short but I can't feel them - then again, I haven't exactly tried. You can go to a doctor and have them check occasionally to make sure it's still in the right place but that's probably overkill.

When I had the ring, I gained weight and felt crabby. That has not been my experience with my IUD. I don't think of myself as an IUD evangelist but honestly, I can't think of any side effects. Looking at the website, it seems like the most common side effects are headaches, acne and moodiness which are things I all had occasionally before Mirena and I don't think the frequency has changed since Mirena. Insertion wasn't fun but now I don't have to think about it for five years. And if you're contemplating kids in the future, I think you're pretty much good to go as soon as you get it removed. Those things are pretty rad in my opinion.
posted by kat518 at 8:29 AM on June 18, 2013

If you could share why your health care provider doesn't want you to take HBC pills anymore, that'd be helpful.

If it's an issue with estrogen (like, for example, you have risk factors for DVT or stroke), then the NuvaRing won't be good for you either, but a mini-pill (progestin-only pill/POP) could work. If the issue is some kind of issue that affects how your body absorbs the hormones when you take them orally, then NuvaRing could still be a good option. There's also Depo-Provera (progestin-only), but if you're at risk for bone density issues, that could be an issue. Also with Depo if you have terrible side effects, there's nothing much to do except wait it out and not get the next shot (each one lasts 3 months), which might not appeal to you considering your worries about school.

I have several friends who are very happy with their Mirenas. A few of them had spotting for the first six months or so, a couple of them stopped getting periods entirely, and the spotting stopped and periods went back to normal for the others between 3-9 months. None of them experienced heavy bleeding. None of them have mentioned skin issues. I had one friend who had mood issues with the Mirena, but she's found that she's sensitive to most forms of hormonal BC. She also noticed the mood changes the first month she had it (it exacerbated her PMS to an absurd degree).
posted by SugarAndSass at 8:29 AM on June 18, 2013

I had Mirena installed 2 years ago, and was a former BCP user for many years as well. I have a history of very heavy periods, painful periods, ovarian cysts, suspected endometriosis, and PCOS. I have had excellent results with Mirena--lighter flows, shorter periods, very clear skin, no more problems with cysts (they used to swell and press against my sciatic nerve--I have not had that recently!). And most importantly for me, I feel like myself again. BCPs made me truly ragey.

In answer to your questions:

My doctor wanted me to give it a try for at least 6 months. That is comparable to the "give it 3 months" advice usually given to see if a particular type of BCP is worth continuing. Obviously if you're in pain or suspect uterine perforation, or it falls out, you need to be seen urgently.

Questions to ask at the appointment: I'd be concerned about if you are a good candidate for Mirena. Some of this concerns anatomical issues you probably can't find out until your appointment to insert it (i.e., is your uterus tipped, is it large enough, etc) when the doctor will use a device to measure your uterus. I would also ask about an evaluation period, as you're asking about in your first question. If it doesn't go as planned, what is the back-up plan? How often does your doctor have to remove them due to patient dissatisfaction? Etc. Barring the anatomical issues, there probably isn't a reason to not get it. You can ask for a sedative if you think you'll need it, and I would also ask about topical anesthesia on your cervix (topical lidocaine) so you don't feel the pinch when the insertion is done. Personally I recommend taking 400-600 mg ibuprofen prior to the insertion if you can, just to stave off any cramping. I found insertion to be no more uncomfortable than a yearly exam. Having a doctor who inserts a lot of IUDs will help--that makes it faster as they are more skilled in insertion.

I don't have any response for your third question. I have throughly enjoyed Mirena, and I hope you do too. Hope it works for you.
posted by FergieBelle at 8:31 AM on June 18, 2013 [1 favorite]

I got the Mirena about 8 months ago. I like it a lot. A few things:

1) It hurt like a bitch getting it placed. They said it would hurt, I took advil ahead of time, IT WAS NOT GOOD ENOUGH. I nearly passed out. I had a heating pack to wear the rest of the day and was advilled to the gills, but really it was about 2-3 days before it didn't hurt anymore. Nothing was placed improperly, my uterus was just very displeased. YMMV, of course, but this was my experience.

2) Month one and two were great. Months 3 though 6 got progressively worse, period symptom-wise. Months 7 and 8 were both a cakewalk. I was actually considering at month six to go back to HBC because my cramps were so awful, but suddenly everything got much, much better.

At your initial appointment, ask if you can get a local anesthetic for the insertion.
posted by phunniemee at 8:49 AM on June 18, 2013 [1 favorite]

I had a Mirena after my first kid and it was the bomb! I didn't have a period for 5 years. Not "light periods", but no period at all. I did find it to be a bit harder to lose weight on but I think that varies a lot.

One thing, if you do get it, don't get the strings trimmed until you've had it at least a month. They tend to curl up and away if they are long enough but if you get them cut too short, they'll be pokey forever. Just so you know.
posted by dawkins_7 at 8:50 AM on June 18, 2013

I was prescribed the Mirena for heavy periods. Insertion was awful, almost traumatic, but I was vaguely prepared for it to be awful and once it was over I thought I'd be good. For the first three or four months, my periods were just as heavy as they were pre-Mirena, but the accompanying cramps were much, much, much worse. So bad, in fact, that they turned into doubled-over-can't-breathe stabbing pain in my lower abdomen.

After that, my period gradually went away and I didn't have one for the rest of the time I was on the Mirena, though the occasional stabbing cramp remained.

Unfortunately, the Mirena was AWFUL for my sex drive, my skin, and my allergies. I developed autoimmune progesterone dermatitis, which my doctor in part ascribes to the progesterone in the Mirena. Also, my previous ob-gyn had cut the Mirena strings too short on insertion, so I had to be doped up in order for the doctor to go fish around in my uterus to retrieve it. I was on it for a year and a half, and while I did like that I did not get my period, the rest of it was a complete disaster and I'm still physically recovering from it almost a year later. Never again would I do it.

We went from using the withdrawal method pre-Mirena, to the Mirena, to the withdrawal method plus FAM (Fertility Awareness Method), and now we've just started trying to conceive (which has the wonderful side benefit of me not having any periods for a while, hopefully). I had previously tried the pill (Yasmin) and the Nuvaring, neither of which worked for me, hormonally. I've learned since that hormones are a real no-no for me.

If the doctor prescribes Misoprostol pre-insertion, ask him or her if patients might not prefer to do without. I used it and, as per my new gyno, it can very much exacerbate insertion pain rather than the other way around.
posted by lydhre at 8:58 AM on June 18, 2013

As a data point, I was not offered or even told of the existence of Misoprostol, and I really wish I had. My doctor had to manually dilate me with little spreader clamp things, so instead of one quick bad pain, I had like 4 bad pains before they could even insert the damn thing. Then, the insertion itself was like the worst 4 seconds ever. All I was on was a bunch of Advil, and reading other people's experiences later, it seems like Misoprostol and/or heavier-duty painkillers seemed to help people. Granted, I've never had children and everyone reacts differently and YMMV and all, but I'd reccomend finding out all of the options that might make insertion easier.
posted by Weeping_angel at 9:20 AM on June 18, 2013 [1 favorite]

I have had a good experience with the Mirena. Insertion for me was painful but not traumatic, and very quick. I had bad cramps the rest of the evening but I made sure I had nothing to do that evening and sat on the couch and watched movies and drank tea and it was fine. I was prescribed something to take beforehand (the night before and several hours before the appointment.) I'm pretty sure it was a painkiller + muscle relaxant, but I can't recall the name.

My doctor scheduled a follow up for one month after insertion, and I expressed some concern because I'd had daily spotting since I'd gotten it in. She said to wait 3 months to see if things evened out, and sent me to get an ultrasound which confirmed that it was seated correctly (incidentally, no one told me it was going to be a transvaginal ultrasound until I was in the office signing forms--it would have been nice to get a little more warning)

Pretty much immediately after that, the spotting stopped and I haven't had a period since, which is awesome. Before starting on HBC my periods were irregular and fairly heavy, and on the pill they were regular but still annoying, so not having to worry about it at all is fantastic.

My skin is less good than it was on HBC, and I'm pretty sure that showed up fairly quickly as well (definitely within 3 months and probably within 1 month)
posted by quaking fajita at 9:29 AM on June 18, 2013

Your diagnosis potentially makes a big difference in what changes, if any, you'll see after Mirena insertion. I had VERY HEAVY bleeding 24/7/365, which was why I was prescribed the Mirena. It didn't go away, but that's because--as I later found out by getting a second opinion from a different doctor--the bleeding wasn't just random "Oh hey, you bleed like a stuck pig now" with no reason but aging and hormonal fluctuations. I actually had adenomyosis, like endo but in a different location. While an IUD can sometimes help that, it didn't for me. So it took months of changing docs, waiting and seeing if it worked, tracking symptoms, and seeing what changed to be able to pick apart what was the IUD and what was the the condition.
posted by ImproviseOrDie at 9:37 AM on June 18, 2013

From the OP:
Thanks for the great thoughts so far. To address the questions you've asked: the new diagnosis involves additional stroke risk factors -- I've been happy with how my body behaves on BCP but my PCP is concerned about its continued safety.
posted by jessamyn (staff) at 9:53 AM on June 18, 2013

Oh, OK. I'm actually 28 and going off ortho tri cyclen lo for the first time in 11 years (not because a doctor told me to, but because I want to experiment and figure out what it feels like to be an adult woman with my natural hormone levels and I have no recollection of what my pre-bc periods are like.). If you like Pills they have PRogestin only pills (which have ther same hormone the Mirena releases). I try to avoid surgical procedures, even minor ones because they freak me out, so I'm trying good old condoms for a few months while getting started on teh Fertility awareness method. I got the book "TAking charge of your FErtility" from the library and it explains all the details, but it might be something for you to consider since it doesn't involve any hormones or foreign bodies in you which could exacerbate risks or symptoms of stuff and teh main basis is taking your temperature right upon waking every day and tracking it, which if you've been used to remembering to take a pill everyday isn't a hard transition.
posted by WeekendJen at 10:02 AM on June 18, 2013

Got it. I'd say that the sooner you get it the better or wait until after you get a new care provider. Continuity of care in the first few months is important to your stress level when dealing with the side effects of a medication.
posted by the young rope-rider at 10:40 AM on June 18, 2013

I had a Mirena inserted a year and a half ago and ended up moving 4 months after. My recommendation on the Dr. side would be to find someone who is known for being good at insertions and generally good (I used angie's list). My insertion was a bit tricky so my Dr. ordered a vaginal ultrasound. This was also really good for my peace of mind, and might be a good step to plan on before you go back to school just so you aren't worrying about the placement. After my move I found that Mirena is common enough that all of the ob/gyn places I considered were experienced with it, but you can always call places and discuss your situation. If it is something you are worried about, I recommend doing the research before you get the insertion done so that you no longer have to worry about it.

Its going to involve cramps that feel different and bleeding that is different most likely (people seem to have all sorts of different responses, I had about 1 week of bad cramps followed by 2 weeks of intermittent light cramps, after that fairly regular periods with only one day of cramping that was much less than previous pain-wise and much much lighter bleeding). The thing that helped me most was knowing that it was done correctly and that I just needed to wait it out.
posted by Feantari at 11:08 AM on June 18, 2013

I'm on my second Mirena and I love it. I'm one of the lucky ones, insertion was mildly uncomfortable, not painful. I had minor cramping and spotting the first few days both times, and maybe spotting for the first month for the first one. Now I don't have periods at all. I think the first year I had ver light spotting instead of periods. This is maybe not typical, but I think it's good to hear good experience to counterpoint bad ones. I've had no other side effects, and any I might have had PMS is much better.

As I recall, the first three months are when you are likely to experience problems if you are going to. You chances of expelling the IUD go way down after that.

I had both of mine put in at Planned Parenthood. The Dr. that did my last one was great, and clearly had lots of experiencei I recommend that wherever you end up going, actually write out a list of questions. I know I'm terrible at remembering what I wanted to ask in the moment.
posted by catatethebird at 11:47 AM on June 18, 2013

I used to use bc and then the Nuvaring for several years. I recently switched to an IUD, and I'm definitely one of the lucky ones- after a few months of light spotting I'm now happily period free.

Insertion, however, hurt very much. I had an excellent doc who has bunches of experience inserting IUDs (mostly for college women who have never had kids), but unfortunately I just ended up being pretty sensitive. I hadn't even had any Advil, because the person who made the appointment said most people don't feel enough pain to make it worthwhile.

When I have to get another one, I will much more seriously explore pain control options for insertion. Even if nothing helps, though, I'll still get another one- it's been fabulous for me actually having the Mirena (not to mention cheaper both for me and my insurance, when you add up the BC cost over the five years I'll have it).
posted by nat at 12:37 PM on June 18, 2013

Had a Mirena, had to have it removed after three months because my migraines were getting much more frequent and much more severe. Except for that it was okay. I had some minor effects on sexual response, but nothing too remarkable. My period just about stopped by the third month. Insertion was quite painful, but as soon as all the instruments were removed I was fine.
posted by dilettante at 4:52 PM on June 18, 2013

I got a Mirena 10 months ago and I've had zero problems and also pretty much zero negative symptoms. I may be an extremely rare everything-is-excellent case; it didn't even hurt to put it in. I took a large dose of Ibuprofen before insertion and it basically felt like intense, uncomfortable pressure (light cramp-ish) for 30 seconds, no pain, and that was it. I didn't really have any spotting or cramping afterward, and now I basically have zero periods other than an occasional mild cramp and tiny bit of blood for a day every couple months. I was on HBC before for a few years with great results as well, and only requested a Mirena when my family reached the deductible on our insurance and I could get it nearly 100% paid for by insurance. Before the pill or IUD, I had horrendous periods with psychotically heavy bleeding and crippling cramps for which birth control was a miracle cure.

I'll parrot others and say the sooner the better. If something's going to go wrong, you definitely want to figure it out before school starts. I actually got my Mirena put in a couple weeks before grad school started, so I'm very thankful nothing went sideways.
posted by rawralphadawg at 6:55 PM on June 18, 2013

I have one. Got it after my six week post-natal visit. My baby was delivered via c-section. Women who have given birth vaginally generally have easier insertions, so my doctor made sure to give me a Misoprostal for the night before. Te point of Misoprostal is to dilate your cervix (it's actually also used in early abortions). She used a local the day of (do yourself a favor and don't look at that needle). Now, it may have been because I had a fetus doing head stands on my cervix for a few months, but it did not hurt at all. Maybe a couple of twinges.

I made sure to ask her about whether she has done many early removals due to side effects and she said it was very rare. I think more horror stories make it to the Internet than good experiences, which is only natural.

My experience has been very good. I had some cramping at first. My skin is a mess now, but my skin tends to get crazy from time to time, and I'm probably still hormonal lay whacked out from pregnancy and nursing.

I would say to get it now if you trust this doctor, assuming you can get the Misoprostal and the local.. It will help you be more relaxed during insertion. Removal is easy. Apparently there are even instructions on the Internet for removing it yourself if you are ever feeling brave.
posted by smalls at 7:06 PM on June 18, 2013

I was on Ortho Trisomething Lo for several years, and then briefly nothing at all, before deciding to try the Mirena. I love the concept, but I found that it made me emotional ("in touch with my feelings") and needy and caused a tendency to cry over things like ads for breakfast cereal.

I felt the side effects almost immediately after insertion of the Mirena. I was also given a high dose of progesterone to start my period prior to insertion, to make it easier to put in, so I may have been feeling effects of that too. And to be fair, I was also going through a very stressful time (relationship issues and finals at school) which may have contributed more than I gave them credit.

At any rate, I knew I wanted it OUT of me. My gyno pushed back b/c normally her patients have such great success with it, so I think I kept it a total of 8-10 weeks before swapping out for the copper IUD. Incidentally, don't recommend the copper IUD for your situation--my periods are finally regular, but heavier than anyody's I've ever heard of.

Insertin was one of the more painful things I've experienced, but mine was over in a minute and I was on my way home. Easy. Recommend. Would try again, except I got spooked on hormones after that.
posted by ista at 8:23 PM on June 18, 2013 [1 favorite]

If you decide not to get an IUD for whatever reason, consider progesterone-only pills. Since they don't contain estrogen, they are appropriate for people who cannot take combination pills due to stroke risk factors. The most common side-effect is spotting, but for most people they control heavy bleeding (and many people don't bleed at all on them).
posted by Violet Hour at 9:19 PM on June 18, 2013

I have endometrial hyperplasia. I was on BCP for a short time and they did nothing, plus at the time I was a smoker. My dr decided Mirena would work better and talked me into it (we had tried for years to get pregnant with no luck, having to get an IUD pissed me off.)

I was having periods that lasted a month at a time with me barely being able to leave the house due to the amount of bleeding. Within hours of the Mirena being inserted (under general as I have other health issues) they stopped.

I am on my second Mirena, year seven overall and have only even spotted twice. I love my mirena and since we have given up on trying to get pregnant, I will have one until menopause.
posted by SuzySmith at 12:48 AM on June 19, 2013

I'm a special snowflake, as I currently have a Mirena and am on BCP on top of it -- thank you fibroids!

However, I'm a little confused as to why your PCP would recommend Mirena if he/she is concerned about long term BCP use (presumably because of hormones) as Mirena is hormonal.

I got the Mirena 2 years ago. It was very painful to insert, and I spotted for a few months, and then my period stopped for 2 years. In January, heavy periods began and a I found out I had a fibroid. Symptoms increased, and my doctor wanted to try to remove the Mirena. It had migrated, and after 20 painful minutes, could not be found.

Now I need to get more imaging to see if they can find it, and figure out how to remove it. Apparently the original doctor cut the strings too short, and that is why we couldn't find it.
posted by hrj at 2:59 PM on June 21, 2013

However, I'm a little confused as to why your PCP would recommend Mirena if he/she is concerned about long term BCP use (presumably because of hormones) as Mirena is hormonal.

Yes, but the OP is being advised to discontinue combined oral contraceptives due to stroke risk, which means it's only the estrogen that is the problem. Mirena contains a very low does of progesterone (about equal to one progesterone-only pill per week, if I recall correctly) and no estrogen, so it is safe for people who cannot take estrogen due to factors that increase stroke risk (the most common are elevated blood pressure and smoking).
posted by Violet Hour at 10:40 PM on June 22, 2013

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