Mirena: Am I crazy or is this IUD really giving me the blues?
July 15, 2016 4:53 PM   Subscribe

I think my Mirena IUD may be the ultimate explanation for my drop off in mood, motivation and energy levels over the last sixteen months. I need some insight from other Mirena users, both past and current.

After studying over my own personal journal entries, mood fluctuations and productivity fluctuations for the past two years, I finally realized that the insertion of my Mirena IUD coincides with the beginning of my descent into a very deep depression that has only worsened.

I'm approaching 30 and have been on HBC (hormonal birth control) since I was 18 - first Nuvaring, then depo provera, then Mirena. I switched to Mirena sixteen months ago because I wanted something that was long term, easy and wasn't going to affect my bone density the way depo provera potentially can. While on depo provera, I stopped having periods. There was no 'lapse' between my time on depo-provera and Mirena, and I still have not had a period since I switched to an IUD.

Prior to Mirena, I had already stabilized my mental illnesses (major depression, generalized social anxiety disorder, ADHD inattentive type) with both medication and therapy. I was in a good place and had been for about six or seven years. Motivation was not too difficult; and my depression and anxiety were pretty much in check.

Since I started the Mirena, a little over a year ago, I have been experiencing:

- Increased brain fog (I had a little brain fog already from being on Wellbutrin, but there's been a definite increase since Mirena, and my Wellbutrin dosage has been the same for years)

- Steep decline in motivation. I feel like I have lead in my ass at almost all times. No matter how many motivation techniques I try, or the fact that I was already well acquainted with the proper and effective use of ADHD stimulant medication, doing anything - putting away dishes, remembering to water the plants - has become so daunting that I feel like I did before I was treated for ADHD. Only worse!

- The steep decline in motivation is really just a subset of an overall increase in depression and anxiety.

- I am fatigued all the time. Note that I am a daily vigorous exerciser, eat clean, limit my alcohol consumption, stay hydrated, and practice good sleep hygiene. These things have become MUCH harder since Mirena, but I'm still doing them at about 70-85% capacity when compared to my performance before Mirena.

- Since I feel fatigued all the time, even good sleep hygiene (no screens/blue light before bed, no electronics in the bedroom, going to bed at the same time and waking at the same time, sleeping deeply and falling asleep within 20 minutes of getting in bed) doesn't make a difference. I use a sunrise alarm clock, and shortly after starting Mirena it was like it didn't work anymore.

- The fatigue/trouble waking up has affected my life adversely, because I have been late to work several times, not to mention when I am there I cannot summon the internal "strength" I once did to get through a day's work. My job is mentally grueling, and I've gone from being one of the best in my department to barely mediocre.

- I had my physician do bloodwork and several other tests a few months ago, concerning the fatigue, and was "all clear" for thyroid or other health problems.

- No changes in my other medications throughout this time.

- Note that in my last post I asked about Cymbalta, but I ended up not starting Cymbalta when I suddenly realized that Mirena might be the problem. I discussed it with my psychiatrist. He agreed Mirena could be the problem, and that it would be okay to explore that first before adding another antidepressant to the mix.

So I think I want to get my Mirena removed and see what happens.

What I want to know, before my appointment with my gyno to get the Mirena removed:

- Are these Mirena side effect symptoms really that common? (I never had mood side effects from my other HBC, so this is new for me).

- Should I take a break from HBC altogether, to see how I am without it at all?

- If Mirena and depo provera are no good for me, what else should I maybe consider as a form of HBC?

- If you quit Mirena after similar symptoms, what was it like for you afterward and how long (if at all) did it take for you to feel an improvement?
posted by nightrecordings to Health & Fitness (18 answers total) 1 user marked this as a favorite
I became a weepy, irritable mess as soon as the Mirena was inserted, stayed that way for a year, and it went away almost immediately after I got it removed. My gyn said that it was impossible that the Mirena was a factor, but then googling I found a massive thread (maybe the website was curezone, but it was a long time ago) of like 2000 comments by women with similar complaints. A quick Google today shows that Erin Brockovich has started a Mirena side effects website. All anecdata, but I am super glad I got mine removed.
posted by hungrytiger at 5:01 PM on July 15, 2016 [3 favorites]

Depression was a side effect for 6.4% of users in clinical trials according to the prescribing information available on the Mirena official website. So, while most people will not have this side effect, it's not exactly rare either.
posted by yonglin at 6:05 PM on July 15, 2016 [5 favorites]

I had increased anxiety with a different low dose birth control. I was informed depression can be a side effect of Mirena, especially in folks prone to it. Given the options, I got a copper IUD. It has no impact on anxiety and depression, and i appreciate knowing my emotions are 100% my own. My period is slightly longer but no other side effects. I highly recommend it.
posted by Kalmya at 6:10 PM on July 15, 2016 [1 favorite]

My relative and I had the same awful sleepiness on the Mirena. My symptoms came in only after a very good first few years on it, I think I had 2-3 years with it happily at first, and a different brand before that was done. It got pulled and within a month, I wasn't napping all day. I had odd reactions to a depo provera shot too.
posted by dorothyisunderwood at 6:16 PM on July 15, 2016

Yes!! I definitely noticed fatigue and depression. I also felt like I was carrying a bag of bricks. My depression/mood disorder was mostly under control as well but I realized I was feeling irritable and just extra meh. I had it removed after a couple of months. Oh and my skin started breaking out. I guess I started feeling better within a month or two.

Like you I was on hormonal birth control since I was a teen. Started on Ortho Tricyclen, then Depo, then Nuvaring, then the Mirena. Unfortunately I've come to accept that it's just too dangerous for me personally. I've been battling depression also since I was a teen and it's just more difficult to manage while on hormonal bc. I hit my lowest point while on Nuvaring.
posted by puppup at 6:25 PM on July 15, 2016

My experience of depression on Mirena was so severe and immediate that I only had it in for, like, a week? If that? i described it here at Metafilter some months later.
posted by not that girl at 7:08 PM on July 15, 2016 [1 favorite]

Even different types of OCP can cause different mental reactions - about 2 years ago I switched from one formulation to another, and very shortly after the switch I noticed a lightening of my all around mental state.
posted by AliceBlue at 7:23 PM on July 15, 2016

I love my Mirena, but mine does not give me that level of fatigue. I don't think that is normal or something you should put up with.

I did have severe mood swings with Ortho Tricyclen, but was much happier on Nordette. ( and then Nuvaring for several years until Mirena). So mostly this comment is to second that there are many pill variations, and one may work for you. Your doc should be able to help you choose one with a low incidence of fatigue/depression as a side effect. Additionally there are several options (Eg seasonale) that let you skip some periods, and some people have luck running pill packs together in order to not have them at all (if that's a concern for you). As for how long it takes to reset- unfortunately after Ortho it took me a couple months to feel right, and the problems themselves crept up over time; it can be tough to know when you need to try something new. As you probably already know from getting your depression in check before.

In an ideal world, you would have one doctor or one team who can help you with finding a good drug regimen for both HBC and depression; failing that you will have to provide the communication link yourself.
posted by nat at 12:39 AM on July 16, 2016

I too felt tired and really really down on the mirena, took it out, and felt better almost immediately. Couldn't believe the difference.
posted by stevedawg at 12:51 AM on July 16, 2016

Yes. I had varying levels of fatigue, depression, and cyclic moodiness with a Mirena. Like you, I doubted it, and since I'm a skeptic and I was depressed I figured it would take months and months to figure out whether it was the problem (if I could work out the difference at all).

It was pretty obviously the Mirena after a few weeks. Very obvious after three months. I gave it a full 6 months, had a Paragard inserted and my life is So Much Better. I also lost ~2% of excess body fat I gained during my 2.5 years on Mirena, although I attribute that to no longer being fatigued and depressed and not wanting to leave my house more than direct weight side effects.

Anyway, as my friend said: if you change your mind you can always have one put back in, but you're not gonna know until you take it out.
posted by deludingmyself at 6:08 AM on July 16, 2016

Hormonal birth control is not for everyone (it makes me feel like a pile of shit unremittingly). And I find it kind of upsetting that people generally think of HBC as the end all be all. There are other options. Definitely give the Paragard IUD a chance. My periods did become significantly longer and heavier (though not more painful at all!) but I'm more mentally able to handle it because I'm not miserable.
posted by bobobox at 6:14 AM on July 16, 2016 [1 favorite]

I'll confirm that I had depressive symptoms on my Mirena. Not as bad as when I was on pill HBC (daily suicidal ideations) but still bad enough that I had it yoinked. I considered a copper core IUD but haven't gotten around to it yet as my Mirena insertion was painful.
posted by some chick at 9:46 AM on July 16, 2016

Response by poster: Thank you, everyone - I feel a lot less crazy and alone, now. I have an appointment to get it removed this week. Wish me luck. For anyone interested in that Erin Brockovich website, it's here.
posted by nightrecordings at 11:48 AM on July 16, 2016

IIRC, the Canadian insert for Mirena actually included a caution for patients with a history of depression. I don't know why the U.S. insert doesn't include this information.
posted by mylittlepoppet at 1:52 PM on July 16, 2016

IANYD etc etc, but if you've been on hormonal birth control basically your entire adult life, it might be worthwhile to take a break and see what happens.
I was on the pill (ortho tricyclen I think?) from 16-21, went off it and thought that the changes on my mood/attitude/outlook on life were because I was "a grown up" (teehee). Fast forward four years, I went back on The Pill and immediately turned into a disaster. For me & my boyfriend it was very easy to decide that we should use a different method of birth control. It was like a cruel joke that the thing meant to prevent pregnancy ALSO turned me into someone no one would have wanted to have sex with (and killed my sex drive too).
Without my HBC vacation from 21-25, I never would have realized what was "me" vs what was side effect.
posted by dotparker at 5:46 PM on July 17, 2016

A side effect doesn't have to be common for it to be real. Regulatory agencies require studies because anecdotal data only goes so far. The mirena can be an awesome device that works for a ton of people without side effects, but that doesn't mean your side effect isn't real! I see no downside for you for getting out it and seeing what happens. If there are financial issues with replacing it (with whatever you decide) maybe do another Ask and see resources are out there. But your mental health is a precious resource and it is worth a little trial and error testing.
posted by Salamandrous at 10:12 AM on July 19, 2016

If you don't actively need birth control a break could be good. I'd be tempted to go straight for the copper iud since at least on my experience going straight from one to the other was a lot easier than the initial installation. Not all women get increased bleeding, and if it's an experiment you could afford to 'lose' on, I think it would be worth a shot, especially if there is some reason you would prefer not to go back to your pre-depo method (sometimes doctors have issues with family history of certain cancers). Good luck!
posted by Salamandrous at 10:17 AM on July 19, 2016

Response by poster: Update: I had my Mirena removed four days ago and today is the first day I have woken up, in a year, and felt like my old "ready and happy to do things!" self. I'm always suspicious of confirmation bias and psychosomatic reactions, but any other Saturday of the past year, I'd be struggling to move right now. I feel good and relaxed. No other changes (positive or negative) have occurred in the last week, so I'm going to assume for now this is the start of life post-Mirena.

Also, you wouldn't believe how much my doctor argued with me over several aspects of this. He told me he's inserted over 2,000 Mirena in his lifetime as an obgyn and that he's never had a patient complain to him of fatigue as a symptom. This was after I told him I'd spent the last year ruling out mental health changes (through trial and error with my psychiatrist), personal life/work stressors/changes, other issues like thyroid, and dietary/fitness changes. @dotparker, sure, YANMD, but I honestly wish you were, because my doc gave me such a hard time about my suggestion to go HBC-free for a spell (and he knows I've been on HBC my entire adult life!). I do like him as a physician, but he engaged in a disappointing amount of mansplaining. For example, how he needed (he needed?!) to be reassured that I had other methods in place to ensure I would not get pregnant if I'm not seeking out pregnancy at this time. I gave him a cold look and said, "Condoms. In the event of an emergency, Plan B. Also, I'm nearly 30 and a responsible adult. I'm not 16." Sheesh.

Anyway, I'm done/threadsit over. I just wanted to let others know that I am seeing a change for the better after having Mirena removed. If you are on Mirena and feeling the way I did, it's probably not just in your head! Trust your gut, advocate for yourself, and don't necessarily let your physician convince you out of what you feel is best for you.
posted by nightrecordings at 11:36 AM on July 23, 2016 [3 favorites]

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