Extremely ambivalent about getting a Progestin IUD
September 28, 2017 5:40 AM   Subscribe

I'm 32F and otherwise healthy. I have an appointment today to put in a Mirena IUD, which my doctor suggested purely as a hormonal therapy. I've been really ambivalent (details below), and the internet is just full of horror stories. YANMD, I know, but any experiences, stories, and so forth will be tremendously appreciated!! (TMI warning)

I am queer and have never and probably will never have a male partner, so the Mirena is not at all for birth control.

Over the last two years, my PMS symptoms have gotten worse and longer-- basically half of a month, at least. I experience water retention to the point of needing a larger size pants, fatigue, migraines, brain fog, insomnia, and back pain that is so bad I can't sit. I also found out that I am anemic from, ahem, bleeding the red sea every month.

I brought these issues to my GP, who suggested that the symptoms might be endometriosis and recommended some form of hormonal therapy. She prescribed a Mirena. She's very enthusiastic about it, saying that she got all her friends on the Mirena. I have an appointment today to put it in, but I have a lot of reservations:

1) Could my symptoms be caused by anything else? I did a blood and a urine test but never heard what they found. I just feel weird about slapping some Progestin in my body without really knowing why.

2) This is the big one. I'm currently having a lot of gender identity-related body image issues. I'm seeing a therapist for this. I'm born with wide hips and generally a very womanly shape, and I cannot tell you how uncomfortable the curves are for me. It's very incongruent with my genderqueer identity. I've been working really hard to keep my body fat low and increase muscle mass-- it's one of the only ways I can cope with the discomfort of living in this body.
One of the most widely cited side effect of Mirena is weight gain, and specifically fat gain. I've read everything from BuzzFeed to actual science papers. I'm really worried that the weight gain is going to epically mess with my head.

If you've had any experience with Mirena, I'd really love to hear from you. If you have any thoughts, suggestions, recommendations, I'd really love them, too. If you specifically have something to say about weight and Mirena (whether gain, loss, or no change despite the hype), please, please let me know!
Many thanks in advance!
posted by atetrachordofthree to Health & Fitness (42 answers total) 3 users marked this as a favorite
I had a Mirena put in about 6 weeks after the birth of my son.

Weight: no change (in fact, since getting mine installed 5 years ago, I successfully lost 35 lbs and have kept 30 of them off).

Periods: nonexistent.

I have heard that if you haven't had children, the insertion might be painful. I did not give birth vaginally, but I did dilate at least partially and while the insertion was not a walk in the park, it wasn't too awful. But, like all medical devices, mileage varies.

The good news is that they can be taken out just as easily as they're put in. If you do not experience improvement or you are experiencing untenable side effects, do not be afraid to say thanks but no thanks and have it removed.
posted by soren_lorensen at 5:49 AM on September 28, 2017 [2 favorites]

I loved my IUD with hormone (branded as Mirena in the US & Canada).

It hurt like hell going in - but like a really bad toe stubbing and over about as quickly. I recommend pain killers before the appointment. It hurt less overall than bad cramps.

After about a week of mild cramping - it was bliss. My period was substantially reduced, my cramps (very bad before) disappeared completely - I loved it. Didn't gain any weight.

I did have an issue with the second one, which wasn't inserted correctly and spontaneously partially ejected itself after a couple of weeks (and I had to get it removed the rest of the way). But if the clinic you're going to has done lots of them, I wouldn't worry - and removal is easy and much less painful.
posted by jb at 6:00 AM on September 28, 2017 [1 favorite]

IUDs are amazing. I don't have the Mirena, since I use the copper one, but the insertion principle is the same. I have genderfeels, but do need the birth control component, so having a nonhormonal method that I don't have to look at or think about has been really, really helpful, for me.

The symptoms you describe do sound like they might respond well to hormonal therapy, though! Anecdotally it seems that Mirena causes less weight gain than taking pills. Any form of hormonal birth control *can* cause weight changes, but the people I know who have one have not had issues. I understand the concern about body changes -- but for me, the monthly 'oh i have Parts that cause a period' reminder is kind of rough. Not having to deal with a monthly period might help you feel better emotionally, would probably really help you feel better physically, and those things may more than offset any weight issues -- especially since those may not even happen!

I have had two insertions now -- I wore out my first one and had it replaced last fall. I have never been pregnant. Insertion was only painful when the provider had difficulty aligning the thing. My uterus is apparently a weird shape, so there was a bit of trouble, but each time they eventually called in a cervix whisperer and then it was fine. You can ask for misoprostol prior to insertion -- it will soften the cervix and make insertion easier. It's also a good idea to take some ibuprofen beforehand. If you are in the US, Planned Parenthood are wonderful at this. They can help you afford the insertion if that's a concern, and in my experience are very good about asking for and using the pronouns that are appropriate for every patient.
posted by halation at 6:02 AM on September 28, 2017 [2 favorites]

Your GP is nuts. I have PMS bordering on PMDD and I have endometriosis. They’re not in any way related except that people with uteruses can get both of them. Mirena might help with PMDD but it might easily make your mood symptoms a 24/7 thing—it did for me.

You need a referral to a specialist if you can get it. Ideally a psychiatrist who works with OBs to manage hormonal mood disorders. You’re right that sticking a Mirena in without further investigation is kinda crazy.

Your therapist might know a good doctor to refer you to if you don’t want to ask your GP
posted by Rock 'em Sock 'em at 6:02 AM on September 28, 2017 [7 favorites]

I've been using a Mirena IUD for about a decade, altogether. No weight gain on it for me (in fact I had my most successful weight loss with an IUD in my uterus). Very reduced PMS symptoms, which is great because every other month my PMS symptoms include suicidal ideation if I'm not using even a mild hormonal BC. Little to no actual bleeding during menstruation -- I bought a box of tampons five years ago that I am only about halfway through as of today. Insertion was a little painful but also over very very quickly, and when it was time the removal was a breeze, so if you do decide to have one inserted and then you change your mind, please know that the removal process is easier than insertion.
posted by palomar at 6:03 AM on September 28, 2017 [1 favorite]

I had the red sea experience (I had tablets to take to reduce bleeding, even) doc prescribed ultrasound, they found a fibroid. I had surgery where they sorted out the fibroid and inserted the mirena, so I can't talk about the insertion.

I love it. I haven't noticed weight gain, but I have noticed the periods- SO MUCH better. For me, some months it's hard to figure out exactly when it starts (I'm using clue to track my cycle) and I haven't had to use the naproxin drugs, just ibuprofen or panadol on the odd occasion. My mood is better!
I have another friend who loves hers.

Another two friends HATED their mirenas. Everyone's body is different. Some people react badly. It's ok to get it out if it's not working.

In summary:
Ultrasound for endo/fibroids/?? - get one?
Bye bye gushers! It's so worth it.
Might not be great: ok to get it removed.
posted by freethefeet at 6:10 AM on September 28, 2017

In my natural state, my periods are long and heavy (but without particularly bad PMS). I've been on regular hormonal birth control, the shot, and have had a Mirena now for about 4 years. It's easily the best birth control option I've used, in terms of side effects and effect on my period. I stopped having a period at all about a year after getting it inserted (and my periods in the year after insertion were so light I barely needed a pantyliner). I've also found that the hormone-y side effects are much less than with the pill. Insertion was painful in the moment, but I didn't really need any pain medicine more serious than ibuprofen. I also experienced some twinges from the Mirena itself in the first year or so, to the point that I had an ultrasound done to check that it was positioned correctly. I don't think that's common, though, and I probably could have skipped the ultrasound entirely since it was purely for peace of mind.

If it helps, consider that many ob/gyns would probably put you on the pill first to treat your symptoms, which is a much higher exposure to hormones. The Mirena is much more targeted and comes with fewer side effects like weight gain and loss of libido.
posted by MadamM at 6:10 AM on September 28, 2017 [1 favorite]

As one of the "no children, had a Mirena put in" crowd, I would definitely recommend both taking painkillers ahead of time and asking for cervical anaesthetic if it isn't offered to you. With the latter, the pain was bad but brief. There were probably 3-4 days after where I felt slightly weird physically - it wasn't cramping or even really pain at all, just a sense of something in the general area of my lower abdomen that shouldn't be there. The sensation went away but I mention it in case it's something useful to be prepared for.

I did not experience weight gain, but I was switching from birth control pills to the Mirena so that may be a different scenario than if you're going from no-hormones to some-hormones.

Your periods may go away and if they do that might be helpful for your dysphoria - but that might not happen, or you might experience several months of semi-random spotting before your body settles down, so if that would be a bad thing for your mental health, you'd want to be prepared for the possibility. You will be advised to check the length of the strings periodically, which means poking your fingers on up inside to check out your own cervix (or having a partner do so), which may or may not be okay with you, but again is something you should be prepared for.

Basically, this sounds like it might be a reasonable option for you - but it also sounds like you have unanswered questions about your test results and maybe also about your other treatment options, and that you feel a little rushed into making this choice . So if a stranger's permission to postpone helps: It's okay to postpone this appointment! It's okay to spend more time researching other options and perhaps getting a second opinion.

I love my Mirena, and will happily evangelize it to all and sundry, it's probably the best money I've ever spent. But they're not the right option for everyone and it is completely and totally okay to be sure this is really the choice you want to make before you make it.
posted by Stacey at 6:13 AM on September 28, 2017 [3 favorites]

I had complications with the Skyla IUD and Nexplanon. Since last October I've been taking pregnenolone with no other hormonal birth control and for the first time in eight years my periods are like clockwork with average flow and I'm not suicidal during PMS. It's a progesterone precursor that a friend recommended to me and while I take the low dose listed on the label I feel like it's made a gigantic difference in my quality of life.
posted by annathea at 6:17 AM on September 28, 2017

I am on my second Mirena. I have never given birth and the first insertion was painful. I also recommend painkillers prior to your appointment. Second one - no pain whatsoever. Some light cramping. When it came to physical intimacy, I took it easy for a day or two afterwards.

Understanding that every person's experience is unique, I have not had a period since I first got an IUD, in over 5 (!) years. And I too have successfully lost weight during that time.
posted by nathaole at 6:32 AM on September 28, 2017

Ultrasound is super easy and will detect endometriosis.
posted by jbenben at 6:34 AM on September 28, 2017

I got a hormonal IUD a week ago, and it was a great choice for me. I went with the Kyleena, which has a lower hormone dose than Mirena. This means I'm more likely to keep having normal periods, so perhaps less appropriate in your case.

Insertion was more uncomfortable than painful and I had minimal cramping, but I seem to have a pretty high pain tolerance in general. Hormonal contraception doesn't seem to cause weight or mood changes for me, but everyone is different!

I think your concerns are real. If I were you, I would go to a OBGYN or other specialist for a second opinion, since you have some kind of underlying health issue going on. I was pretty nervous about getting my IUD and I wouldn't have felt comfortable if it had been presented as my only option. And if you decide to go with the IUD, I feel it's better to get it inserted by a doctor who's done literally thousands of insertions.
posted by toastedcheese at 6:36 AM on September 28, 2017

Ultrasound will not detect most endometriosis, for what it's worth. Only a laparoscopy can. Most women have superficial lesions, which can cause as many symptoms as the Deep Infiltrating Endometriosis which is detectable by ultrasound.

I have suspected endo and the Mirena did help the physical discomfort: no periods, no ovulation, no endometrial pain. However, the emotional side effects were AWFUL and I spent a year or so being completely miserable until I had it removed and good riddance. I gained a little weight but nothing dramatic. If you are in any way sensitive to hormones (I can't do birth control pills or the nuvaring either) I would not recommend it.
posted by lydhre at 6:44 AM on September 28, 2017 [3 favorites]

I've had Mirena for about a year (primarily for birth control) and I don't *love* it but it's ok.

One year in my periods are *much* lighter and less crampy, but they definitely still happen and they are also a day or two longer with spotting for a few days on either side, which I don't love. On the other hand, not having to pay so much *attention* to my period (i.e. not having to change an extra-heavy tampon/empty cup three or four times a day) is great. I didn't get PMS bad before and that hasn't gotten any worse, though I feel like there's some flattening out of my hormonal feelings. No particular weight gain.

Anyway, I said I would give mine a year trial period, and it's been "OK enough" that I haven't scheduled an appointment to have it out and probably won't until my partner has had a vasectomy.
posted by mskyle at 6:48 AM on September 28, 2017

I have had a laparoscopy for endometriosis (my symptoms were very different from yours) and went on Mirena afterwards to help manage / slow the return of any endometrial symptoms. My endo was diagnosed easily through an ultrasound - if that's an option for you I would highly recommend it so you know what you're dealing with and whether a surgical intervention might be indicated. I had the Mirena inserted while I was still knocked out for the lap, so I didn't have to experience any insertion pain - bonus! No weight gain, no bad side effects, was VERY happy with the thing and removal was a cinch.
posted by oneaday at 6:55 AM on September 28, 2017

I'm a straight nulliparous 27yo cis woman, and I've had my Mirena for about 1.5 years. I absolutely LOVE it. The insertion pain was pretty mild for me (and my provider did not use a numbing agent or cervical softener like some others do). It obviously hurt some, but it was all over in less than 5 minutes and, as I told my provider, if I only have to do that once every 5 years, I'm sold!

I have not experienced any weight gain, and my periods are super short (1-2 days) and extremely light, if they happen at all. (I actually keep some pregnancy tests at home now, since I skip periods so often!)

Also, I've had migraines for about 15 years now, and they improved dramatically after my Mirena was inserted. I went from getting several Really Bad migraines per month to getting just one Pretty Mild one per month.

As you think about this, I would try to remember that people are far more likely to share bad experiences than good ones, which should explain why you find a disproportionate number of horror stories online. That said, if you have any reservations, you should talk to your provider about other options - the Mirena is perfect for me and many others, but it's not for everyone.
posted by schroedingersgirl at 7:00 AM on September 28, 2017

I had a Mirena for six months, but got it removed back in April or May. Like you, I have genderfeels (as another commenter so perfectly put it); unlike you, I had no noticeable hormonal or reproductive woes, and was using it for birth control. I'll also mention that until then I'd only used condoms and Fertility Awareness, which means that I was trying out hormonal birth control after a couple decades of no hormonal birth control whatsoever. The insertion was shockingly painless (really!), and after three months I stopped having periods at all, which was glorious. I also didn't gain any weight (though I'm already curvier than I'd like).

The reason I got it taken out was because it made me unbelievably emotionally voluble, ready to cry over anything and more prone to picking foolish fights with my partner or feeling wounded over things that ordinarily wouldn't have bothered me, and exacerbated my mild depression. It also kinda affected my sex drive, and I'm hugely glad to feel fully human again with it out.

That said, I think a lot of people who suffer from hormonal woes or need long term birth control love the Mirena, and part of it I suspect is that it's super easy and that most women in hetero relationships are already so goddamn accustomed to ceding some aspect of their mental wellbeing in exchange for reproductive autonomy that enhanced PMS, depression, and volubility are just par for the course no matter which way you cut it. Still, the insertion is dead easy (or awful for ten minutes, depending), and it's super easy to get it taken out, and it's free if we still have Obamacare. I'd try it out "just to see," and feel totally comfortable getting it taken out in a few months if things don't work perfectly.
posted by tapir-whorf at 7:03 AM on September 28, 2017

I had a Mirena put in about 8 years ago.

Weight: no change

Periods: nonexistent

Love it!
posted by stewiethegreat at 7:05 AM on September 28, 2017

Due for my third Mirena this year. Zero issues. I got my first one because my docs wanted me off the pill because of the pill’s added stroke risk, and it’s been the best thing ever. I forget what periods are like. No weight change that can be attributed to it specifically (my pasta habit on the other hand....). Love it. Its literally been a set-it-and-forget-it experience me for.
posted by cgg at 7:18 AM on September 28, 2017

I have had an easier time losing weight with the mirena (I'm on #3) and I have no periods. It's fantastic and I've had zero issues.
posted by Medieval Maven at 7:31 AM on September 28, 2017

I'm on #2 and year 7. No weight gain. No periods in 7 years. I cannot even imagine going back to having periods again (seems like some kind of punishment women had to suffer in the "dark ages").
posted by yonglin at 7:33 AM on September 28, 2017

I had a Mirena put in about 3 years ago

Weight: no change

Periods: none

(I love it! best decision ever!)
posted by Thisandthat at 7:40 AM on September 28, 2017

I'm nine months into a Skyla, which is a lower-dosage and smaller version of the Mirena that lasts for three years.

Insertion was unpleasant, like a particularly drawn out pap smear or a very short labor pain, but was bearable and I felt fine immediately after. I've had no weight gain, a significant reduction in PMS and migraines, and no real change in emotional volubility, despite having had huuuuuuuuuuuuuuuuuuuuuuuuuuuge issues with that in particular the last time I tried hormonal birth control (Depo Provera).

The main annoyance is that my periods are now irregular, and while super light, go on for a while, which mean that every two or three months, I wear a pantyliner for about 10-14 days.

If you're in the US and nulliparous, I'm actually surprised your provider's first suggestion was Mirena, rather than something like a Skyla, Liletta, or a Kyleena which have lower dosages of hormones, especially the Skyla.
posted by joyceanmachine at 8:10 AM on September 28, 2017

I got my THIRD Mirena this year and as far as I am concerned, it is the MOST AMAZING THING EVER. Almost no periods... just the most basic of spotting. That alone makes it worth it.

First insertion hurt like a SOB. 2nd and 3rd were a breeze.
posted by CoffeeHikeNapWine at 8:21 AM on September 28, 2017

Short story: I love my Mirena so much that I'm getting another one put in next month. It's awesome and I love it so much because it made my awful PMS-related cramps barely noticeable.

Longer story: My periods sucked before I got the Mirena. I've never had a heavy flow, but cramping, pain, and general curling-up-and-wanting-to-die feelings were something I experienced nearly every month along with other generally awful PMS symptoms.

I've never been pregnant and was actually a virgin still at the time when I put my first Mirena in. I was a little moody for the first week or so while I adjusted (there was some unexpected sobbing at commercials). My periods disappeared within the first three months of having it inserted. My doctor was really nice once I explained to her what I was looking for in birth control and why I was interested in an IUD.

While I was researching what kind of IUD I wanted online, I too made the mistake of reading reviews online. There were a lot of really awful experiences, and I was getting anxious. But I asked my doctor about it, she told me that most of these go smoothly, and people are less likely to write online about a good experience over a bad one. I needed to make a good decision for myself, and she wouldn't let me do anything completely unsafe because she was my doctor and it was her job to make sure what I wanted could be implemented safely.

So, the day of my insertion, I was advised to eat a light, protein-heavy breakfast and take two ibuprofen about an hour before my appointment. I was also advised to take two days off from work to recuperate, and to have someone drive me home from the appointment, since I might feel some pain.

The most pain I felt was when the doctor used her speculum to open me up to slip the Mirena inside. I did not like that feeling AT ALL, and she tried to tell me that we couldn't do this if I was in too much pain. I knew it was my anxiety mostly causing me to react that way, so I told her to go on, because I really wanted my Mirena. The Mirena slipped in, she trimmed my cords, and I felt no further pain. Afterward, we laughed about the speculum being the worst part of the whole process!

Later, I was a little crampy and tired, so I mostly hung out on my aunt's sofa with a heating pad and some bad daytime TV for the rest of the afternoon. On a scale of worst-period-cramps to best, I was probably hovering around a 6. I probably could have gone back to work the next day if I'd wanted to.

Now that my Mirena is nearing the end of its lifespan, I'm starting to feel a little crampier when my period rolls around, and I've started spotting more. I hated seeing the blood come back, but it was an excellent visual reminder to get me to call the doc to schedule a removal and re-insertion of a fresh one. It's in two weeks and I'm really excited to be worry-free for up to five years again.
posted by PearlRose at 8:32 AM on September 28, 2017

I've had the Mirena for about a year. It was suggested for me because I was having such heavy periods that I was anemic. Since I got it, I've had hardly any periods (yesssssss) and I've felt so much better. I haven't gained weight either. Overall for me it has been a good choice, the no periods alone is like a gift from the gods.
posted by fairlynearlyready at 8:56 AM on September 28, 2017

The comment about ultrasound diagnosis endometriosis by jbenben is incorrect; definitive diagnosis of endometriosis is by laparoscopy.

Regarding the Mirena, my wife is on her second one. She has it for period management (not birth control, we're both cis women so no need) and it's been fantastic for her. She had spotting for the first few months, but overall went from pre-Mirena very heavy periods that rendered her barely functional to no periods and no cramps at all. The insertion of the first one was very painful for her. When it was time to replace it after 5 years, she asked for and was given a single pill of an anti-anxiety med (xanax maybe?), which she found really helpful - tensing up can make insertion more painful, which causes more tensing, etc. Something to consider if you decide to go for it! I don't think she had any weight gain when she first got it - I didn't notice any.

I also have very painful periods and probable endometriosis, so after seeing how happy my wife is with hers I tried to get a Mirena too. Unfortunately my body decided to reject it, so I tried again and it was rejected again, alas. I talked to my doctor and while rejection is a thing that does occasionally happen, it's rare. And it wasn't painful, the Mirena just came out. I'm still sad that it didn't work out for me, I would LOVE to stop my periods.
posted by insectosaurus at 9:12 AM on September 28, 2017 [1 favorite]

I encourage you to get an ultrasound following the insertion. It is standard procedure with my doctor, not sure about others. The ultrasound caught issues with both of my IUDs. Turns out my uterus is retroflexed, oddly sized, so I'm not the best candidate. This is pretty rare, I think, but I wanted to let you know it is a (minute) possibility.

Insertion and removal were very briefly painful, but subsided immediately. I'd take an ibuprofen beforehand for the cramps. Good luck!
posted by elerina at 9:33 AM on September 28, 2017 [1 favorite]

Honestly, getting it just to control your hormones seems like a raw deal, if you're not having sex with men (especially in terms of migraines--mine made migraines much worse and more frequent). Can your doc not refer you to a specialist and help you look into hormone replacement therapy?
posted by Miss T.Horn at 10:18 AM on September 28, 2017

I was diagnosed with atypical endometrial hyperplasia about 2 years ago, and for various reasons, my oncologist suggested the Mirena as an alternative to a hysterectomy. It worked like a charm: the bleeding stopped, and the followup biopsies have been sufficiently clean that I no longer have a cancer diagnosis on my chart.

I have gained a couple of pounds since I got the Mirena, but within my normal range of weight. I have not been able to lose more than a couple of pounds, which has been frustrating, but I'm also in menopause, so it's hard to blame the Mirena rather than normal changes in my metabolism.

I have had no other side effects from the Mirena, although I admit that getting it inserted hurt like the dickens. Get something stronger than OTC ibuprofen beforehand.
posted by suelac at 10:49 AM on September 28, 2017

I was investigated late last year for my severe anaemia and mentioning my always heavy and painful periods saw me getting a Mirena fitted. I've not given birth and it wasn't a terribly comfortable experience but nowhere near a painful one. The periods have lightened immeasurably and I also just get a few cramps as opposed to the previous lower-half-inserted-into-a-vice torture.

An ultrasound had also suggested that I had some thickening of the endometrial lining, which didn't turn out to be the case, but the consultant said having the coil fitted would cure any hyperplasia that might be present.

I have also been losing weight for a couple of years now and the Mirena insertion coincided with a slowdown in that, but I have not put weight on subsequently, just continued to lose but very slowly.
posted by Martha My Dear Prudence at 12:07 PM on September 28, 2017

I'm 30, haven't ever given birth, and I just got the Mirena inserted earlier this year. Cis female, have always had heavy painful periods, but had also, over the last couple years, seen them get worse and worse. Unlike you, I'd had a try at hormonal BC maybe seven to ten years back, and found that they worked to regulate and lighten my period. I didn't stay on them because I couldn't easily afford it at the time.

Before I decided on getting an IUD, I first thought I'd prefer to try hormonal birth control again. In fact I didn't think I wanted an IUD at all-- I was leery of making big changes, I wasn't sure it would even help my situation, etc. I decided to go on the pill again instead, to see if that had enough of an effect that I could stop there.

Long story short, it didn't. Or rather, though the pill I was taking did lighten my periods a bit and did let me skip periods, it didn't do it as well as I'd hoped (skipping one period? Fine. Skipping two in a row? So-so but ok. Three? A week plus of constant light bleeding, annoying as all heck). Plus taking it on time etc was a pain, and while it seemed to control my period ok, it did nothing whatsoever for the period pain (excruciating) and the pelvic pain I'd get during and around my period (less excruciating, but not good). The latter especially is something I started seeing more and more over the last two years.

What eventually pushed me into opting for an IUD was a combo of the Planned Parenthood doctor's hopefulness and my internal feeling of "well, it can't get any worse". Or, more accurately, "it's bad enough that I'll try anything once". Insertion hurt, but I'd dosed up on Aleve beforehand, and I'd been warned re exertion afterward, so I just moseyed on home and laid down and didn't plan to do much for the next two days.

Cramping ensued for the next day or so, but not as bad as I'm used to. Then a somewhat irregular period followed-- I don't remember, now, how painful it was, so probably it was just one of the usual. Then I had some spotting, some light bleeding, and then just nothing. Well, nothing on my scale: having to deal with discharge again, having to deel with monthly two-three day spotting or very light bleeding, plus the occasional light menstrual and ovarian cramps. Which is nothing compared to the flood (switching to a menstrual cup helped, but there's only so much one can fit, ok), curling around a heating pad and vaguely wishing for death (painkillers dulled my cramps, but you can bet I still felt them), or the brain fog I'd get even when I wasn't on Aleve. Which I'd found was better for my period pain, but still left me slow-headed and fuzzy.

So yeah, more than half a year later, I'm definitely in the "try it" camp, even though the birth control benefits are basically just a side perk for me. You know your periods are bad, and are getting worse, and while the Mirena or maybe even the Paragard (copper, non hormonal IUD) may not be right for you, I feel they are worth trying. Even if all it does is lighten or ease your periods a bit, so long as the side effects don't try to push you over the same cliff you're trying to get away from, it'll be worth it. And if your periods do mostly vanish the way mine did, and don't leave you struggling in other ways... I didn't know how much I had grown to hate mine until the first time I skipped it.

Last few points: weight gain was not an issue for me; I had some PMS (increased depression came along just before my period like clockwork) that has maybe eased off somewhat now, though perhaps its just easier to deal with when I'm not having a 'real' period. YMMV; fingers crossed that whatever solution you end up going for helps you out.
posted by logarythmic at 12:14 PM on September 28, 2017

Have had a Mirena for a little over a year. Slight weight gain, but the no periods, no pms more than made up for that in my opinion. Wish I'd done it years ago. Planning to keep using it until menopause. I love my new cyborg uterus so much.

I had no previous pregnancies when I had it inserted, and I won't lie--it hurt like crazy. About five minutes of extreme pain, followed by about a week of heavy cramping. And I took a massive dose of advil beforehand, as my doctor advised. Had one light period after, then nothing but a day of spotting once every three months or so since.

I wonder if you could try a low dose BC pill for a few months to see if the hormones help your symptoms? If they do, then maybe take the IUD plunge.
posted by lovecrafty at 12:39 PM on September 28, 2017

Had a Mirena. Loved it. No periods. No PMS. Insertion hurt. Cramping for a week. Then I didn't even know it was there. Removal was a breeze.
posted by songs_about_rainbows at 12:52 PM on September 28, 2017

I'm 39 and nulliparous and had the Liletta (another progestin-only IUD). It was an utterly miserable experience for me and I had it removed after seven months, as soon as I felt like I'd really given it a fair shake.

Insertion was excruciatingly painful and traumatic. I had intense intermittent cramping unrelated to my period for months afterward and severe cramping during the first several days of my periods. Although my periods became lighter, they also became longer, and since my cycle was already short, it meant I often bled lightly for nine days and then only had twelve days before I started bleeding again. I also gained weight steadily.

I know a lot of people do love their IUDs, but I most definitely did not.
posted by merriment at 1:05 PM on September 28, 2017

Had some similar (and some different) issues: I am loving my Mirena.

No kids, insertion was not the most fun thing ever, and I took the rest of the day off work both times (more on that in a second) but mostly felt weird, but not in pain. I took ibuprofen beforehand, and kept taking it for a day, and I think that helped a lot.

There were a couple of bits of very intense going into pain sensations that were brief (5-10 seconds), and a lot more 'this is a really awkward position and angles are hard' with the speculum in that I actually find harder to manage without some help. In my case, having a pillow under my hips made the discomfort I was having with insertion hugely better, so discuss with your doctor if something like that would help (especially if you've had issues with Pap smears with what feels like angles.)

My first IUD mispositioned itself after about a month, and they confirmed that with an ultrasound (this is not terribly common, but common enough most doctors are "Oh, yeah, so here's what we do" about it and it's no big deal), so we removed it and put in a new one. The second insertion was a lot easier.

No weight gain on my end (though I'm a large woman), and my periods went to just spotting for a few months, and have now settled out to 2-3 days of moderate bleeding, not the flooding/major cramps/inability to function for a day or two I was having before. (They're also much more regular, which I wasn't previously.)

Overall, big win, will do it again when I need to.
posted by modernhypatia at 1:13 PM on September 28, 2017

Ultrasound is super easy and will detect endometriosis.

As stated above, this is not true. CT scan won't find it either. I'm 4 months out from resection surgery (by the way, resection is the way to go, that's actual removal of the tissue, not just lasering the surface.)

So I do think this is very likely endometriosis. And hormones can help it but won't make it go away. My periods continued to get worse on hormonal birth control (monthly, not continuous.)

I can't fully answer the IUD section but on actual birth control I had no weight changes but ended up with severe depression after I had been on it for 8 years. Pay attention to emotional changes.

Birth control helped mine but unfortunately my body can't tolerate hormones. I never wanted an IUD and my doctor did mention it can sometimes increase cramps if you are cramp-prone. So be aware of that.

I do always suggest the Nexplanon arm implant as an alternative because insertion and removal was super easy (again, my own personal body doesn't like hormones.) They just numb your arm and shoot it in. It's sore a bruised for a while but otherwise easy.
posted by Crystalinne at 1:27 PM on September 28, 2017

I had a Mirena for four months a few years ago. It made my migraines way worse and I had it taken back out. There were some other things I didn't like about it but that was the big one.
posted by dilettante at 1:47 PM on September 28, 2017

8 years on the Mirena here! Two insertions, one removal. In my opinion, having my cervix swabbed during a regular 'ol pap is WAY worse then having the IUD inserted. Afterwards, nest up with a long movie, glass of whiskey, and a hot pad. I've loved mine. No periods, no problems, and I'm sure I'll be getting Mirena #3 in a couple years.
posted by coldbabyshrimp at 2:28 PM on September 28, 2017

I've had a Mirena for 2.5 years. I'm 35 now, no children/pregnancies.

Insertion: Really painful, but only for a few seconds. I took 800mg ibuprofen beforehand. Ob/gyn didn't use any numbing agent or cervical softener. I took the rest of the day off work.

Weight gain: None.

Periods: Very light. They last 1-3 days, 30-60 days apart. I rarely have to use tampons anymore. When I wasn't on hormonal birth control, I'd bleed through a super heavy tampon and heavy pad (combined) in less than two hours on my heaviest day. Sleeping through the night was out of the question.

Other side effects: It hasn't seemed to make my depression and anxiety worse. I got severe monthly cramps that would last a couple hours for about 6 months. (I'd never had cramps before insertion, so this was disturbing enough that I went back for an ultrasound to check on positioning. It was fine.) My skin was greasier than usual and I got painful cystic acne once a month for about a year, but that's also cleared up. Also, I'm pretty sure every form of hormonal birth control I've tried has affected my sex drive, but my unregulated periods were making me suicidal. I consider it an acceptable trade-off for not living with crushing fatigue and brain fog 1-2 weeks out of every month and washing gallons of blood out of my clothes and sheets.

Overall: Not perfect, but would still buy again.
posted by kiripin at 3:51 PM on September 28, 2017

I had the Mirena for five years. I know this is late, but my anecdata for anyone still reading:

Insertion: I've never had kids; I also have a slightly tilted uterus. Really painful for a few minutes and then horrible cramping for the entire rest of the day, through the night. My boyfriend at the time was actually frightened for me.

Periods: No periods, but I had random spotting/ breakthrough bleeding the entire time I had the Mirena. I also still got cramps from time to time.

Weight gain: None that I could isolate to the IUD.

Skin: My face broke the hell out. Bad. Cystic and regular acne.

Overall: Absolutely would not do again. I got it taken out on time (I was really nervous about the removal but it was a breeze) and switched to the NuvaRing, and never looked back.
posted by sm1tten at 9:39 PM on September 28, 2017

I'm a woman who never plans to have biological children, and I plan to replace my Mirena every X years until I finally hit menopause.

It has improved my quality of life so much that I can't stop talking about it. I had no idea how debilitating my periods were until I had the chance to live life without them, and holy god. Not for everyone, definitely. These kinds of hormones are very tricky.

Before I got the Mirena I was anemic and couldn't use cup type menstrual devices because they'd overflow regularly. Now I can use panty liners. I'm not vomiting from cramp pain. It's such a difference, it makes me angry over all the years I spent suffering!

I don't have any side effects I can conclusively pin on the Mirena but the quality of life calculus still comes out immeasurably on the positive side.
posted by ZeroDivides at 3:32 PM on September 29, 2017

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