Placement of mirena on which day of the cycle. Mirena intrauterine device: reviews of doctors. Expulsion - prolapse of the intrauterine device
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An intrauterine device (IUD) is a T-shaped device that is inserted into the uterine cavity to achieve a contraceptive effect.
There are 2 types of spirals: spirals containing copper or silver, and spirals containing hormones. Spirals containing hormones are recognized as more effective, therefore, they are now more often used in gynecological practice.
What is the Mirena intrauterine device?
The Mirena IUD is a coil containing the hormone levonorgestrel. Every day, Mirena releases a certain small dose of a hormone into the uterine cavity, which acts only within the uterus and is practically not absorbed into the blood. Due to this, the risk of side effects of hormonal effects is significantly reduced, there is no suppression of the ovaries and there is a therapeutic effect, which we will discuss below.
How effective is the Mirena IUD?
More than 20 years have passed since the advent of the Mirena Navy. During this time, Mirena has shown high efficacy in preventing unwanted pregnancy.
According to statistics, within one year of using Mirena, pregnancy occurs in one woman out of 500. Compared to birth control pills, the Mirena spiral is a more reliable contraceptive.
What are the pros and cons of the Mirena IUD compared to other contraceptive methods?
Mirena has its advantages and disadvantages, so it is not suitable for all women. After learning about the pros and cons of Mirena, you can decide if this method of protection against pregnancy is right for you.
Mirena Pros:
- Having installed a spiral once, you no longer need to worry about contraception. While birth control pills need to be taken every day in order for the contraceptive effect to remain reliable.
- The coil does not need to be changed often: you can walk with one coil for up to 5 years in a row. Whereas birth control pills or condoms need to be replenished monthly.
- Unlike condoms, during intercourse, the coil is not felt by you or your sexual partner.
- Unlike birth control pills, the spiral does not increase appetite and does not cause water retention in the body, which means it will not cause weight gain.
- It can be used as a treatment for adenomyosis (endometriosis of the uterus) and for.
- Reduces blood loss during menstruation and.
Cons of Mirena:
- It is impossible to install a spiral on your own: for this you need to visit a gynecologist.
- Unlike, it does not protect against sexually transmitted diseases (including HIV infection, herpes, etc.), therefore it is not suitable for women who have sex with unfamiliar partners.
- In the first 4 months after the installation of the spiral, a woman has an increased risk of inflammation of the fallopian tubes ().
- May cause long-term appearance in the first months after installation.
- May cause irregular periods in the first months after insertion.
- It can cause a temporary cessation of menstruation, but after the removal of the spiral, menstruation returns within 1-3 months.
- May cause . These cysts are not dangerous to health and rarely require any treatment. Usually, they resolve themselves within a few months after the appearance.
- There is a risk of unnoticeable loss of the spiral, which can lead to an unwanted pregnancy.
- If pregnancy occurs while wearing the spiral, then there is a risk of an early miscarriage.
At what age can Mirena be installed?
Among gynecologists, there is an unspoken rule that intrauterine devices can only be installed in women who have given birth. However, there are studies in which the spirals were installed in nulliparous women, and even girls under 18 years old, and at the same time, the spirals were effective and safe.
And yet, most gynecologists will not undertake to put a spiral if you are under 25 years old and you have not yet given birth.
What tests should be taken before putting the Mirena coil?
Before installing the coil, your doctor will prescribe:
- to make sure there is no inflammation. If the smear detects inflammation, then you will need to be treated first and only after recovery, the doctor will install the spiral.
- to make sure your cervix is healthy and you don't have any precancerous or cancerous changes.
- to make sure that the uterus has a normal shape and the installation of the spiral will be safe. You will not be able to put a spiral with a bicornuate uterus, the presence of partitions in the uterus or other abnormalities in the development of the uterus.
- or to make sure you are not pregnant.
For whom is the Mirena IUD contraindicated?
There are not so many contraindications for installing Mirena. This:
- Pregnancy or suspected pregnancy
- Inflammation of the vagina or cervix
- Chronic genital tract infections that often get worse
- Inflammation of the urethra or bladder
- Precancerous or cancerous changes in the cervix
- Cancer or suspected breast cancer
- Inflammation of the uterus (endometritis) after childbirth or abortion within the last 3 months
- Anomalies in the development of the uterus: bicornuate uterus, septa in the uterus, etc.
To make sure that the spiral is in place, you can try to feel its "antennae" yourself. To do this, wash your hands thoroughly and insert the fingers of one hand deep into the vagina to reach the cervix. "Antennae" to the touch resemble the threads of fishing line. The length of the "antennae" can vary: you can only feel the tips, or feel 2-3 cm. If the threads are longer than 2-3 cm, or if you have not felt them, then you need to contact a gynecologist.
How often do I need to visit a gynecologist if there is a Mirena spiral?
If nothing bothers you, then the first visit to the gynecologist should be done a month after the installation of the spiral. Then see a doctor in another 2 months. If the doctor confirms that Mirena is in place, then further visits should be done once a year.
Smearing discharge after installing the Mirena coil
In the first months after the installation of Mirena, prolonged spotting bloody (dark brown, brown, black) discharge may appear. This is a normal phenomenon associated with the installation of the spiral. Such discharge can be observed during the first 3-6 months after the installation of Mirena. If spotting persists for more than 6 months, then you need to visit a gynecologist.
Irregular periods after Mirena
Some women who use the Mirena intrauterine device may experience irregular periods. This not connected with hormonal disorders or ovarian dysfunction. The cause of the failure of the menstrual cycle is the local effect of the spiral on the endometrium of the uterus. It is not dangerous to health and does not lead to any negative consequences.
Consult your gynecologist if irregular periods persist for 6 months or more after coil insertion.
No period after Mirena coil
Approximately 20% of women who use the Mirena coil for a year or more, menstruation stops altogether.
If the next menstruation has not come, and more than 6 weeks have passed since the last menstruation, pregnancy must first be excluded. To do this, you can either pass.
If pregnancy is excluded, then the absence of menstruation is caused by a spiral. The hormones that the intrauterine device releases affect the endometrium, inhibiting its growth. The endometrium remains thin and therefore menstruation does not occur. The absence of menstruation does not adversely affect the body and does not cause any consequences in the future.
Menstruation recovers on its own within 1-3 months after the removal of the spiral.
What should I do if I become pregnant while wearing Mirena?
The likelihood of pregnancy while wearing Mirena is quite small, and yet, such cases are described.
If the pregnancy test showed a positive result, then you need to visit a gynecologist as soon as possible. The gynecologist will examine you and send you for an ultrasound. Ultrasound will help determine where the fetus is located: in the uterus or is it an ectopic pregnancy. If the fetus is located in the uterus, then there is a chance to keep the pregnancy.
Do I need to remove the coil if pregnancy occurs?
In order to reduce the risk of early miscarriage and, doctors recommend removing the intrauterine device. In the first hours and days after the removal of the spiral, the risk of miscarriage will be quite high, but if the pregnancy can be maintained, then nothing will threaten the unborn child.
If you decide not to remove the spiral, or if its removal is impossible for other reasons, then during pregnancy you will need more careful monitoring by doctors in order to prevent or identify possible complications (miscarriage, inflammation, premature birth) in time.
Can Mirena cause developmental anomalies in an unborn child?
Unfortunately, this is not yet known, since there were not so many cases of pregnancy, and it is impossible to compile any reliable statistics.
Cases of the birth of healthy children after pregnancy with a helix are described. Cases of birth of children with developmental anomalies also exist, but so far it has not been possible to establish whether there is a connection between these anomalies and the fact that the coil was not removed during pregnancy.
How is Mirena coil replaced or removed?
Mirena coil works for 5 years. After this period, the spiral should be removed (if you are planning a pregnancy or want to switch to another method of contraception), or replaced with another spiral (if you are not planning a pregnancy and do not want to switch to other methods of contraception).
You can remove the coil earlier if you are planning a pregnancy. To do this, it is not necessary to wait until the five-year term of the Mirena expires.
It is best to remove the Mirena coil during the next menstruation. If your periods stop while wearing Mirena, or if you want to remove the coil outside of your period, then you need to start using condoms 7 days before removing the coil.
If you want to replace the coil, you do not need to use condoms, and the replacement can be done on any day of the cycle.
When can I get pregnant after Mirena removal?
The Mirena spiral does not affect the functioning of the ovaries, so you can become pregnant in the next cycle after Mirena removal.
Intrauterine contraceptive
Active substance
Levonorgestrel (micronized) (levonorgestrel)
Release form, composition and packaging
Intrauterine Therapy System (IUD) is a T-shaped levonorgestrel-releasing construct, placed in the conductor tube (conductor components: insertion tube, plunger, index ring, handle and slider). The IUD consists of a white or almost white hormonal elastomeric core placed on a T-shaped body and covered with an opaque membrane that regulates the release of levonorgestrel (20 µg/24 h). The T-body is provided with a loop at one end and two arms at the other; threads are attached to the loop to remove the system. The IUD is free from visible impurities.
Excipients: core made of polydimethylsiloxane elastomer; a membrane of polydimethylsiloxane elastomer containing silicon dioxide colloidal anhydrous 30-40% of the mass.
Other components: T-shaped polyethylene body containing 20-24% wt., a thin thread of brown polyethylene, dyed with iron oxide black ≤1% wt.
Delivery device: conductor - 1 pc.
Navy (1) - sterile blisters (1) - cardboard packs.
pharmachologic effect
Mirena is an intrauterine therapeutic system (IUD) that releases levonorgestrel and has mainly a local gestagenic effect. The progestogen (levonorgestrel) is released directly into the uterine cavity, which allows it to be used at an extremely low daily dose. High concentrations of levonorgestrel in the endometrium contribute to a decrease in the sensitivity of its estrogen and progesterone receptors, making the endometrium immune to estradiol and exerting a strong antiproliferative effect. When using Mirena, morphological changes in the endometrium and a weak local reaction to the presence of a foreign body in the uterus are observed. Increasing the viscosity of the cervical secretion prevents the penetration of sperm into the uterus. Mirena prevents fertilization due to inhibition of sperm motility and function in the uterus and fallopian tubes. Some women also experience suppression of ovulation.
Previous use of the drug Mirena does not affect the childbearing function. Approximately 80% of women who want to have a baby become pregnant within 12 months after the IUD is removed.
In the first months of using Mirena, due to the process of inhibition of endometrial proliferation, there may be an initial increase in spotting bloody discharge from the vagina. Following this, a pronounced suppression of endometrial proliferation leads to a decrease in the duration and volume of menstrual bleeding in women using Mirena. Scanty bleeding often transforms into oligo- or amenorrhea. At the same time, ovarian function and the concentration of estradiol in the blood remain normal.
Mirena can be used to treat idiopathic menorrhagia, i.e. menorrhagia in the absence of hyperplastic processes in the endometrium (endometrial cancer, metastatic lesions of the uterus, submucosal or large interstitial node of uterine fibroids, leading to deformation of the uterine cavity, adenomyosis), endometritis, extragenital diseases and conditions accompanied by severe hypocoagulation (for example, von Willebrand disease, severe thrombocytopenia ), the symptoms of which are menorrhagia.
After 3 months of using Mirena, menstrual blood loss in women with menorrhagia is reduced by 62-94% and by 71-95% after 6 months of use. When using Mirena for 2 years, the effectiveness of the drug (reducing menstrual blood loss) is comparable to surgical methods of treatment (ablation or resection of the endometrium). A less favorable response to treatment is possible with menorrhagia due to submucosal uterine myoma. Reducing menstrual blood loss reduces the risk of iron deficiency anemia. Mirena reduces the symptoms of dysmenorrhea.
The efficacy of Mirena in preventing endometrial hyperplasia during chronic estrogen therapy was equally high with both oral and transdermal estrogen.
Pharmacokinetics
Suction
After the introduction of the drug Mirena, levonorgestrel begins to be immediately released into the uterine cavity, as evidenced by the measurement data of its concentration in the blood plasma. The high local exposure of the drug in the uterine cavity, which is necessary for the local effect of Mirena on the endometrium, provides a high concentration gradient in the direction from the endometrium to the myometrium (the concentration of levonorgestrel in the endometrium exceeds its concentration in the myometrium by more than 100 times) and low concentrations of levonorgestrel in blood plasma (the concentration of levonorgestrel in the endometrium exceeds its concentration in blood plasma by more than 1000 times). The rate of release of levonorgestrel into the uterine cavity in vivo is initially approximately 20 mcg/day, and after 5 years decreases to 10 mcg/day.
After the introduction of the drug Mirena, levonorgestrel is detected in the blood plasma after 1 hour. Cmax is reached 2 weeks after the administration of the Mirena drug. In line with the declining release rate, the median plasma concentration of levonorgestrel in women of reproductive age with a body weight above 55 kg decreases from 206 pg / ml (25th-75th percentiles: 151 pg / ml - 264 pg / ml), determined by at 6 months, up to 194 pg/ml (146 pg/ml-266 pg/ml) at 12 months and up to 131 pg/ml (113 pg/ml-161 pg/ml) at 60 months.
Distribution
Levonorgestrel binds nonspecifically to serum and specifically to sex hormone-binding globulin (SHBG). About 1-2% of circulating levonorgestrel is present as the free steroid, while 42-62% is specifically bound to SHBG. During the use of Mirena, the concentration of SHBG decreases. Accordingly, the fraction associated with SHBG during the period of use of the drug Mirena decreases, and the free fraction increases. The average apparent V d of levonorgestrel is about 106 liters.
It has been shown that body weight and plasma SHBG concentration affect the systemic concentration of levonorgestrel. those. with low body weight and / or high concentration of SHBG, the concentration of levonorgestrel is higher. In women of reproductive age with low body weight (37-55 kg), the median plasma concentration of levonorgestrel is approximately 1.5 times higher.
In postmenopausal women who use Mirena simultaneously with the use of intravaginal or transdermal estrogen, the median plasma concentration of levonorgestrel decreases from 257 pg / ml (25th-75th percentile: 186 pg / ml - 326 pg / ml), determined at 12 months, up to 149 pg/ml (122 pg/ml-180 pg/ml) at 60 months. When Mirena is used concomitantly with oral estrogen therapy, the plasma concentration of levonorgestrel, determined after 12 months, increases to approximately 478 pg / ml (25th-75th percentile: 341 pg / ml - 655 pg / ml), which is due to induction synthesis of SHPG.
Metabolism
Levonorgestrel is largely metabolized. The main metabolites in plasma are unconjugated and conjugated forms of 3α, 5β-tetrahydrolevonorgestrel. Based on the results of in vitro and in vivo studies, the main isoenzyme involved in the metabolism of levonorgestrel is CYP3A4. The isoenzymes CYP2E1, CYP2C19 and CYP2C9 may also be involved in the metabolism of levonorgestrel, but to a lesser extent.
breeding
The total clearance of levonorgestrel from blood plasma is approximately 1 ml / min / kg. In unchanged form, levonorgestrel is excreted only in trace amounts. Metabolites are excreted through the intestines and kidneys with an excretion rate of approximately 1.77. T 1/2 in the terminal phase, represented mainly by metabolites, is about a day.
Linearity/Nonlinearity
The pharmacokinetics of levonorgestrel depends on the concentration of SHBG, which, in turn, is influenced by estrogens and androgens. When using Mirena, a decrease in the average concentration of SHBG by approximately 30% was observed, which was accompanied by a decrease in the concentration of levonorgestrel in the blood plasma. This indicates the non-linearity of the pharmacokinetics of levonorgestrel over time. Given the predominantly local action of Mirena, the effect of changes in systemic concentrations of levonorgestrel on the effectiveness of Mirena is unlikely.
Indications
- contraception;
- idiopathic menorrhagia;
- prevention of endometrial hyperplasia during estrogen replacement therapy.
Contraindications
- pregnancy or suspicion of it;
- inflammatory diseases of the pelvic organs (including recurrent);
- infections of the external genital organs;
- postpartum endometritis;
- septic abortion within the last 3 months;
- cervicitis;
- diseases accompanied by increased susceptibility to infections;
- cervical dysplasia;
- diagnosed or suspected malignant neoplasms of the uterus or cervix;
- progestogen-dependent tumors, incl. ;
- uterine bleeding of unknown etiology;
- congenital and acquired anomalies of the uterus, incl. fibromyomas leading to deformation of the uterine cavity;
- acute liver disease, liver tumors;
- age over 65 years (no studies have been conducted in this category of patients);
- Hypersensitivity to the components of the drug.
Carefully and only after consultation with a specialist should the drug be used in the following conditions:
- congenital heart defects or heart valve disease (in view of the risk of developing septic endocarditis);
- diabetes.
Consideration should be given to removing the system if any of the following conditions are present or first occur:
- migraine, focal migraine with asymmetric loss of vision or other symptoms indicating transient cerebral ischemia;
- Unusually severe headache
- jaundice;
- severe arterial hypertension;
- severe circulatory disorders, incl. stroke and myocardial infarction.
Dosage
Mirena is injected into the uterine cavity. Efficiency is maintained for 5 years.
The release rate of levonorgestrel in vivo at the beginning of use is approximately 20 μg / day and decreases after 5 years to approximately 10 μg / day. The average rate of release of levonorgestrel is approximately 14 mcg / day for up to 5 years.
The Mirena IUD can be used in women receiving oral or transdermal estrogen-only hormone replacement therapy (HRT).
With the correct installation of Mirena, carried out in accordance with the instructions for medical use, the Pearl index (an indicator reflecting the number of pregnancies in 100 women using a contraceptive during the year) is approximately 0.2% for 1 year. The cumulative rate, reflecting the number of pregnancies in 100 women using a contraceptive for 5 years, is 0.7%.
Rules for the use of the Navy
Mirena is supplied in a sterile package, which is opened only immediately before the installation of the IUD. Asepsis must be observed when handling an opened system. If the sterility of the packaging appears to be compromised, the IUD should be disposed of as medical waste. The same should be done with the IUD removed from the uterus, since it contains hormone residues.
Insertion, removal and replacement of the IUD
Before installation Mirena drug woman should be informed about the effectiveness, risks and side effects of this IUD. It is necessary to conduct a general and gynecological examination, including an examination of the pelvic organs and mammary glands, as well as an examination of a smear from the cervix. Pregnancy and sexually transmitted diseases should be excluded, and inflammatory diseases of the genital organs should be completely cured. Determine the position of the uterus and the size of its cavity. If it is necessary to visualize the uterus before the introduction of the Mirena IUD, an ultrasound of the pelvic organs should be performed. After a gynecological examination, a special instrument, the so-called vaginal mirror, is inserted into the vagina, and the cervix is treated with an antiseptic solution. Mirena is then injected into the uterus through a thin, flexible plastic tube. The correct location of the Mirena preparation in the bottom of the uterus is especially important, which ensures a uniform effect of the progestogen on the endometrium, prevents the expulsion of the IUD and creates conditions for its maximum effectiveness. Therefore, you should carefully follow the instructions for installing Mirena. Since the technique of insertion in the uterus of different IUDs is different, special attention should be paid to working out the correct technique for inserting a particular system. The woman may feel the insertion of the system, but it should not cause her much pain. Before the introduction, if necessary, you can apply local anesthesia of the cervix.
In some cases, patients may have cervical stenosis. Do not apply excessive force when administering Mirena to such patients.
Sometimes after the introduction of the IUD, pain, dizziness, sweating and pallor of the skin are noted. Women are advised to rest for some time after Mirena is administered. If these phenomena do not go away after a half-hour stay in a calm position, it is possible that the IUD is not positioned correctly. A gynecological examination must be performed; if necessary, the system is removed. In some women, the use of Mirena causes allergic skin reactions.
The woman should be re-examined 4-12 weeks after insertion, and then once a year or more often if clinically indicated.
In women of reproductive age Mirena should be inserted into the uterine cavity within 7 days from the onset of menstruation. Mirena can be replaced with a new IUD on any day of the menstrual cycle. IUD can also be installed immediately after an abortion in the first trimester of pregnancy in the absence of inflammatory diseases of the genital organs.
The use of an IUD is recommended for women with a history of at least one birth. Installation of the Navy Mirena in the postpartum period should be carried out only after the complete involution of the uterus, but not earlier than 6 weeks after birth. With prolonged subinvolution, it is necessary to exclude postpartum endometritis and postpone the decision to administer Mirena until the involution is completed. In the event of difficulty inserting an IUD and/or severe pain or bleeding during or after the procedure, a pelvic exam and ultrasound should be performed immediately to rule out perforation.
For the prevention of endometrial hyperplasia when conducting HRT with drugs containing only estrogen, in women with amenorrhea, Mirena can be installed at any time; in women with preserved menstruation, the installation is performed in the last days of menstrual bleeding or withdrawal bleeding.
Delete Mirena preparation by gently pulling on the threads captured by the forceps. If the threads are not visible and the system is in the uterine cavity, it can be removed using a traction hook to remove the IUD. This may require the expansion of the cervical canal.
The system should be removed 5 years after installation. If a woman wants to continue using the same method, a new system can be installed immediately after the previous one is removed.
If further contraception is needed, in women of childbearing age, removal of the IUD should be performed during menstruation, provided that the menstrual cycle is maintained. If a system is removed in the middle of a cycle and a woman has had sexual intercourse within the previous week, she is at risk of becoming pregnant, unless the new system was installed immediately after the old one was removed.
The insertion and removal of an IUD can be accompanied by some pain and bleeding. The procedure may cause syncope due to vasovagal reaction, bradycardia or seizures in patients with epilepsy, especially in patients with a predisposition to these conditions or in case of cervical stenosis.
After removing Mirena, the system should be checked for integrity. In case of difficulties with the removal of the IUD, isolated cases of slipping of the hormonal-elastomer core on the horizontal arms of the T-shaped body were noted, as a result of which they were hidden inside the core. Once the integrity of the IUD is confirmed, this situation does not require additional intervention. Limiters on the horizontal arms usually prevent the core from completely separating from the T-body.
Special groups of patients
Children and teenagers Mirena is indicated only after the onset of menarche (establishment of the menstrual cycle).
women over the age of 65 therefore, the use of Mirena is not recommended for this category of patients.
Mirena is not a first choice drug for postmenopausal women under the age of 65 with severe uterine atrophy.
Mirena is contraindicated in women with acute diseases or tumors of the liver.
Mirena has not been studied in patients with impaired renal function.
Instructions for the introduction of the IUD
It is installed only by a doctor using sterile instruments.
Mirena is supplied with a guidewire in a sterile package that must not be opened prior to insertion.
Should not be re-sterilized. The IUD is for single use only. Mirena should not be used if the inner packaging is damaged or open. Mirena should not be installed after the month and year indicated on the package.
Before installation, you should read the information on the use of Mirena.
Preparation for the introduction
1. Conduct a gynecological examination to determine the size and position of the uterus and to exclude any signs of acute inflammatory diseases of the genital organs, pregnancy or other gynecological contraindications for the installation of Mirena.
2. The cervix should be visualized with the help of mirrors and the cervix and vagina should be completely treated with an antiseptic solution.
3. If necessary, use the help of an assistant.
4. Grab the anterior lip of the cervix with forceps. Straighten the cervical canal by gentle traction with forceps. The forceps must be in this position during the entire time of insertion of the Mirena preparation to ensure gentle traction of the cervix towards the inserted instrument.
5. Carefully moving the uterine probe through the cavity to the bottom of the uterus, you should determine the direction of the cervical canal and the depth of the uterine cavity (the distance from the external os to the bottom of the uterus), exclude septa in the uterine cavity, synechia and submucosal fibroma. If the cervical canal is too narrow, widening of the canal is recommended and pain medication/paracervical block may be used.
Introduction
1. Open the sterile package. After that, all manipulations should be carried out using sterile instruments and sterile gloves.
2. Move the slider forward at the very distant position in order to draw the IUD into the guide tube.
You should not move the slider in a downward direction, because. this may lead to premature release of Mirena. If this happens, the system will not be able to be placed inside the conductor again.
3. While holding the slider in the farthest position, set upper edge index ring in accordance with the measured probe distance from the external pharynx to the bottom of the uterus.
4. Keep holding the slider in the farthest position, you should advance the conductor carefully through the cervical canal into the uterus until the index ring is about 1.5-2 cm from the cervix.
Do not push the conductor with force. If necessary, expand the cervical canal.
5. Holding the conductor still, move the slider to the mark to open the horizontal shoulders of the Mirena preparation. You should wait 5-10 seconds until the horizontal hangers are fully opened.
6. Gently push the conductor inwards until index ring will not come into contact with the cervix. Mirena should now be in the fundal position.
7. Holding the conductor in the same position, release the Mirena preparation, moving the slider as far down as possible. While holding the slider in the same position, carefully remove the conductor by pulling on it. Cut the threads so that their length is 2-3 cm from the external os of the uterus.
If the doctor has doubts that the system is installed correctly, the position of Mirena should be checked, for example, using ultrasound or, if necessary, remove the system and insert a new, sterile system. The system should be removed if it is not completely in the uterine cavity. The remote system must not be reused.
Removal/replacement of Mirena
Before removing / replacing Mirena, read the instructions for use of Mirena.
The Mirena preparation is removed by gently pulling on the threads grasped by the forceps.
The doctor can install a new Mirena system immediately after removing the old one.
Side effects
In most women, after the installation of Mirena, a change in the nature of cyclic bleeding occurs. During the first 90 days of using Mirena, an increase in the duration of bleeding is noted by 22% of women, and irregular bleeding occurs in 67% of women, the frequency of these phenomena decreases to 3% and 19%, respectively, by the end of the first year of its use. At the same time, amenorrhea develops in 0%, and rare bleeding in 11% of patients during the first 90 days of use. By the end of the first year of use, the frequency of these phenomena increases to 16% and 57%, respectively.
When Mirena is used in combination with long-term estrogen replacement therapy in most women, cyclic bleeding gradually stops during the first year of use.
The following are data on the incidence of adverse drug reactions that have been reported with Mirena. Determining the frequency of adverse reactions: very often (≥1/10), often (from ≥1/100 to< 1/10), нечасто (от ≥1/1000 до <1/100), редко (от ≥1/10 000 до <1/1000) и с неизвестной частотой. Hежелательные реакции представлены по классам системы органов согласно MedDRA . Данные по частоте отражают приблизительную частоту возникновения нежелательных реакций, зарегистрированных в ходе клинических исследований препарата Мирена по показаниям "Контрацепция" и "Идиопатическая меноррагия" с участием 5091 женщин.
Adverse reactions reported during clinical trials of Mirena for the indication "Prevention of endometrial hyperplasia during estrogen replacement therapy" (involving 514 women) were observed with the same frequency, except for cases indicated by footnotes (*, **).
Often | Often | Infrequently | Rarely | Frequency unknown |
From the side of the immune system | ||||
Hypersensitivity to the drug or a component of the drug, including rash, urticaria and angioedema | ||||
Mental disorders | ||||
Depressed mood Depression |
||||
From the side of the nervous system | ||||
Headache | Migraine | |||
From the digestive system | ||||
Abdominal/pelvic pain | Nausea | |||
From the skin and subcutaneous tissues | ||||
acne hirsutism |
Alopecia Itching Eczema Skin hyperpigmentation |
|||
From the musculoskeletal system | ||||
Backache** | ||||
From the genital organs and mammary gland | ||||
Changes in the volume of blood loss, including an increase and decrease in the intensity of bleeding, "spotting" spotting, oligomenorrhea and amenorrhea Vulvovaginitis* Discharge from the genital tract* |
Pelvic infections ovarian cysts Dysmenorrhea Breast pain** Breast engorgement IUD expulsion (full or partial) |
Uterine perforation (including penetration) *** | ||
Laboratory and instrumental data | ||||
Elevated blood pressure |
* "Often" according to the indication "Prevention of endometrial hyperplasia during estrogen replacement therapy".
** "Very common" for the indication "Prevention of endometrial hyperplasia during estrogen replacement therapy".
*** This frequency is based on data from clinical studies that did not include women who were breastfeeding. In a large prospective, comparative, non-interventional cohort study of women using an IUD, uterine perforation in women who were breastfeeding or who had an IUD inserted up to 36 weeks postpartum was reported with an "infrequent" frequency.
MedDRA terminology is used in most cases to describe certain reactions, their synonyms, and related conditions.
Additional Information
If a woman with an established Mirena drug becomes pregnant, the relative risk of ectopic pregnancy increases.
The partner can feel the threads during intercourse.
The risk of breast cancer when Mirena is used for the indication "Prevention of endometrial hyperplasia during estrogen replacement therapy" is unknown. Cases of breast cancer have been reported (frequency unknown).
The following adverse reactions have been reported in connection with the insertion or removal of Mirena: pain during the procedure, bleeding during the procedure, insertion-related vasovagal reaction accompanied by dizziness or fainting. The procedure can provoke an epileptic seizure in patients suffering from epilepsy.
infection
Cases of sepsis (including group A streptococcal sepsis) have been reported following IUD insertion.
Overdose
With this method of application, an overdose is impossible.
drug interaction
It is possible to increase the metabolism of gestagens with the simultaneous use of substances that are enzyme inducers, especially isoenzymes of the cytochrome P450 system involved in the metabolism of drugs, such as anticonvulsants (for example, phenytoin, carbamazepine) and agents for the treatment of infections (for example, rifampicin, rifabutin, nevirapine, efavirenz). The effect of these drugs on the effectiveness of the drug Mirena is unknown, but it is assumed that it is not significant, since Mirena has a mainly local effect.
special instructions
Before installing Mirena, pathological processes in the endometrium should be excluded, since irregular bleeding / spotting is often noted in the first months of its use. Pathological processes in the endometrium should also be excluded if bleeding occurs after the start of estrogen replacement therapy in a woman who continues to use Mirena, previously prescribed for contraception. Appropriate diagnostic measures should also be taken when irregular bleeding develops during long-term treatment.
Mirena is not used for postcoital contraception.
Mirena should be used with caution in women with congenital or acquired valvular heart disease, bearing in mind the risk of septic endocarditis. When inserting or removing an IUD, these patients should be given antibiotics for prophylaxis.
Levonorgestrel in low doses can affect tolerance to, and therefore its plasma concentration should be regularly monitored in women with diabetes using Mirena. As a rule, dose adjustment of hypoglycemic drugs is not required.
Some manifestations of polyposis or endometrial cancer may be masked by irregular bleeding. In such cases, additional examination is necessary to clarify the diagnosis.
The use of intrauterine contraception is preferred in women who have given birth. IUD Mirenana should be considered as the method of choice in young nulliparous women and should be used only if it is impossible to use other effective methods of contraception. IUD Mirenana should be considered as the method of first choice in postmenopausal women with severe uterine atrophy.
Available data indicate that the use of Mirena does not increase the risk of developing breast cancer in postmenopausal women under the age of 50 years. Due to the limited data obtained during the Mirena study for the indication "Prevention of endometrial hyperplasia during estrogen replacement therapy", the risk of breast cancer when Mirena is used for this indication cannot be confirmed or refuted.
Oligo- and amenorrhea
Oligo- and amenorrhea in women of childbearing age develops gradually, in approximately 57% and 16% of cases by the end of the first year of using Mirena, respectively. If menstruation is absent within 6 weeks after the start of the last menstruation, pregnancy should be excluded. Repeat pregnancy tests for amenorrhea are not necessary unless there are other signs of pregnancy.
When Mirena is used in combination with permanent estrogen replacement therapy, most women gradually develop amenorrhea during the first year.
Inflammatory diseases of the pelvic organs
The guidewire helps protect Mirena from infection during insertion, and the Mirena injection device is specifically designed to minimize the risk of infection. Inflammatory diseases of the pelvic organs in women using intrauterine contraception are often caused by sexually transmitted infections. It has been established that the presence of multiple sexual partners is a risk factor for infections of the pelvic organs. Pelvic inflammatory disease can have serious consequences: it can impair fertility and increase the risk of ectopic pregnancy.
As with other gynecological or surgical procedures, severe infection or sepsis (including group A streptococcal sepsis) can develop after IUD insertion, although this is extremely rare.
With recurrent endometritis or inflammatory diseases of the pelvic organs, as well as with severe or acute infections that are resistant to treatment for several days, Mirena should be removed. If a woman has persistent pain in the lower abdomen, chills, fever, pain associated with sexual intercourse (dyspareunia), prolonged or heavy spotting/bleeding from the vagina, a change in the nature of the discharge from the vagina, you should immediately consult a doctor. Severe pain or fever that occurs shortly after IUD insertion may indicate a severe infection that needs to be treated promptly. Even in cases where only a few symptoms indicate the possibility of infection, bacteriological examination and monitoring are indicated.
Expulsion
Possible signs of partial or complete expulsion of any IUD are bleeding and pain. Contractions of the muscles of the uterus during menstruation sometimes lead to displacement of the IUD or even to pushing it out of the uterus, which leads to the termination of the contraceptive effect. Partial expulsion may reduce the effectiveness of Mirena. Since Mirena reduces menstrual blood loss, its increase may indicate the expulsion of the IUD. A woman is advised to check the threads with her fingers, for example, while taking a shower. If a woman finds signs of displacement or prolapse of the IUD or does not feel the threads, sexual intercourse or other methods of contraception should be avoided, and a doctor should be consulted as soon as possible.
If the position in the uterine cavity is incorrect, the IUD must be removed. At the same time, a new system can be installed.
It is necessary to explain to the woman how to check the threads of Mirena.
Perforation and penetration
Perforation or penetration of the body or cervix of the IUD is rare, mainly during insertion, and may reduce the effectiveness of Mirena. In these cases, the system should be removed. With a delay in diagnosing perforation and migration of the IUD, complications such as adhesions, peritonitis, intestinal obstruction, intestinal perforation, abscesses or erosion of adjacent internal organs can be observed.
In a large prospective comparative non-interventional cohort study in IUD users (n=61448 women), the incidence of perforation was 1.3 (95% CI: 1.1-1.6) per 1000 insertions in the entire study cohort; 1.4 (95% CI: 1.1-1.8) per 1000 injections in the Mirena study cohort and 1.1 (95% CI: 0.7-1.6) per 1000 injections in the copper IUD cohort.
The study demonstrated that both breastfeeding at the time of insertion and insertion up to 36 weeks postpartum were associated with an increased risk of perforation (see Table 1). These risk factors were independent of the type of IUD used.
Table 1. Perforation rate per 1000 insertions and hazard ratio stratified by breastfeeding and time postpartum at insertion (parous women, entire study cohort).
An increased risk of perforation with IUD insertion exists in women with fixed malposition of the uterus (retroversion and retroflexion).
Ectopic pregnancy
Women with a history of ectopic pregnancy, tubal surgery, or pelvic infection are at higher risk of ectopic pregnancy. The possibility of ectopic pregnancy should be considered in the case of lower abdominal pain, especially if it is combined with the cessation of menstruation, or when a woman with amenorrhea begins to bleed. The frequency of ectopic pregnancy when using Mirena is approximately 0.1% per year. In a large prospective comparative non-interventional cohort study with a follow-up period of 1 year, the incidence of ectopic pregnancy with Mirena was 0.02%. The absolute risk of ectopic pregnancy in women using Mirena is low. However, if a woman with an established Mirena drug becomes pregnant, the relative likelihood of an ectopic pregnancy is higher.
Loss of threads
If, during a gynecological examination, the threads for removing the IUD cannot be found in the cervical region, pregnancy must be excluded. The threads can be drawn into the uterine cavity or cervical canal and become visible again after the next menstruation. If pregnancy is excluded, the location of the threads can usually be determined using careful probing with an appropriate instrument. If the threads cannot be detected, perforation of the uterine wall or expulsion of the IUD from the uterine cavity is possible. To determine the correct location of the system, an ultrasound can be performed. If it is unavailable or unsuccessful, an X-ray examination is performed to determine the localization of the Mirena preparation.
ovarian cysts
Since the contraceptive effect of Mirena is mainly due to its local action, women of childbearing age usually experience ovulatory cycles with rupture of the follicles. Sometimes the atresia of the follicles is delayed, and their development can continue. These enlarged follicles are clinically indistinguishable from ovarian cysts. Ovarian cysts have been reported as an adverse reaction in approximately 7% of women using Mirena. In most cases, these follicles do not cause any symptoms, although sometimes they are accompanied by pain in the lower abdomen or pain during intercourse. As a rule, ovarian cysts disappear on their own within two to three months of observation. If this does not happen, it is recommended to continue monitoring with ultrasound, as well as carrying out therapeutic and diagnostic measures. In rare cases, it is necessary to resort to surgical intervention.
The use of Mirena in combination with estrogen replacement therapy
When using the drug Mirena in combination with estrogens, it is necessary to additionally take into account the information specified in the instructions for use of the corresponding estrogen.
Excipients contained in Mirena
The T-shaped base of the Mirena preparation contains barium sulfate, which becomes visible on x-ray.
It must be borne in mind that Mirena does not protect against HIV infection and other sexually transmitted diseases.
Influence on the ability to drive vehicles and control mechanisms
Not observed.
Additional information for patients
Regular checkups
The doctor should examine you 4-12 weeks after the insertion of the IUD, and then regular medical examinations are required at least once a year.
Consult your doctor as soon as possible if:
You no longer feel the threads in the vagina.
You can feel the lower end of the system.
You assume you are pregnant.
You experience persistent abdominal pain, fever, or a change in your normal vaginal discharge.
You or your partner experience pain during intercourse.
You have noticed sudden changes in your menstrual cycle (for example, if you had few or no periods and then had persistent bleeding or pain, or if your periods became excessively heavy).
You have other medical problems, such as migraine headache or severe recurring headache, sudden visual disturbances, jaundice, high blood pressure, or any of the other diseases and conditions listed in the "Contraindications" section.
What to do if you are planning a pregnancy or want to remove the drugMirenafor other reasons
Your doctor can easily remove the IUD at any time, after which pregnancy becomes possible. Usually, the removal is painless. After removal of the Mirena drug, reproductive function is restored.
When pregnancy is not desired, Mirena should be removed no later than day 7 of the menstrual cycle. If Mirena is removed later than the seventh day of the cycle, use barrier methods of contraception (for example, a condom) for at least 7 days before removing it. If there is no menstruation when using Mirena, 7 days before the removal of the IUD, you should start using barrier methods of contraception and continue their use until menstruation resumes. You can also install a new IUD immediately after removing the previous one; in this case, no additional measures of protection against pregnancy are required.
How long can Mirena be used
Mirena provides protection against pregnancy for 5 years, after which it should be removed. If you wish, you can install a new IUD after removing the old one.
Restoration of the ability to conceive (Is it possible to become pregnant after stopping the use of Mirena?)
Yes, you can. Once Mirena is removed, it will no longer interfere with your normal reproductive function. Pregnancy may occur during the first menstrual cycle after Mirena is removed
Effects on the menstrual cycle (Can Mirena affect your menstrual cycle?)
Mirena drug affects the menstrual cycle. Under its influence, menstruation can change and acquire the character of "smearing" discharge, become longer or shorter, flow with more abundant or less than usual bleeding, or stop altogether.
In the first 3-6 months after the installation of Mirena, many women experience, in addition to their normal menstruation, frequent spotting or scanty bleeding. In some cases, very heavy or prolonged bleeding is noted during this period. If you experience any of these symptoms, especially if they persist, tell your doctor.
It is most likely that with the use of Mirena, the number of days of bleeding and the amount of blood lost will gradually decrease every month. Some women eventually find that their periods have completely stopped. Since the amount of blood lost during menstruation with the use of Mirena usually decreases, most women experience an increase in hemoglobin in the blood.
After removing the system, the menstrual cycle is normalized.
No periods (Is it normal not to have periods?)
Yes, if you are using Mirena. If, after installing Mirena, you noted the disappearance of menstruation, this is due to the effect of the hormone on the uterine mucosa. There is no monthly thickening of the mucous membrane, therefore, it is not rejected during menstruation. This does not necessarily mean that you have reached menopause or that you are pregnant. The plasma concentration of your own hormones remains normal.
In fact, the absence of menstruation can be a big advantage for a woman's comfort.
How can you know you are pregnant
Pregnancy in women using Mirena, even if they do not have menstruation, is unlikely.
If you haven't had a period in 6 weeks and you're concerned about it, take a pregnancy test. If the result is negative, no further tests are needed unless you have other signs of pregnancy such as nausea, fatigue, or breast tenderness.
Can Mirena cause pain or discomfort?
Some women experience pain (similar to menstrual cramps) for the first 2-3 weeks after IUD insertion. If you feel severe pain, or if the pain continues for more than 3 weeks after the system was installed, contact your doctor or the hospital where you had Mirena installed.
Does Mirena affect sexual intercourse?
Neither you nor your partner should feel an IUD during intercourse. Otherwise, sexual intercourse should be avoided until your doctor is satisfied that the system is in the correct position.
How much time should elapse between the installation of Mirena and sexual intercourse
The best way to give your body a rest is to refrain from sexual intercourse for 24 hours after Mirena is inserted into the uterus. However, Mirena has a contraceptive effect from the moment of installation.
Can tampons be used
What happens if Mirena spontaneously passes out of the uterine cavity?
Very rarely, during menstruation, IUD expulsion from the uterine cavity can occur. An unusual increase in blood loss during menstrual bleeding may mean that Mirena has fallen out through the vagina. Partial expulsion of the IUD from the uterine cavity into the vagina is also possible (you and your partner may notice this during intercourse). With the complete or partial exit of Mirena from the uterus, its contraceptive effect immediately stops.
What signs can be used to judge that the Mirena drug is in place
You can check for yourself if the Mirena threads are in place after your period has ended. After the end of menstruation, carefully insert your finger into the vagina and feel for the threads at the end of it, near the entrance to the uterus (cervix).
Shouldn't be pulled threads, because You may accidentally pull Mirena out of your uterus. If you can't feel the threads, see your doctor.
Pregnancy and lactation
Pregnancy
The use of the drug Mirena is contraindicated in pregnancy or suspicion of it.
Pregnancy in women who have Mirena installed is extremely rare. But if the IUD falls out of the uterus, the woman is no longer protected from pregnancy and must use other methods of contraception before consulting a doctor.
During the use of Mirena, some women do not have menstrual bleeding. The absence of menstruation is not necessarily a sign of pregnancy. If a woman does not have periods, and at the same time there are other signs of pregnancy (nausea, fatigue, soreness of the mammary glands), then it is necessary to consult a doctor for examination and a pregnancy test.
If pregnancy occurs in a woman during the use of Mirena, it is recommended to remove the IUD, because. any IUD left in situ increases the risk of spontaneous abortion and preterm birth. Removing Mirena or probing the uterus can lead to spontaneous abortion. If careful removal of the intrauterine contraceptive is not possible, medical abortion should be discussed. If a woman wants to keep the pregnancy and the IUD cannot be removed, the patient should be informed about the possible risk of septic abortion in the second trimester of pregnancy, postpartum purulent-septic diseases that can be complicated by sepsis, septic shock and death, as well as the possible consequences of premature birth for the child. In such cases, the course of pregnancy should be carefully monitored. An ectopic pregnancy must be ruled out.
A woman should be explained that she should inform the doctor about all symptoms suggesting complications of pregnancy, in particular, the appearance of spastic pain in the lower abdomen, bleeding or bloody discharge from the vagina, and fever.
The hormone contained in the Mirena preparation is released into the uterine cavity. This means that the fetus is exposed to a relatively high local concentration of the hormone, although through the blood and the placental barrier the hormone enters it in small quantities. Due to intrauterine use and local action of the hormone, the possibility of a virilizing effect on the fetus must be taken into account. Due to the high contraceptive efficacy of Mirena, clinical experience related to pregnancy outcomes with its use is limited. However, the woman should be informed that at this point in time there is no evidence of congenital effects caused by the use of Mirena in cases of continuation of pregnancy until delivery without removal of the IUD.
breastfeeding period
Breastfeeding a child while using Mirena is not contraindicated. About 0.1% of the dose of levonorgestrel can enter the child's body during breastfeeding. However, it is unlikely that it poses a risk to the child at doses released into the uterine cavity after the installation of Mirena.
It is believed that the use of Mirena 6 weeks after birth does not adversely affect the growth and development of the child. Monotherapy with gestagens does not affect the quantity and quality of breast milk. Rare cases of uterine bleeding have been reported in women using Mirena during lactation.
Fertility
After the removal of the drug Mirena in women, fertility is restored.
For impaired liver function
Contraindicated in acute liver diseases, liver tumors.
Terms of dispensing from pharmacies
The drug is dispensed by prescription.
Terms and conditions of storage
The drug should be stored out of the reach of children, protected from light at a temperature not exceeding 30°C. Shelf life - 3 years.
The Mirena plastic coil contains progesterones in the core, which are secreted daily into the carrier's body at a dosage of 25 mcg. This principle of action provides a quick and effective treatment of endometrial pathologies and guarantees high-quality protection against unwanted pregnancy.
The IUD includes a core made up of hormonal substances and a plastic case in the form of the letter "T". The soft shell prevents the active components from leaking, due to which the medicine enters the body evenly.
Threads are fixed at the end of the case, with their help the Mirena hormonal coil is removed. The device is inserted into a tube that allows you to easily and quickly install the device inside the vagina.
The composition of the hormonal intrauterine device Mirena includes levonorgestrel.
After implantation, the hormone at a dosage of 25 mcg is released daily into the uterine cavity. After 3 years of use, the concentration of the drug drops to 15 mcg per day. One spiral contains 53 mg of the drug substance.
How does it work
Protection against unwanted pregnancy is achieved through a small but constant local inflammation, which develops due to the introduction of the device inside. This reaction of the body does not allow the endometrium to gain a foothold for the implantation of the embryo.
The device operates as follows:
- Inhibits the natural growth of the endometrium;
- The uterine glands begin to work weaker;
- The submucosal layer thickens.
In addition, the Mirena intrauterine plastic spiral thickens the natural mucus in the uterine cavity, which prevents the embryos from fixing to the walls. The hormonal components of the drug inhibit the activity of spermatozoa, prevent their penetration into the egg.
Advantages and disadvantages
The advantages of the device include:
- Effective therapeutic effect;
- Long-term protection against fertilization;
- Soft effect of active substances on organs;
- Rapid recovery of reproductive functions;
- Quick installation;
- Prevention and treatment of various types of pathologies.
- The price of one spiral is from 12 thousand rubles;
- There is a risk of menorrhagia;
- High risk of inflammation with frequent changes of sexual partner;
- If the device is installed incorrectly, internal bleeding is possible;
- Abundant menstruation after the introduction;
- Does not protect against infectious pathologies.
Intrauterine hormonal coil "Mirena" is recommended:
- To protect against fertilization;
- With menorrhagia of the idiopathic type;
- As a prevention of gynecological pathologies.
Most often, the Mirena hormonal plastic coil is installed to control menorrhagia. Pathology is characterized by severe internal bleeding due to the absence of the endometrium. Blood loss is noticeably reduced already within 5-6 months of regular use of the device.
Contraindications
The IUD is contraindicated in the detection of:
- pregnancy;
- Infectious diseases of the urinary system;
- Precancerous formations on the reproductive organs;
- Intrauterine bleeding of unknown origin;
- Deformations of the uterine walls due to a large tumor;
- Pathological failure of the menstrual cycle;
- Pathological condition of the liver;
- In old age (after 60 years);
- Allergic reaction to components of Mirena analogues.
In addition, Mirena should be used with caution when:
- hypertension;
- myocardial infarction;
- Diabetes mellitus 1-2 degree;
- Diseases of the cardiovascular system;
- Migraines of unknown etiology.
If there is at least one of the contraindications, after installing the spiral, you should carefully monitor the state of health. If you experience any side effects or if you feel worse, contact your gynecologist.
Installation
It is forbidden to introduce the Mirena spiral on your own without the help of a gynecologist. Before installation, the patient must take tests and undergo diagnostics to check if there are any contraindications.
The following diagnostic measures are prescribed:
- Blood and urine analysis;
- HCG analysis;
- Gynecological and surgical examination;
- Blood test for the detection of genital infections;
- Ultrasound of the reproductive organs;
- Colposcopy.
When the Mirena intrauterine device is introduced as a contraceptive, the procedure is carried out during the first week of a new cycle. If the installation is done for treatment, then the day does not matter. In the postpartum period, a spiral can be inserted one month after childbirth, when the uterus recovers. The day of the procedure is scheduled individually.
The whole procedure takes no more than 25 minutes. The doctor inserts a speculum into the uterine cavity. The walls of the uterus are treated with an antiseptic preparation for disinfection, after which a spiral is inserted through the cervix using a special tube.
After installation
After the introduction of the spiral, the patients complain that menstruation decreases or stops completely.
When using the device, the disappearance of menstruation is normal. The core of the device contains hormones that stop the growth of the endometrium. Therefore, menstruation becomes scarce or stops altogether.
The opposite effect is also possible after the installation of the IUD, the amount of menstruation released can increase by 2-3 times. Abundant discharge is observed for the first 40-50 days. No need to worry, this is also a normal reaction to the release of hormones in the female body.
Adverse reactions
Mostly adverse reactions appear due to the restructuring of the menstrual cycle. There may also be negative reactions from the nervous system:
- Migraine;
- Aggressiveness;
- Irritability;
- Mood swings.
The annotation to the device states that if a negative reaction occurs, additional drug therapy is not needed. All symptoms disappear 1–2 months after implantation.
It is worth seeking help from a gynecologist only in case of the following symptoms:
- Complete absence of menstruation for 60 days;
- Acute pain in the lower abdomen that is permanent;
- Fever;
- Pain and discomfort during sex;
- Changes in color, smell and consistency of secretions;
- During menstruation, a large amount of blood is released .
Complications
An invasive procedure using a hormonal system can cause a number of complications. Therefore, before installing the spiral, it is worth exploring the options for negative reactions associated with the installation of a contraceptive.
The most common complication is the loss of the spiral from the uterine cavity. Expulsion usually occurs during the menstrual cycle. To avoid this, it is recommended to regularly check the threads after menstruation.
Expulsion is accompanied by pain in the groin and profuse bleeding. After falling out or displacement, Mirena no longer has a therapeutic effect on the body. Therefore, during intercourse, pregnancy can occur.
Perforation
When using Mirena, penetration of the uterine wall is rarely observed. Most often, this can happen due to improper installation of the spiral, or if the girl has recently given birth and is breastfeeding. If the spiral is installed too early after childbirth, injuries to the uterine walls are possible.
infections
The risk of infection increases after insertion of the device, when the uterine cavity becomes inflamed. During this period, the reproductive organs are susceptible to infection, so doctors do not recommend changing sexual partners and often having sex.
If an infectious disease is detected during the diagnosis, then the IUD is not installed. Infections are the main contraindication. Also, a complication due to the use of Mirena is considered an ectopic pregnancy, amenorrhea or ovarian cyst.
Removal and replacement
After 3-4 years, the spiral must be changed or removed, since the release of the hormone from the core of the device into the uterine cavity ends.
The extraction of funds is done on the 2nd day of menstruation to prevent accidental fertilization and infectious diseases. If the Mirena coil was removed on the 15-17th day of the cycle and a new one was not introduced, the risk of conception increases.
The intrauterine plastic spiral Mirena is removed with threads. If they were not in the vagina, then the spiral is taken out with tweezers.
Removing the device may make you feel unwell. The condition is a completely adequate response to the cessation of the release of hormones into the blood and normalizes after a few hours.
Possibility of conception
The onset of an unplanned pregnancy with an established spiral is not uncommon. If the pregnancy is confirmed, you need to check whether the embryo is properly fixed. If the implantation of the embryo was successful, further actions are discussed with the pregnant woman on an individual basis.
If the pregnant woman decides to continue bearing, then the spiral is removed.
A coil left in the uterine cavity for the period of bearing a fetus increases the risk of miscarriage or premature birth. In some cases, the coil cannot be safely removed. Then there is the question of induced abortion. If the procedure is refused, the doctor informs the patient that in the future there may be problems with the child's health.
If the spiral has not been removed and has been in the uterus throughout the pregnancy, secondary sexual characteristics may appear in the fetus. However, this phenomenon is extremely rare.
Keeping pregnancy, a woman should be regularly examined by a gynecologist. If you experience suspicious symptoms (pain, bleeding, fever), you should immediately seek medical help.
After childbirth
Endometriosis is a pathology in which the intrauterine functional layer constantly grows, going beyond the organ cavity. The most serious complication of the disease is infertility. At the initial stages, the disease is asymptomatic, at a more serious stage it is manifested by acute pain and menstrual irregularities. Pathology requires competent treatment. The Mirena spiral proved to be extremely effective for endometriosis. The drug is produced by the famous German brand Bayer.
Mirena is a T-shaped intrauterine device (IUD). Inside the plastic capsule is a hormonal preparation, which is gradually released into the uterine cavity. This synthetic hormone prevents the endometrium from growing. The agent is contained in a dosage calculated for an effective effect for five years.
The peculiarity of the Mirena spiral lies in the local effect. The composition enters the body in a localized manner, which allows the use of smaller doses of the drug than in the treatment of tablets. The procedure for inserting an IUD takes no more than 10-15 minutes, it is completely painless and safe. Extraction of the element is carried out as prescribed by the doctor. For this, special threads are attached to the device on one side.
Spiral with endometriosis leads to significant changes in the female body. The levonorgestrel contained in the capsule effectively stops the growth of endometrioid tissue cells.
Using the device also allows you to:
- regulate the menstrual cycle;
- reduce the amount of bleeding during menstruation;
- eliminate discharge between periods;
- eliminate pain syndrome.
If endometriosis is at the initial stage and proceeds in a mild form, the action of the spiral helps to completely eliminate the foci. Within 3-5 days after the insertion of the IUD, women experience heavy spotting, but they soon pass. A sign of effective treatment is the complete disappearance of bleeding.
Side effects and contraindications
Before putting a spiral as a treatment for endometriosis, it is necessary to establish what side effects this method of hormone therapy causes. The presence of a foreign body in the uterine cavity can cause an inflammatory process. An acidic environment is created in the body, which slows down the movement of sperm to the egg.
If the situation worsens and inflammation causes a threat to health, you should urgently seek help from a specialist.
Mirena, like any hormone-containing drug, can cause a reaction in the body. The body does not always respond well to the IUD, often the installation of the element causes such side effects as:
- nausea and vomiting;
- migraine;
- depression;
- swelling of the mammary glands;
- increased irritability;
- hair loss and acne;
- acute pain in the lumbar region.
Such symptoms are not a reason to extract the spiral.
Within 1-2 cycles, the body adapts and stops reacting negatively to the spiral, unpleasant symptoms will disappear by themselves. A more serious complication from the use of the IUD is the perforation of the walls of the uterus and the development of an ectopic pregnancy. Also, the coil can spontaneously come out through the vagina.
Another risk is the development of thrombosis and thrombophlebitis. This condition causes the action of gestagens. The appearance of symptoms of varicose veins or other pathologies associated with the formation of blood clots is the reason for contacting a medical institution.
Mirena is not always used to treat endometriosis. There are a number of circumstances in which the drug should not be used.
Contraindications include:
- individual intolerance to the components;
- pregnancy and lactation;
- the presence of inflammation and infections in the uterus;
- oncological formations;
- bleeding;
- decreased immunity;
- liver disease.
Is it possible to put a spiral, the doctor decides. To decide, he pre-assigns a woman a series of tests, ultrasound, performs a thorough gynecological examination and collects anamnesis.
Advantages and disadvantages of the method
The use of the German Mirena spiral in the complex therapy of endometriosis has supporters and opponents. Opinions are mixed, because the technique has its pros and cons.
The advantages of the Navy include:
- contraceptive effectiveness;
- high-quality therapeutic effect;
- reduction of blood loss during menstruation.
It is these facts that are fundamental when prescribing Mirena to women with endometriosis. The disadvantages of the technique are the high cost of the device, the presence of side effects, possible changes in the menstrual cycle.
It should be noted that the disadvantages are indirect, because the purchase of hormonal pills every month in total will be more expensive than one Mirena for five years. Side effects after 1-2 months pass without third-party intervention. Changes in the menstrual cycle come down to a decrease in bleeding, which will positively affect patients with anemia and low hemoglobin.
To prevent the development of complications after the installation of the IUD, it is necessary to take preventive measures. They consist in a systematic visit and consultation with a doctor. It is necessary to apply for a scheduled examination a week after the manipulation, then a month later, then another six months later.
Mirena is installed in women of reproductive age, as well as in the period of premenopause and menopause. In such cases, the device helps to cope with the unpleasant symptoms of aging and inhibition of sexual function. For women over the age of 50, the spiral is not used if they have pathologies of the cardiovascular system, severe diabetes and cancerous tumors.
Methods of contraception are different. Some women use oral contraceptives to prevent unwanted pregnancies. Others use a condom, while others resort to injectable protection methods. There are also special patches and rings that prevent the fertilization process. And far from the last place in this list is the spiral. The Mirena system has been especially popular lately. Side effects from its use are not felt by all women. Some simply do not notice the spiral and consider it an excellent contraceptive.
Composition and description
The Mirena intrauterine device not only protects against unwanted pregnancy, but also heals. It contains the hormonal substance levonorgestrel in the amount of 52 ml. The secondary component in the composition of the spiral is polydimethylsiloxane elastomer.
The appearance of the intrauterine therapeutic system resembles the letter "T" placed in a special conductor tube, which has a white core and has an elastomeric-hormonal filling. The body of the spiral is equipped on one side with a loop, on the other - with two shoulders. Threads are attached to the loop, with the help of which the spiral is removed from the vagina.
Pharmacological properties
The Mirena therapeutic intrauterine device (side effects from using the product are described in detail in the instructions for use, and they should be studied before using the system) has a local gestagenic effect by releasing levonorgestrel into the cavity of the uterine environment. This makes it possible to use the hormonal substance in the minimum daily dosage.
Over time, levonorgestrel accumulates in the endometrium, and its high content reduces the sensitivity of progesterone and estrogen receptors. As a result, the endometrium does not perceive estradiol and has an antiproliferative effect.
IUD "Mirena" (side effects and contraindications before using the therapeutic system must be taken into account) when used, it affects morphological changes in the endometrium. It causes a rather weak reaction of the body to the presence of a foreign body. Affects the thickening of the lining of the cervical canal, which prevents sperm from entering the uterus. The spiral prevents the process of fertilization, inhibits the activity of spermatozoa, their motor functions. There are women in whom the product inhibits ovulation.
The use of "Mirena" does not have a negative impact on the reproductive apparatus of a woman. As a rule, after the removal of the spiral, a woman becomes pregnant within a year.
At first, using a therapeutic intrauterine system may be disturbed by spotting. Over time, the inhibition of the endometrium leads to a decrease in the duration of menstruation and a decrease in their abundance. The effect of the spiral on the woman's body does not affect the functioning of the ovaries and the amount of estradiol in plasma.
It is allowed to use a spiral in the treatment of idiopathic menorrhagia, but on condition that the woman does not have gynecological and extragenital diseases, as well as ailments with severe hypocoagulation.
After 90 days after the insertion of the spiral into the uterus, the volume of menstrual flow decreases by 88%. If there is menorrhagia, which was caused by fibroids, then the result of treatment with a therapeutic system is not pronounced. Reducing the duration of menstruation reduces the likelihood of iron deficiency anemia. Reduces negative symptoms in dysmenorrhea.
Indications and contraindications
What other reviews can you hear about Mirena? Side effects are very rare. According to women, the spiral can cause negative symptoms not only because of its incorrect use, but also because of the individual intolerance of the body. In this case, doctors advise to remove the therapeutic system and select other methods of contraception.
The main indications for the use of the Mirena therapeutic system (side effects after using this spiral are observed in many women, only in some women they disappear over time, while in others the negative symptoms worsen, which forces the woman to abandon this medical product) are protection from unwanted pregnancy and idiopathic menorrhagia. The intrauterine device is recommended to prevent endometrial hyperplasia, which can occur with estrogen replacement treatment.
The use of "Mirena" should be abandoned during pregnancy and if there is even the slightest suspicion of it. Do not use a spiral for gynecological inflammatory diseases. The intrauterine system should be abandoned if there are diseases of the genitourinary system, postpartum endometritis, cervical dysplasia, as well as malignant and benign formations in the body are observed.
Do not use a spiral after a septic abortion, with cervicitis, bleeding of various origins, abnormalities of the uterine organ, liver diseases and hypersensitivity to the components that are part of the therapeutic system.
"Mirena" should be used only after consulting a specialist if the patient suffers from migraine, severe headaches and if there is arterial hypertension. With extreme caution, a spiral is used for jaundice, circulatory disorders and after a stroke, myocardial infarction.
It is believed that in small doses levonorgestrel is able to penetrate into the milk of a nursing mother, but if the child is six weeks old, he is not able to harm the baby. Therefore, for the use of the spiral during breastfeeding, additional specialist advice is required.
"Mirena". Instructions for use, dosage
The spiral is inserted into the uterine cavity. Its term of operation is five years. At the very beginning of the use of the spiral, the daily release rate of levonorgesgrel is 20 mcg. Over time, this figure decreases. Five years later, it is 11 mcg per day. The approximate average daily rate of release of a hormonal substance is 14 mcg.
The therapeutic uterine system can be used in women who have used hormone replacement therapy in their treatment. The most important thing is that the drugs used in the treatment contain estrogen, and not a progestogen. If the Mirena spiral is installed properly, then it is 0.1%.
The Mirena product is sold in sterile packaging. If at the time of purchase the product did not have sterile packaging, then it should not be used. It is also not necessary to store spirals removed from the cervix, as they still have remnants of the hormonal substance.
The sterile packaging of the spiral is opened only before the introduction of the product into the body of a lady. Only an experienced doctor with relevant experience in this field should install Mirena. Before introducing a therapeutic system, the doctor must familiarize the lady with contraindications and possible negative phenomena. Conduct a gynecological examination. Take a gynecological smear. Send the lady for a blood test. The doctor examines the mammary glands before installing the Mirena product. Side effects (the instruction warns of all the negative consequences that often occur after the introduction of the spiral) will be minimized if the patient is examined and the therapeutic system is installed correctly.
During the examination of the patient, it is necessary to exclude pregnancy, as well as ailments of an infectious and inflammatory nature. All detected diseases must be eliminated before the introduction of the spiral into the body of a woman.
Before inserting the spiral, the uterus and the parameters of its cavity are studied. It is considered correct to find "Mirena" at the bottom of the uterine organ. In this case, a uniform effect of the active substance of the product on the uterine environment is ensured.
The first time a lady after installing a spiral is examined after 3 months, then once a year. If necessary, the patient is examined more often.
If a woman is of childbearing age, then the spiral is established within seven days from the beginning of critical days. Mirena can be replaced with another intrauterine device at any convenient time. It is allowed to install an IUD immediately after an abortion, which was made in the first trimester.
After delivery, the spiral is allowed to be inserted six months after the involution of the uterus. If the involution occurs with a delay, then you should wait for its completion. If the insertion of an IUD occurs with complications, severe pain, or is accompanied by bleeding, an ultrasound should be performed as soon as possible to rule out the possibility of perforation.
With estrogen replacement therapy, to maintain the functions of the endometrium, women with a diagnosis of amenorrhea have the Mirena coil installed at any time. In patients with prolonged menstruation, the therapeutic system is administered in the last days of menstruation. The spiral is not used for postcoital contraception.
The Mirena therapeutic system is removed carefully by pulling the threads with forceps. If the threads could not be found, then a traction hook is used to extract the spiral. Sometimes the cervix needs to be dilated to remove the IUD.
The system, if there are no side effects, is removed after five years. If the lady wants to continue to use this method of contraception, then a new spiral is introduced immediately after the removal of the previous system.
Hormonal spiral "Mirena". Side effects
Negative symptoms in patients may appear in the first days after the introduction of the therapeutic system into the uterus. So the body gets used to the foreign element. As a rule, if the spiral is used for a long time, then the side effects soon disappear.
Quite often, side effects after installing Mirena are the following symptoms:
- bleeding, both vaginal and uterine;
- discharge of a smearing bloody character;
- ovarian cysts;
- oligo- and amenoria;
- bad mood and nervousness;
- decrease in sexual desire;
- migraine;
- pain in the lower abdomen and in the back;
- nausea;
- acne rashes;
- tension and soreness in the region of the mammary glands;
- weight gain;
- hair loss;
- swelling.
If negative phenomena appear, you should consult a gynecologist. When using the Mirena therapeutic system, many side effects appear almost immediately, but gradually the body gets used to the foreign element.
special instructions
Women during treatment with the Mirena therapeutic system should pay attention to the appearance of signs of venous thrombosis. When they appear, it is recommended to consult a doctor and take all measures to treat this disease.
Many women have experienced side effects when using the therapeutic system. Reviews of the Mirena IUD note that when using this method of contraception, women increased weight and acne appeared on the skin. If negative symptoms appear, the contraceptive should be removed from the body and replaced with another.
With caution, the spiral should be used by women with problems with the valves of the heart organ. In this case, there is a risk of septic endocarditis. Such patients, on the days of the manipulations associated with the installation and removal of the spiral, are prescribed a course of antibiotics to prevent the onset of this disease.
Small doses of levonorgestrel can affect glucose tolerance, so women with diabetes should have regular blood sugar tests when using the spiral.
In 20% of cases, Mirena can cause oligo- and amenorrhea. If menstruation does not appear in a lady for more than six months, then pregnancy must be completely excluded. Amenorrhea in women can be observed throughout the year if the spiral is used along with other hormonal agents in estrogen replacement therapy.
VCM "Mirena" is removed for infectious and bacterial diseases of the vagina, endometritis, pain and bleeding. The therapy system should be removed from the uterus if it is placed incorrectly.
About how to check the threads of the product, the doctor notifies the woman immediately after he has installed the Mirena spiral. According to reviews, the side effects after the introduction of the IUD should alert the lady. When they appear, you should immediately visit a doctor to exclude possible complications and pathologies. Many patients are satisfied with the contraceptive, as it affects the absence of heavy periods and reliable contraception for five years of operation.
The cost of an intrauterine device
The Mirena spiral not only protects against unwanted pregnancy, but also heals. This explains the increased interest of women in this product. You can buy it at a pharmacy. The cost of a therapeutic vaginal system ranges from 9-12 thousand rubles.