Dr. Ahmed
Mirena and PCOS: Because Mirena IUD is commonly used by women to control bleeding and menstrual problems, discussing Mirena for PCOS is important.
PCOS is a very common problem affecting up to 13% of women in their reproductive age group. Menstrual irregularities are part and parcel of PCOS.
Women with PCOS opt for different contraceptive and hormonal treatments to:
- Regularize their menstrual cycles
- Reduce pain and discomfort during the menstrual cycles
- Reduce symptoms of high testosterone such as acne, facial hair, frontal balding, and thick pubic hair.
- Prevent pregnancy or conceive easily after stopping the contraceptives.
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How Mirena might help women with PCOS to have regular cycles or pain-free cycles?
Mirena and Kyleena contain different doses of Levonorgestrel which is a progestin hormone. Progestin hormone is said to have fewer side effects compared to Estradiol or estrogens.
In addition, progestin hormones, especially the 3rd and 4th generation progestins, have slight anti-androgenic activity as well.
Antiandrogenic activity is one desirable side effect of progestins.
Because women with PCOS need a drug that can reduce their testosterone levels, progestins either in the form of oral contraceptives or as IUDs are commonly utilized.
Mirena or Kyleena are indicated as second-line drugs for the treatment of heavy and painful periods in women after oral progestin-containing contraceptives.
Mirena is indicated for the treatment of heavy menstrual bleeding and preventing pregnancy. It is effective for up to 5 years when used to control heavy periods and for up to 8 years when the primary indication is to prevent pregnancy [Ref]
Mirena, apart from keeping the cycles lighter or less painful, also keeps the endometrial lining healthy. This is in contrast to most estrogen-containing combined oral contraceptives which keep the endometrial lining in an overstimulated state.
Women who used Mirena had a variable response. Some women had severe cramps during insertion and during the first few months of inserting Mirena.
Others were very satisfied and happy and had lighter and painless periods. In addition, the risk of endometrial carcinoma is reduced in women who are using Mirena compared to those who are on estrogen-containing contraceptives.
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Mirena and Cysts:
Mirena IUD has been associated with ovarian cysts in about 8% of women [Ref]. Although these cysts are not as dangerous and usually transient, they may be associated with pain and discomfort during sex.
Because women with PCOS have their ovaries filled with cysts, Mirena can make them worse during the first few months.
Knowing this is essential to make an informed consent and expect slight discomfort during the first three months.
If the pelvic pain and the cysts persist or enlarge on repeat ultrasound, it is important to seek advice.
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Mirena and Periods:
Mirena can change how you bleed during your period. It might cause spotting, irregular periods, heavy periods, periods that are far apart (oligomenorrhea), or even stop your periods altogether (amenorrhea).
In the first 3-6 months of using Mirena, you might have more days of bleeding or spotting, and your periods might not follow a regular pattern.
After that initial period, the number of bleeding and spotting days usually goes down, but your periods may still be irregular.
If you notice unusual bleeding while using Mirena for a long time, it’s a good idea to get checked by a doctor to ensure there’s no problem with your uterus.
About 20% of women using Mirena stop having periods within a year. If your period stops and you’re worried about being pregnant, it’s a good idea to take a pregnancy test.
If it’s negative and you have no other signs of pregnancy or pelvic pain, you typically don’t need to keep taking pregnancy tests.
For women who have heavy periods, the number of bleeding and spotting days might increase in the first few months of using Mirena but usually gets better with time, and the amount of blood you lose during your period tends to decrease.
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Does Mirena Help in Treating Acne and Facial Hair in Women with PCOS?
Acne and hirsutism are common with hormonal contraceptives. With progestin-containing contraceptives, these problems are relatively less compared to estrogen-containing contraceptives.
In studies, as mentioned in the manufacturer’s labeling, about 6.8% of the women developed acne and less than 5% developed hirsutism and excessive facial hair [Ref]
It is likely that a greater percentage of women with PCOS might develop acne and hirsutism compared to women without PCOS.
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Is Mirena Better than Kyleena or Nexplanon?
Mirena and Kyleena, both contain Levonorgestrel while Nexplanon has etonogestrel.
Levonorgestrel and etonogestrel are both progestin contraceptives. Hence, all these three intrauterine devices have a similar mechanism of action.
However, Kyleena has less amount of the active drug and hence may be indicated for women who require little hormones.
These may include women who are underweight, adolescents, women who are breastfeeding, and women with underlying medical conditions.
Nexplanon, unlike Mirena and Kyleena, has a more advanced form of progestin hormone, Etonongestrel.
Nexplanon is a subcutaneous implant that is put in the arm rather than the uterus. It is less painful and has little androgenic activity compared to Mirena and Kyleena and may be more useful in women with PCOS.
In addition to being less painful, its anti-androgenic activity might help women heal their acne, and facial hair, and cure their male-like baldness.
However, women have a mixed response and no one IUD is preferred over another.
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In Conclusion:
Mirena is a progestin-containing highly potent IUD for preventing pregnancy and controlling heavy menstrual periods.
It is one of the preferred IUDs in women with PCOS because it has little androgenic activity. However, it is best to consult and discuss the PROS and CONS of Mirena and other IUDs and implants.
