Bleeding after Mirena insertion. Mirena intrauterine device: reviews from doctors

This is an intrauterine therapeutic system, which includes:

• Active substance: levonorgestrel 52 mg (gestagen).
• Excipient: polydimethylsiloxane elastomer 52 mg.

The IUD is placed in a guide tube. The system consists of a white or off-white hormone-elastomer core placed on a T-shaped body and covered with an opaque membrane that regulates the release of levonorgestrel.

The T-shaped body has a loop at one end and two arms at the other. Threads are attached to the loop to remove the system. The system and conductor are free of visible impurities.

Mirena is a T-shaped intrauterine device (IUD) that, once inserted into the uterus, releases the hormone levonorgestrel directly into the uterine cavity.

The system is made T-shaped to fit the shape of the uterus as best as possible. The vertical part of the T-shaped body carries a cylinder containing the hormone. At the lower end of the vertical part there is a loop to which two threads are tied to remove the system.

The vertical part of the T-shaped body contains the hormone levonorgestrel, similar to one of the hormones produced by the woman's body.

The system releases levonorgestrel into the woman's body at a constant rate, but in very small quantities (20 micrograms, i.e. 20 millionths of a gram, per day).

Mirena prevents pregnancy by controlling the monthly development of the inner lining of the uterus so that this lining does not reach a thickness sufficient for pregnancy; at the same time, the normal mucous membrane of the cervical canal (the entrance to the uterus) thickens, and therefore sperm cannot enter the uterus and fertilize the egg.

Mirena prevents the movement of sperm into the uterus, preventing fertilization.

Effectiveness of Mirena

In terms of its effectiveness as a contraceptive, Mirena is comparable to sterilization of a woman. It is as effective as today's most effective copper-containing intrauterine devices and oral contraceptives (birth control pills).

Studies (clinical trials) have found that over the course of a year, for every 1,000 women using Mirena, there are only two pregnancies.

In women with excessive menstrual bleeding, Mirena causes a significant reduction in its intensity within three months after insertion into the uterus. Some women stop bleeding altogether.

Indications

Mirena is used for contraception (prevention of pregnancy), treatment of excessive menstrual bleeding and to prevent excessive growth of the lining of the uterus during replacement therapy estrogens.

Contraindications

Mirena should not be used for any of the following conditions.

• Pregnancy or suspicion of it.
• Existing or recurrent inflammatory diseases pelvic organs.
• Infections of the lower genitourinary tract.
• Postpartum endometritis.
• Septic abortion within the last three months.
• Cervicitis.
• Diseases accompanied by increased susceptibility to infections.
• Cervical dysplasia.
• Malignant neoplasms of the uterus or cervix.
• Progestogen-dependent tumors, including breast cancer.
• Pathological uterine bleeding of unknown etiology.
• Congenital or acquired anomalies of the uterus, including fibroids, leading to deformation of the uterine cavity.
• Acute liver diseases or tumors.
• Hypersensitivity to the components of the drug.

Use with caution

Mirena can be used with caution after consultation with a specialist, or your doctor may discuss the need to remove it if you have, or shortly after insertion of the system into the uterus, one of the following conditions:

• migraine, focal migraine with asymmetric vision loss or other symptoms indicating transient cerebral ischemia;
• unusually strong headache;
• jaundice;
• severe arterial hypertension;
• severe circulatory disorders, including stroke and myocardial infarction.

Pregnancy and breastfeeding

Pregnancy in women who have Mirena installed is extremely rare. But if Mirena passes out of the uterus, you are no longer protected from pregnancy and should use other methods of contraception until you talk to your doctor.

While using Mirena, some women experience no menstrual bleeding. The absence of menstruation does not necessarily indicate pregnancy. If you are not menstruating and have other signs of pregnancy (nausea, fatigue, breast tenderness), you should see your doctor for an examination and a pregnancy test.

If you become pregnant while using Mirena, Mirena should be removed as soon as possible. Leaving Mirena in your uterus during pregnancy increases the risk of miscarriage, infection, or premature birth. You can also discuss the suitability of a medical abortion. The hormone contained in Mirena is released into the uterine cavity. This means that the fetus is exposed to a relatively high local concentration of the hormone, although the hormone enters it in small quantities through the blood and placenta.

Currently, the effect of such amounts of the hormone on the fetus is unknown, since cases of pregnancy in women with Mirena in the uterus are very rare. Due to the intrauterine use and local action of the hormone, it is necessary to take into account the possibility of a virilizing effect on the fetus. However, to date there is no evidence of birth defects caused by the use of Mirena in cases where pregnancy was maintained until natural birth.

You can breastfeed your baby while using Mirena. Levonorgestrel has been found in trace amounts in the breast milk of nursing women. About 0.1% of the levonorgestrel dose may enter the child's body during breastfeeding. None dangerous influences Mirena was not observed to affect the growth and development of the child when used six weeks after birth. Mirena does not affect the quantity or quality of breast milk.

Directions for use

Before inserting Mirena, a vaginal smear may be taken, a mammary gland examination may be performed, and, if necessary, other studies may be carried out, for example, aimed at identifying infections, including sexually transmitted infections. To determine the position and size of the uterus, a gynecological examination should be performed.

Mirena can be inserted into the uterus no later than seven days after the start of menstrual bleeding.

It can also be installed in the uterus immediately after a medical abortion; in this case, the doctor must be sure that there is no genital infection.

Mirena should not be placed until six weeks after birth.

It can be replaced new system any day menstrual cycle.

Mirena is not used as a contraceptive used after sexual intercourse (as a “fire contraception”).
To protect the lining of the uterus during estrogen replacement therapy, Mirena can be placed at any time in women with amenorrhea (who do not menstruate); In women with continued menstruation, Mirena is installed in the last days of menstrual bleeding or “withdrawal” bleeding.

How to install Mirena

After a gynecological examination, a special instrument, the so-called vaginal speculum, is inserted into the vagina and the cervix is ​​treated with an antiseptic solution.

Mirena is then inserted into the uterus through a thin, flexible plastic tube. You may feel the insertion of the system, but it should not cause you much pain. Before administration, if necessary, you can apply local anesthesia cervix.

Some women experience pain and dizziness after insertion of the system. If, after staying in a quiet position for half an hour, these phenomena do not go away, it is possible that the intrauterine system is not positioned correctly.

A gynecological examination must be performed; if necessary, the system is removed.

With correct installation of Mirena, carried out in accordance with the instructions for use, the Pearl index (an indicator reflecting the number of pregnancies in 100 women using a contraceptive for 1 year) is about 0.2%.

The cumulative rate reflecting the number of pregnancies in 100 women using contraceptives for 5 years is 0.7%.

Side effects

Side effects most often develop in the first months after Mirena is inserted into the uterus; with prolonged use they gradually disappear.
Very common side effects (seen in more than 10% of women using Mirena) include uterine/vaginal bleeding, spotting spotting, oligo- and amenorrhea, benign ovarian cysts.

The average number of days of spotting in women of childbearing age gradually decreases from nine to four days per month during the first six months after IUD insertion. The number of women with prolonged (more than eight days) bleeding decreases from 20 to 3% in the first three months of using Mirena. IN clinical studies It was found that in the first year of Mirena use, 17% of women experienced amenorrhea lasting at least three months.

When Mirena is used in combination with estrogen replacement therapy, most peri- and postmenopausal women experience spotting and irregular bleeding in the first months of treatment. Subsequently, their frequency decreases, and in approximately 40% of women receiving this therapy, bleeding completely disappears in the last three months of the first year of treatment.

Changes in bleeding patterns are more common in the perimenopausal period than in the postmenopausal period. The frequency of detection of benign ovarian cysts depends on the diagnostic method used. According to clinical trials, enlarged follicles were diagnosed in 12% of women who used Mirena.

In most cases, the enlargement of follicles was asymptomatic and disappeared within three months.

Possible side effects when using Mirena:

• Headache, migraine
• Decreased mood
• Nervousness
• Decreased libido
• Stomach ache
• Nausea
• Back pain
• Vulvovaginitis
• Breast tension
• Breast tenderness

If any of the above or others develop side effects you should consult a doctor.

Interaction with other drugs

If you use any medications (such as antiepileptic drugs) for a long time, you should tell your doctor.

The metabolism of gestagens may be enhanced by concomitant use of substances that are enzyme inducers, especially cytochrome P450 isoenzymes involved in the metabolism of drugs, such as anticonvulsants (for example, phenobarbital, phenytoin, carbamazepine) and drugs for the treatment of infections (for example, rifampicin, rifabutin, nevirapine , efavirenz).

The effect of these drugs on the effectiveness of Mirena is not known, but it is believed that it is not significant since Mirena has mainly local effects.

Special instructions

The results of some recent studies indicate that women taking progestogen-only contraceptives may have a slight increase in the risk of venous thrombosis; however, these results are not well defined.

However, if signs of thrombosis of veins and arteries appear, you should immediately consult a doctor.

Symptoms of venous or arterial thrombosis include:

• unilateral leg pain and/or swelling in the leg;
• sudden severe pain in chest, regardless of whether it gives to the left hand;
• sudden severe breathing problems;
• sudden cough;
• unusually severe, prolonged headache;
• sudden partial or complete loss of vision;
• double vision; slurred or difficult speech; dizziness; collapse (sometimes with convulsive seizure);
• weakness or very significant loss of sensation that suddenly appears on one side or in one part of the body;
• movement disorders; sharp pain in the abdomen.

Signs of a blood clot forming in the blood vessels of the eye include unexplained partial or complete loss of vision and any other unexplained visual disturbances.

It has not yet been established whether there is a connection between varicose veins or superficial thrombophlebitis (inflammation of the veins with the formation of a blood clot) with the phenomenon of venous thromboembolism.

Women who have not given birth

Mirena is not the first choice for young women who have never been pregnant or for postmenopausal women with age-related shrinkage of the uterus.

Infections

The guide tube helps protect the Mirena from contamination by microorganisms during insertion into the uterus, and the Mirena guide tube is designed to minimize the risk of infection.

Despite this, the risk of pelvic infection immediately after insertion of the system into the uterus and for the next four months is increased. Infections of the pelvic organs in patients using intrauterine systems are often classified as sexually transmitted diseases.

The risk of infection increases if a woman or her partner has multiple sexual partners.

If a pelvic infection is detected, it should be treated immediately. These infections can impair fertility and increase the risk of ectopic pregnancy in the future.

In case of recurrent infection of the pelvic organs or their acute infection resistant to treatment for several days, Mirena should be removed.

If you have persistent pain in the lower abdomen, fever, pain associated with sexual intercourse, or unusual bleeding, consult your doctor immediately.

Expulsion (prolapse of the intrauterine system)

Contractions of the uterine muscles during menstruation sometimes lead to the displacement of the intrauterine system or even to its expulsion from the uterus, which leads to the cessation of contraceptive action. TO possible symptoms prolapse includes pain and bleeding that is unusual for you.

If Mirena has moved into the uterine cavity, its effectiveness is reduced. It is recommended to check the threads with your fingers, for example when you take a shower.

If you notice signs of displacement or prolapse of the intrauterine system or cannot feel the threads, you should avoid sexual intercourse or use other methods of contraception, and consult a doctor as soon as possible.

Mirena reduces the intensity of menstrual bleeding; an increase in their intensity may indicate a loss of the system.

Perforation and penetration

In extreme in rare cases As a rule, during insertion into the uterus, Mirena can penetrate the wall of the uterus (penetration) or pierce through it (perforation, or perforation), which can reduce the effectiveness of Mirena.

An intrauterine system that has moved beyond the uterine cavity is ineffective and should be removed as soon as possible.

There may be an increased risk of uterine perforation when an IUD is inserted shortly after birth.

Ectopic pregnancy

Pregnancy occurs extremely rarely when using Mirena. The incidence of ectopic pregnancy with Mirena is approximately 0.1% per year. If you become pregnant while using Mirena, the fetus may be outside the uterus (ectopic pregnancy).

Ectopic pregnancy is a serious pathological condition that requires immediate medical intervention. The risk of ectopic pregnancy is increased in women who have previously had an ectopic pregnancy, or who have had surgery to fallopian tubes ah or pelvic organ infections.

The following symptoms may indicate that you have an ectopic pregnancy and you need to see a doctor immediately.

• Disappearance of menstrual cycles, followed by constant bleeding or pain.
• Wandering or very severe pain in the lower abdomen.
• Signs normal pregnancy combined with bleeding and a feeling of dizziness.

Weakness

Some women experience dizziness after Mirena insertion. This is a normal physiological reaction. Doctors suggest that women rest for some time after Mirena insertion.

Increased size of ovarian follicles

Since the contraceptive effect of Mirena is due mainly to its local action, women of childbearing age usually maintain the ovulatory cycle with follicle rupture. Sometimes the degeneration of the follicle is delayed and its development may continue.

In most cases, this condition is asymptomatic, although sometimes it manifests as pain in the pelvic area or pain during sexual intercourse. Enlarged follicles sometimes require medical intervention, although they usually disappear on their own.

Heart defects

Mirena should be used with caution in women with congenital or acquired heart defects due to the risk of infectious inflammation of the heart muscle. Such patients should undergo a prophylactic course of antibiotic treatment when installing or removing Mirena.

Diabetes mellitus

Women with diabetes mellitus and those using Mirena, it is necessary to regularly determine the level of glucose in the blood. However, as a rule, there is no need to change therapeutic prescriptions in women with diabetes using Mirena.

When to consult a doctor

Regular checkups

You should be examined by your doctor 4-12 weeks after the IUD is inserted, and thereafter regular check-ups are required at least once a year.

Consult your doctor as soon as possible if:

• You no longer feel the threads in your vagina.
• You can feel the lower end of the system.
• You think you are pregnant.
• You experience persistent abdominal pain, fever, or notice unusual vaginal discharge.
• You or your partner feel pain during sexual intercourse.
• You notice sudden changes in your menstrual cycle (for example, if you had light or no periods and then developed constant bleeding or pain, or your periods became excessively heavy).
• You have other medical problems, such as migraine headaches or severe recurring headaches, sudden changes in vision, jaundice, high blood pressure.

What to do if you want to get pregnant

Your doctor can easily remove the intrauterine system at any time, after which pregnancy becomes possible. Removal is usually painless. After Mirena is removed, reproductive function is restored.

When pregnancy is not desired, Mirena should be removed no later than the seventh day of the menstrual cycle. If Mirena is removed later than the seventh day of the cycle, you should use barrier methods of contraception (for example, a condom) for at least seven days before its removal.

If there is no menstruation while using Mirena, seven days before removal of the intrauterine system you should start using barrier contraceptive methods and continue their use until menstruation resumes.

You can also install a new Mirena immediately after removing the previous one; in this case, no additional measures to prevent pregnancy are required.

How long can you use Mirena?

Mirena provides protection against pregnancy for five years, after which it should be removed.

If you wish, you can install a new Mirena after removing the old one.

Can I get pregnant after stopping use?

Yes, you can. Once Mirena is removed, it no longer affects your normal fertility. Pregnancy may occur during the first menstrual cycle after Mirena removal.

Can Mirena affect your menstrual cycle?

Mirena affects the menstrual cycle. Under its influence, menstruation may change and acquire the character of spotting, become longer or shorter, occur with more or less bleeding than usual, or stop altogether.
In the first 3-6 months after Mirena installation, many women experience, in addition to their normal menstruation, frequent spotting or scanty bleeding.

In some cases, very heavy or prolonged bleeding is observed during this period. If you experience these symptoms, especially if they do not go away, tell your doctor.

It is most likely that when using Mirena, the number of days of bleeding and the amount of blood lost will gradually decrease with each month.

Some women eventually find that their periods have stopped completely. Since the amount of blood lost during menstruation usually decreases when using Mirena, most women experience an increase in hemoglobin levels in their blood.
After the system is removed, the menstrual cycle returns to normal.

Is it normal to not have periods (missing periods)?

Yes, if you use Mirena.

If after installing Mirena you notice the disappearance of menstruation, this is due to the effect of the hormone on the inner lining of the uterus. There is no monthly thickening of the inner lining, therefore nothing comes out of the uterus as menstruation.

This does not necessarily mean that you have reached menopause or that you are pregnant. The levels of your own hormones in your blood remain normal. In fact, not having periods can be a great benefit to a woman's health.

How can you tell if you are pregnant?

Women using Mirena are unlikely to become pregnant, even if they are not menstruating.
If you haven't had your period for six weeks and are concerned, take a pregnancy test. If the result is negative, there is no need to do further tests unless you have other signs of pregnancy, such as nausea, fatigue or breast tenderness.

Can Mirena cause pain or discomfort?

Some women experience pain (like menstrual pain) in the first two to three weeks after installation of the intrauterine system. If you experience severe pain or if pain continues for more than three weeks after the system was installed, contact your doctor or the healthcare facility where you had Mirena installed.

Does Mirena affect sexual intercourse?

Neither you nor your partner should feel the intrauterine system during sexual intercourse. Otherwise, intercourse should be avoided until your doctor is sure that the system is in the correct position.

How much time should pass between Mirena installation and sexual intercourse?

To give your body a rest, it is best to abstain 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 I use tampons?

What happens if Mirena spontaneously leaves the uterine cavity?

Very rarely, Mirena may be pushed out during menstruation. An unusual increase in blood loss during menstrual bleeding may mean that Mirena has slipped out through the vagina.

It is also possible that Mirena may partially exit the uterine cavity into the vagina (you and your partner may notice this during sexual intercourse).

If Mirena leaves the uterus completely or partially, contraceptive effect stops immediately.

What signs can be used to judge that Mirena is in place?

You can check for yourself whether the Mirena threads are still in place after your period has ended.

After your period ends, carefully insert your finger into your vagina and feel the threads at the end, near the entrance to the uterus (cervix).
You should not pull on the threads as you may accidentally pull the Mirena out of the uterus. If you cannot feel the threads, consult a doctor.

A fairly popular method of contraception is to use intrauterine device. This method has undoubted advantages over others: there is no need to remember about contraception, long-lasting contraceptive effect, high efficiency. The use of the Mirena intrauterine device has become widespread. Let's consider the principle of its action and the effect of this contraceptive on the female body.

The Mirena intrauterine device is a method hormonal contraception. This means that it contains the hormone levonorgestrel, which is contained in the elastic cylinder (rod) of the spiral and is gradually released from it at a certain speed.

The daily intake of this into a woman’s body provides a contraceptive effect.

Mirena reliably protects against pregnancy for 5 years. This IUD is a reversible method of contraception. After its removal, the reproductive function of the female body is completely restored.

Mirena is a T-shaped type of IUD, which most closely matches the shape of the uterus and helps to conveniently and securely place the IUD in its cavity. Special threads are attached to the lower edge of the rod, with the help of which the system can be removed.

Levonorgestrel is a synthetic hormone similar in structure to progesterone, produced by the female body. Thanks to its effect, the mucus on the cervix becomes very thick, which is a natural obstacle for sperm.

In a viscous environment, their mobility is sharply limited, and they cannot enter the uterine cavity, therefore, fertilization does not occur.

In addition, under the influence of this hormone, thickening of the endometrium does not occur. This means that even if fertilization occurs, the embryo will not be able to implant into the wall of the uterus and develop further.

In addition to the contraceptive effect, Mirena produces a therapeutic effect. After its installation, menstrual blood loss is reduced by almost 90%, and in some women it stops altogether.

This is mainly good for women with excessively heavy periods or those who suffer from iron deficiency anemia due to menstrual blood loss. Mirena is also effective for endometrial hyperplasia.

Thus, the use of the Mirena IUD is not only a reliable method of contraception, but can also simultaneously take part in the treatment of certain diseases.

Indications for use and contraindications

Indications for use

• prevention of unplanned pregnancy
• heavy menstrual bleeding (menorrhagia)
• prevention of excessive growth of the endometrium during estrogen replacement therapy

But installation of the Mirena IUD is not indicated for every woman. The most important contraindication is pregnancy or suspicion of it.

Therefore, any woman, before the planned insertion of an IUD into the uterine cavity, must undergo a test, which will reliably show the presence or absence of pregnancy.

Other conditions prohibiting the use of Mirena are:

• inflammatory diseases of the pelvic organs
• infectious diseases of the genitourinary tract and cervix
• cancer of the uterus or cervix
• presence of hormone-dependent tumors
• dysplasia
• vaginal bleeding with unknown causes
• acute diseases
• infection that develops in the uterus after an abortion
• increased sensitivity to components of the intrauterine system

Typically, adverse reactions are most noticeable in the first months of using the intrauterine system. Over time, many of them go away on their own without requiring additional therapy.

Adverse reactions

• changes in the menstrual cycle (decrease/increase in menstrual flow, spotting, cessation, increase/decrease in cycle, pain during menstruation)
• instability of the psycho-emotional background, headaches, decreased libido
• abdominal pain, nausea, bloating
• appearance, allergic rash, itching, hair loss
• pain in the back and pelvic area, tenderness and tension of the mammary glands
• weight gain, edema
• prolapse of the IUD (if installed incorrectly)
• perforation of the uterine wall

If the installed IUD is not effective, an ectopic pregnancy may occur.

1-3 months after installation of the Mirena system, a woman needs to undergo an examination. Further, medical examinations should be regular, at least once a year (preferably once every six months). This is a necessary condition to prevent the development of inflammatory processes in the pelvic organs.

The dosage of the hormone entering a woman’s body from the Mirena system does not pose a danger to the development of the child. Therefore, you can use the intrauterine device as a method of contraception while breastfeeding, but not earlier than 6 weeks after birth.

Mirena spiral for endomeriosis

The Mirena spiral is used not only as a means of protection against unplanned pregnancy. It is used to treat certain diseases that are influenced by hormones. These diseases include endometriosis (proliferation of the mucous membrane).

The main local effect that the Mirena system has is the suppression of excessive growth of the endometrium, as a result of which it becomes impossible for a fertilized egg to attach to it.

This effect is used in the treatment of women with endometrial hyperplasia. Typically, with this disease, women suffer from heavy and prolonged menstrual bleeding, severe painful sensations during menstruation.

As a result of using the Mirena hormonal system, women's cycles normalize, the duration and amount of bleeding is reduced, they decrease, and often disappear altogether.

In addition, in uncomplicated forms of endometriosis, after using Mirena, there is a decrease in concomitant inflammatory processes and a reverse development of foci of pathology up to complete normalization of the mucous membrane.

Within 1-3 months after Mirena installation, bleeding may temporarily increase, but after this period it becomes short-lived and scanty, and sometimes stops.

Stopping bleeding with endometriosis is a positive thing, since the absence of monthly cyclic changes in the uterine cavity allows the endometrium to recover completely and avoid recurrent pathology in the future.

Not all women with endometrial hyperplasia are eligible for treatment with Mirena.

Contraindications

• period of pregnancy and breastfeeding
• infectious and inflammatory processes in the pelvic organs
• oncological diseases
• bleeding from unknown causes
• defects in the structure of the uterus (both congenital and acquired)
• severe liver dysfunction

There may be other conditions that prevent the installation of the Mirena IUD for treatment. Before inserting the IUD, it is imperative to undergo examinations, which your attending physician will tell you in more detail.

More details about modern methods You will learn about contraception, including the Mirena spiral, from the proposed video.

Thus, the Mirena system is reliable contraceptive, very convenient to use, after which the reproductive function of the female body is completely restored. The main thing is that the indications for installing the IUD do not contradict the woman’s health status. Therefore, for those who decide to use Mirena as a long-term contraceptive or for the treatment of diseases, it is mandatory to undergo a thorough medical examination.

What is an IUD?

An intrauterine device (IUD) is a small plastic device inserted into the uterus to prevent pregnancy. Modern models are made of plastic and contain metal or medicinal product(copper, silver, gold or progestin).

What types of intrauterine devices are there?

Modern intrauterine devices are small plastic or plastic-metal devices. Their dimensions reach approximately 3x4 cm. Typically, copper, silver or gold are used to make spirals.

The appearance of most spirals resembles the shape of the letter “T”. The T-shaped shape of the spirals is the most physiological, as it corresponds to the shape of the uterine cavity.

1-27 — variants of spiral shapes. One thing in common is that they all act as a “foreign body”.

28 - Lipps loop. Spirals of this exact shape were common in the USSR. They were produced in three sizes. It was very inconvenient to insert them, since the disposable conductor, which is now attached to each spiral and is made of transparent polymer, was missing; they used a metal conductor, with which it was difficult to control the insertion process. Therefore, complications such as perforation (perforation) of the uterus occurred more often than at present.

29-32 — T-shaped spirals or “teshki” are modern modifications of metal-containing spirals. 33 - also “teshka”. An extremely convenient option for insertion and removal. Due to the fact that the “shoulders” are pulled into the conductor, the manipulation is almost painless.

34-36 - multi-loud or umbrella coils. They perform their function perfectly, but when inserting and removing them, the cervical canal is often injured. There are also cases of defragmentation (when the “hangers” come off the rod).

Which spirals are better?

There is no ideal spiral that would suit everyone without exception. This issue is decided by the gynecologist individually for each woman.

How does the IUD work?

The effect of the IUD consists of several factors:

• thickening of cervical mucus (i.e. mucus of the cervical canal), which makes it difficult for sperm to penetrate into the uterine cavity;
• a change in the properties of the endometrium (the mucous membrane of the uterine cavity), which makes it unsuitable for the implantation (of) an egg;
• due to the effect of a foreign body, peristalsis of the fallopian tubes increases, which accelerates the passage of the egg through them, during which time it does not have time to reach the degree of maturity required for implantation.

How to use an IUD?

During a short, simple procedure, the doctor inserts an IUD into the uterine cavity.

If you want to make sure that the IUD is in the uterus, you can insert your fingers into the vagina and feel the plastic strings attached to the IUD.

If pregnancy is desired, you can ask your doctor to remove the IUD. Your fertility will be restored immediately.

What are the advantages of this method of contraception?

• High efficiency, comparable to the effectiveness of hormonal contraceptives. To some extent, the IUD is more reliable hormonal pills, since there is no danger of missing pills. When using the IUD, absolutely no action is required on the part of the woman to maintain the contraceptive effect, and, therefore, any possibility of error or accident is eliminated.
• Provides protection from pregnancy for a long time (from 5 to 7 years depending on the type of IUD).
• Use is not associated with sexual intercourse.
• Compared to all other contraceptive methods, the intrauterine device is the cheapest contraceptive method. Despite the fact that the cost of one spiral is many times higher than the cost of one package birth control pills or one regular package of condoms, recalculating its cost for 5 years (the usual period of wearing one coil) shows its undeniable superiority in economic terms.
• Unlike birth control pills, metal or plastic IUDs, which do not contain hormones, have absolutely no overall “hormonal” effect on the body, which many women (in some cases justifiably) fear. For this reason, IUDs, which do not contain hormones, are recommended as the primary method of birth control for women over 35 years of age who are active smokers or have other conditions that make the use of birth control pills impossible but require a very high level of protection against unwanted pregnancy.
• The spiral is not felt at all during sexual intercourse and does not interfere with partners.

What are the disadvantages of the method?

• Unlike, for example, a condom, an IUD does not protect against sexually transmitted diseases.
• Installation and removal of the IUD should only be performed by a doctor.
• After installation of the IUD, it is possible side effects.

What side effects might there be?

Installation of an intrauterine device can lead to some complications, but not all women wearing the device develop complications. Modern research show that more than 95% of women wearing IUDs consider them to be a very good and convenient method of contraception and are satisfied with their choice.

During or immediately after installation (for all types of spirals):

• Perforation of the uterus (extremely rare);
• Development of endometritis (very rare).

During the entire period of use of the spiral (for metal-containing or plastic spirals without hormones):

• Menstruation may become heavier and more painful.
• There may be bloody vaginal discharge between periods.
• Women with sexually transmitted infections (STIs) are at greater risk of developing pelvic inflammatory disease.
• In some cases, expulsion (complete or incomplete loss) of the IUD from the uterus is possible.

When should an IUD not be installed?

Contraindications for installing the IUD are determined by a gynecologist. Only a specialist can determine exactly how safe it is to install a spiral in your case.

An IUD cannot be installed if:

• You think you might be pregnant.
• You have more than one sexual partner.
• There is an acute form of inflammatory diseases of the cervix or pelvic organs, including STIs.
• Over the past three months, inflammatory diseases of the pelvic organs have been observed.
• Vaginal bleeding of unknown origin is observed.
• There is a fast-growing one, also if the myomatous node deforms the uterine cavity.
• There is cancer of the genital organs.
• There is a severe form of anemia (hemoglobin<90 г/л).

• There is a high risk of contracting an STI.

How to prepare for installing a spiral?

The procedure for inserting an intrauterine device cannot be performed in the presence of any sexually transmitted infections or other gynecological diseases, therefore, before installing the device, the gynecologist conducts a general gynecological examination, taking smears to determine the degree of cleanliness of the vagina and a smear for oncocytology, in some cases an ultrasound is necessary. research. If any infections or gynecological diseases are detected, the insertion of the IUD is postponed until cured.

Before installing the spiral:

How to behave after inserting the IUD?

Within 7-10 days after installing the spiral, you cannot:

• Have sex;
• Do douching;

After 7-10 days it is necessary to undergo a follow-up examination.

Be sure to see your doctor sooner if:

• Within a few days of inserting the IUD, you have a fever, very heavy vaginal bleeding, abdominal pain, or an unusual vaginal discharge with a foul odor.
• Any time after inserting the IUD, you feel the IUD in your vagina, notice that the IUD has moved or fallen out, or if you notice a 3-4 week delay in your period.

What is the follow-up?

If menstruation does not occur within 4-6 weeks after insertion of the IUD, seek advice. You should contact us for a preventive examination at least once a year, and at any time if you have questions or problems.

What symptoms should you see a doctor for?

Application is necessary if:

• You suspect pregnancy.
• You have heavy vaginal bleeding (heavier or longer than usual).
• You experience severe abdominal pain;
• pain is felt and bleeding occurs during sexual intercourse.
• There are signs of infection, unusual vaginal discharge, chills, and fever.
• You cannot feel the IUD strings or feel that they are shorter or longer than before.

Will there be any changes in how you feel and the nature of your menstruation after the insertion of an IUD?

After installing IUDs without hormones, the following changes are possible:

• Your periods become more painful, slightly longer, and more abundant than before the IUD was installed.
• Spotting bloody discharge from the vagina may be observed, before or after menstruation, sometimes (less often) and in the interval between two menstruation.
• In some cases, due to increased pain during menstruation and irregular bleeding, women are forced to stop using the IUD and remove it before the end of the period.

After installing the IUD with hormones (in particular):

• There may be a significant shortening of menstruation and a decrease in the total amount of bleeding during menstruation.
• Approximately 20% of women using Mirena experience complete disappearance of menstruation (amenorrhea). The restoration of menstruation in this case occurs only after the IUD expires and is removed from the uterus. It is reliably known that the disappearance of menstruation in women using Mirena is not associated with inhibition of the ovaries (as with the use of oral contraceptives), but with the suppression of the development of the uterine mucosa by small doses of hormones.
• Despite the fact that many women are afraid of the disappearance of their periods, there is no reason to consider it dangerous to health. Moreover, this effect of hormonal IUDs may even be beneficial, since it significantly improves a woman’s quality of life and is an effective method of treating anemia, which many women with long and heavy periods have. The Mirena IUD is used to treat severe uterine bleeding.

How is the intrauterine device removed?

Removal is usually done after 5-7 years (depending on the modification of the spiral). But if the woman wishes, this can be done at any time. The reason may be the desire to become pregnant or the occurrence of any complications.

Before removal, the same examination is carried out as before insertion of the spiral. If necessary, vaginal sanitation (improvement) is prescribed.

Removal is done by pulling the spiral tendrils at a certain angle. In some cases, for example, in the case of wearing a spiral beyond the prescribed period, removal must be carried out in a hospital setting, with anesthesia, by curettage of the uterine cavity.

Within 4-5 days after removing the IUD you cannot:

• Have sex;
• Use vaginal tampons (you can use regular pads);
• Do douching;
• Take a bath, visit a sauna or steam bath (you can take a shower);
• Engage in heavy physical labor or intense exercise.

Removing the IUD does not cause changes in the menstrual cycle. The exception is the Mirena IUD, when worn, there is an absence of menstruation or scanty cyclic bleeding. After Mirena removal, the menstrual cycle usually returns in about 3-6 months.

Be sure to consult a doctor if, within a few days after removing the IUD, you have a fever, very strong vaginal bleeding, abdominal pain, or unusual vaginal discharge with an unpleasant odor.

Is it possible to remove the spiral yourself?

Do not under any circumstances try to do this!

The spiral is removed by pulling on the tendrils, which may break before it is removed. After this, the IUD can only be removed instrumentally and only by penetrating the uterine cavity. In addition, the mustache may break as the spiral passes through the cervical canal and it will get stuck there. Take my word for it, it is very painful.

To remove the IUD, be sure to consult a gynecologist.

How often should the coil be changed?

Metal-containing spirals (for example, copper or gold) can be used for 5-7 years without replacement. IUDs with hormones (for example, Mirena) require replacement every 5 years.

Can I get pregnant if I wear an intrauterine device?

Pregnancy in women wearing an intrauterine device is extremely rare. The probability of pregnancy when using copper coils is no more than 8 chances out of 1000 during the year. When using IUDs with hormones, the chance of getting pregnant is reduced to 1 in 1000 within a year.

In this case, the course of pregnancy is no different from the course of a normal pregnancy, the spiral is located behind the membranes, and during childbirth it is born along with the placenta. Many women are afraid that the IUD may grow into the child’s body. These fears are unfounded, since the child’s body is surrounded by and. Pregnant women who have the IUD are observed to be at risk.

The risk of pregnancy increases significantly if the IUD becomes dislodged or falls out of the uterus. This happens especially often after menstruation, when the IUD can be thrown out of the uterine cavity along with the rejected tissues.

In this regard, all women who wear the IUD are recommended to check the presence of the IUD in the uterus at least once a month by feeling the antennae of the IUD deep in the vagina. If you previously felt the antennae of the spiral well, but can no longer find them, contact your gynecologist, as the spiral may have fallen out and you did not notice it.

How do I know if I am pregnant while wearing the IUD?

If While wearing a non-hormonal intrauterine device, your period is delayed by more than 2-3 weeks, you need to take a home pregnancy test and consult a doctor.

Could the IUD interfere with my ability to get pregnant in the future?

The contraceptive effect of intrauterine devices is easily reversible and disappears soon after their removal from the uterine cavity. The probability of pregnancy occurring within 1 year after removal of the IUD reaches 96%.

Planning a pregnancy is possible as early as the next month after removal of the intrauterine device.

Today, one of the most common types of contraception both in our country and around the world is the use of intrauterine devices. They have been used since the middle of the last century, but are constantly changing and improving. Today, the usual copper-containing spirals are being replaced by hormonal systems, the most popular of which is Mirena. It combines the best qualities of the IUD and oral hormonal contraceptives.

What is the Mirena hormonal system?

Mirena looks like a regular T-shaped spiral, which helps securely secure it in the uterus. One of the edges is equipped with a special loop with thread, which is designed to remove the system. In the center of the spiral is a whitish container that contains the hormone. It is slowly released through a special membrane and enters the uterus. Each system contains 52 mg. gestagen or levonogestrel.

Externally, Mirena is practically no different from a regular spiral

Mirena itself is enclosed in a special tube and packaged in a separate plastic and paper package. You can remove the spiral from it only immediately before installation. In undamaged packaging, the system can be stored for 3 years at a temperature of 15-30 degrees.

How does it work

Immediately after installation, Mirena begins to release hormones into the uterus. Every day 20 mcg enters its cavity, and after five years this amount drops to 10 mcg. per day, so it's time to change the system. Almost all of the hormone is concentrated in the endometrium, exerting a local effect. Only microdoses of the drug enter the blood. The release of the hormone begins approximately an hour after the introduction of the spiral, and after two weeks its maximum concentration is reached.

Of course, this indicator greatly depends on the woman’s weight. Weighing 54 kg. the content of levonorgestrel in the blood is approximately 1.5 times higher. Almost all the substance is broken down in the liver and excreted through the kidneys and intestines.

The white container contains a medicine

The contraceptive effect when using Mirena is achieved both through a local reaction to a foreign body and under the influence of a hormone - this increases its effectiveness by up to one hundred percent. The introduction of a fertilized egg does not occur due to the thinning and suppression of the activity of the uterine epithelium, since its natural growth and the functioning of the glands are suspended.

After the obligatory removal of the spiral after five years, the next one can be installed immediately without any interruptions.

Under the influence of the hormone secreted by the IUD, the motility of sperm in the uterus and its tubes is noticeably reduced, which also enhances the contraceptive effect. In addition, the mucous layer of the cervical canal becomes thicker and less permeable. Therefore, most sperm simply do not penetrate the uterine cavity.

Pros of using Mirena

This hormonal intrauterine system has many advantages, especially when compared with simple IUDs or oral contraceptives. Mirena almost never falls out, as happens with other devices. Her hormone relaxes the muscles of the uterus and prevents it from pushing out the spiral. In addition, the use of Mirena significantly reduces the risk of developing inflammatory processes.

Since many women stop menstruating while using Mirena, as soon as this happens, it is necessary to take a pregnancy test. After receiving a negative result, there is no need to repeat it, since the probability of fertilization in this state is practically zero.

This hormonal system provides much higher contraceptive protection than any other method of preventing pregnancy. Its effectiveness reaches 100%. Moreover, immediately after removal of the IUD, the woman’s reproductive system is almost completely restored. The desired pregnancy occurs within a year in 80% of couples.

Mirena is installed like any other IUD.

A huge advantage of the hormonal system is the possibility of its use in patients of different ages. It does not have a noticeable negative effect when used during lactation, therefore it is superior to oral contraceptives. Mirena can also be used by nulliparous girls and women during menopause.

In addition to the contraceptive effect, it also has medicinal properties, can prevent certain diseases, protect the endometrium from hyperplastic processes, and prevent the growth of endometrioid cysts and fibroids.

Mirena against fibroids

Mirena is often recommended as a medicine against uterine fibroids. It really helps curb its growth and reduce unpleasant symptoms. Often with fibroids, menstruation becomes more painful and profuse, which causes discomfort to the woman. The use of Mirena makes periods almost painless and very scanty, and in 20% of women they stop altogether. At the same time, all organs, including the ovaries, continue to function normally, it’s just that the volume of the uterine mucosa is greatly reduced.

Classification of fibroids

This inhibiting effect allows this hormonal system to prevent the appearance of fibroids. If the tumor already exists, then the presence of Mirena will slow down its growth. In many cases, this allows you to avoid surgery and even removal of the uterus. Of course, the fibroid itself will not go away, but the symptoms will disappear, the progression of the disease will stop, and the woman will be able to live a full life. After the coil is removed, tumor growth can resume - then a new hormonal system is simply installed.

Side effects

Using Mirena, like any other hormonal drug, can lead to various side effects. Some troubles may arise immediately after installing the spiral. At first, menstruation may become longer and more painful. In addition, due to endometrial restructuring, some women experience irregular spotting. But gradually they become more and more rare and scarce until menstruation completely stops. It should be noted that after stopping the use of this product, their characteristics will remain the same for several months.

Abdominal pain is one of the possible side effects of Mirena

Although Mirena releases levonorgestrol directly into the uterine cavity, some of it is still absorbed into the blood. Usually its concentrations in the blood are very small, about seven times less than when using oral contraceptives. But there is still a risk of side effects. They can manifest themselves in the form of a slight decrease in libido, mild pain in the back and abdomen, and some increase in body weight, which is explained by fluid retention in the body. Most unpleasant sensations disappear after a month and a half, occasionally after six months.

Levonorgestrol, which is part of Mirena, affects glucose tolerance. Therefore, patients with diabetes mellitus using this spiral need to more carefully monitor their blood sugar levels.

Ovarian cysts often develop when using Mirena. They can be suspected when severe abdominal pain appears, which does not disappear even after taking painkillers. This condition rarely requires any treatment. Cysts usually disappear on their own in about three months.

Contraindications

Despite the huge number of advantages, there are situations when Mirena cannot be used. This spiral is contraindicated for women with hypersensitivity to any of its components. It is not recommended for patients with a history of severe liver damage, such as active hepatitis, tumors or cirrhosis. Mirena is prohibited for malignant neoplasms in the uterus or its cervix. A history of deep vein thrombosis in the legs is also a contraindication to the use of this hormonal system.

This method of protection is not suitable for women suffering from increased sensitivity to infections and inflammatory diseases of the pelvic organs. The installation of a spiral is also contraindicated in cases of congenital or acquired anomalies of the structure of the uterus, during pregnancy and postpartum endometritis, cervicitis and uterine bleeding. It is also not suitable for patients who have had a septic abortion within the last quarter.

Video about the intrauterine contraceptive "Mirena"

The Mirena Hormonal Spiral is a highly effective modern contraceptive that has a minimum of side effects. At the same time, it can prevent the development of certain diseases and inhibit the growth of uterine fibroids. But before installing it, you must undergo a medical examination and consult a doctor to avoid possible side effects.

The active components of the Mirena spiral are the hormones gestagen and levonorgestrel. The spiral is inserted directly into the uterine cavity. For contraceptive purposes, IUDs are installed in women of childbearing age for 7 days. from the beginning After an abortion in the 1st trimester of pregnancy, Mirena should be installed immediately. After childbirth, the IUD is used when the uterus is restored, but not earlier than after 6 weeks.

In order to protect the endometrium during estrogen replacement therapy in women suffering from amenorrhea, Mirena can be used at any time; in women with preserved ones, the procedure is performed according to the cycle schedule, in the last days of menstruation or immediately after the end of bleeding. Before installing the IUD, it is necessary to undergo examinations of both the mammary glands and pelvic organs, and take a smear test from the cervix. It is also necessary to exclude pregnancy and - without fail - the presence of sexually transmitted diseases. Existing genital infections should be treated.

How to install the Mirena intrauterine device

Mirena is sold in sterile packaging, which must be opened immediately before inserting the spiral. When handling an opened system, you must follow the rules of asepsis. If the sterility of the packaging is compromised, the IUD is destroyed as medical waste. Mirena should be installed by a doctor who already has sufficient experience with this IUD. Before the procedure, the doctor determines the position of the uterus and the size of its cavity. It is important that the IUD is positioned correctly in the fundus of the uterus, which creates the necessary conditions for maximum effectiveness. Mirena is installed using sterile instruments - mirrors and forceps.

After 4-12 weeks, it is necessary to undergo an examination, then it is carried out once a year or more often if indicated. If there are difficulties when installing the Mirena, if there is severe pain or if bleeding occurs during the procedure or occurs after it, an ultrasound is performed immediately to exclude perforation (perforation) of the uterus. The spiral is removed after 5 years, it can be replaced with a new one any day.

Side effects of Mirena

Mirena may have the following side effects: nausea, discomfort and bloating, headache, nervousness, decreased mood, decreased libido, breast engorgement, urticaria, menstrual dysfunction, acne, itching, eczema, back pain and pain in the small area. pelvis, dysmenorrhea, vaginal discharge and bleeding, spotting, endometritis, cervicitis, inflammatory diseases, benign ovarian cysts.