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Forum Name: Gynecology

Question: Efficacy of Mirena after 5 years


 Jesse1188 - Wed Apr 15, 2009 5:20 pm

I am almost 48 and have used Mirena for almost 10 years. The second is due for removal in May. With the 1st one my periods disappeared after a couple of months and returned (very light) after about 4 years on Mirena. It disappeared again after 2nd Mirena was placed in 2004 and still no sign of returning menstruation. Have I moved into menopause without realizing it? I do get hot flushes and night sweats once in a while. Must I get Mirena removed or can I just leave it in place for a couple more years or so? (Please say yes, it works so well after the first horrible 2-4 months after insertion!) Is there any risk I can get pregnant or will the Mirena still release hormones after more than 5 years? If I get it out now, I will probably not have the guts to get one reinserted, due to the bad initial side-effects (mood swings, breast swelling, nausea, headaches, etc.) If Mirena cannot stay, I will have to think about the copper IUD, but then my periods may come back.(Ugh) Any advice will be appreciated. Thank you!
 Debbie Miller, RN - Thu Apr 16, 2009 6:26 pm

User avatar Hello,
You have enjoyed the nice side effect of no periods while on the Mirena and I don't blame you for not wanting to rock the boat.

It would be difficult to say if you have been through menopause without having periods to verify this. Some hormone tests can suggest it so if you want to know, ask your doctor about that. You could be having hot flushes in the perimenopause period, which can occur for several years prior to actual cessation of periods. So, this alone is not enough to say. You are still younger than the average age of menopause (around age 53 or so) and most professionals accept 58 as the age when you can safely assume you have been through menopause based on that alone.

Given that, there have been several studies suggesting that this IUD could be safely used for 7 years in someone over age 40. There could be some decrease in the hormone that is released (Levonorgestrel) but that is only part of the way the device works and just having it in place is effective as a contraceptive device, especially for someone in your age category who is much less likely to get pregnant anyway. So evidence-based, up to 7 years is good. The 5 year timetable is licensed-based, meaning the device is licensed for use this long because release of the hormone is stable at least that long. Current practice is the 5 year recommendation for use, but you could certainly discuss this with your doctor since there is evidence supporting longer-term use in women of your age, but whenever a product is used beyond its license, you should be advised about that, which you are. If it were me, I would feel OK about it as long as I was getting the other GYN care recommended for my age and health. Some women need more reason to see their doctor than simply for routine screening.

Best wishes.

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