LEARN: Is a Mirena for me?

Who might a Mirena be good for?

• As a part of HRT, to protect the lining of the uterus from becoming too thick (risk of uterine cancer)
• Heavy or painful periods - effectively decreases heavy menstrual bleeding, which is common during perimenopause.
• Can help in premenstrual syndrome/hormonal mood changes and perimenopause.
• Menstrual migraines.
• Effective contraception, long lasting.
• Someone wanting less/no period.
• Endometriosis.
• For people who don't tolerate oral progesterone treatments like Utrogestan or oral progestins such as Provera or Norethisterone, the Mirena may be better tolerated as the synthetic progestin does not enter the brain.

Pros of a Mirena

• Fit and forget - less pills to take
• Symptom improvement - can improve periods and premenstrual symptoms, such as mood swings and cramps, due to the steady hormonal support the Mirena provides.
• Can do pipelle/smear at same time
• Little absorption of the systemic hormone, progestin (hence lower side effects, but also improved cardiac, and also breast risk)Contraception - While fertility declines during perimenopause, pregnancy is still possible. The Mirena acts as an effective form of contraception, offering peace of mind during this transitional phase.
• Endometrial protection for 5 years - for women using estrogen therapy, the Mirena can protect the uterine lining from hyperplasia, which is important when balancing hormone replacement (so utrogestan isn't needed, or if you feel well with utrogestan - you can take it nightly throughout the month, and not just in the luteal phase to avoid irregular bleeding)
• Decrease menstrual flow by 71-95%, more effective than COCP. Improves menstruation in 80+ % – this is particularly beneficial in perimenopause when often bleeding can be heavy, longer and also irregular. The Mirena releases a low dose of the hormone levonorgestel (a synthetic progestin) which thins the uterine lining and reduces menstrual bleeding. Many women experience lighter periods, and in some cases (about 20% at 1 year), periods may stop entirely. 
• Your cycle continues in the background so you get the benefits of your hormones
• Help hormone fluctuation - the Mirena provides localized hormonal support, which can help stabilize fluctuating hormones. It reduces the impact of estrogen dominance, a common issue in perimenopause, by counteracting it with progestin.
• Helpful for endometriosis
• Decreases risk of uterine cancer
• Safe and Non-Systemic: The Mirena is a safe option that is not processed by the liver, reducing the risk of systemic side effects.
• Minimal Impact on Breast Health: It has a minimal impact on breast health compared to other hormonal treatments.
• If you find progesterone, such as Utrogestan, beneficial for sleep and overall well-being, you can continue to use it alongside the Mirena.
• Continuous progestin release can improve migraine, as migraine can be impacted by cyclical progestogens.

Cons of a Mirena

• Requires insertion through vagina/cervix which often can be uncomfortable or even painful. Risk of insertion issues.
• Requires removal by a doctor.
• Normal to have spotting for up to 3 months, some experience ongoing irregular bleeding
• Some people experience ongoing discomfort
• Risk of depression is greatest in first 3-6 months, but it usually gets better
• May not align with some cultures
• Some may not want the insertion procedure due to past experiences
• No improvement with sleep