Mirena spiral indications. Hormonal coil Mirena - reviews. negative, neutral and positive feedback. Main benefits of using

Fibromyoma is the most common benign tumor of the uterus in premenopausal women. For its treatment, in particular, hormonal preparations with different methods of introduction into the body are used. For example, a gynecologist may recommend installing a Mirena intrauterine system (IUD) that releases levonorgestrel, a progestogen hormone component.

Hormonal IUD makes it possible to reduce heavy menstrual bleeding, a feeling of heaviness and pain in the lower abdomen. The therapeutic effect is associated with the development against the background of the use of this intrauterine system of atrophy of the endometrium - the inner uterine membrane - and a decrease in the size of the myomatous node.

Is the treatment of uterine fibroids with the Mirena coil effective?

Scientists and doctors are not yet able to reliably answer this question. It is believed that this IUD leads to a decrease in the severity of the symptoms of the disease. However, from the point of view of evidence-based medicine, such a remedy cannot yet be recommended to all women with uterine fibroids due to the small number of reliable clinical studies.

What is Mirena

This is an intrauterine therapeutic system, which is a T-shaped body coated with a hormonal preparation and having a protective shell that provides a gradual release of levonorgestrel. At its end there are threads for subsequent removal from the uterus, and it is placed in the organ cavity with the help of a special conductor attached to the "spiral".

The IUD has an intrauterine progestogen-like effect. In the body, under the influence of gestagens, there is a decrease in the thickness of the endometrium, a deterioration in its blood supply, and a decrease in the activity of dividing uterine cells. The spiral releases the progestogen drug levonorgestrel directly into the uterine cavity, which makes it possible to use the minimum dosage of the active substance. Therefore, under the influence of such an IUD, changes and side effects characteristic of taking progestogens orally or as injections do not develop.

Read more about the Mirena intrauterine device at.

Therapeutic effect

With uterine fibroids, Mirena is prescribed in case of heavy menstrual bleeding. They may be accompanied by symptoms and laboratory signs of chronic iron deficiency anemia - weakness, shortness of breath, pale skin, palpitations, dry skin and hair, and so on. Without cessation of blood loss, the treatment of anemia will be useless. Therefore, especially if a woman wants to preserve the ability to give birth to a child, the use of this remedy is indicated to her.

The gradual long-term release of levonorgestrel inhibits the proliferation (division) of endometrial cells and prevents its thickening. The development of atrophic processes in the first weeks after the introduction of the spiral may be accompanied by an increase in spotting discharge from the vagina, even outside of menstruation. However, they gradually weaken, and after six months, menstrual blood loss is reduced by almost 2 times. 2 years after the installation of the spiral, endometrial atrophy becomes so pronounced that it can be compared with the effect after surgical ablation (removal) of the uterine mucosa.

It is important that the woman does not suffer from the work of the ovaries and hormonal levels. After removal of the coil, most patients can become pregnant within the next year.

Does Mirena help eliminate the tumor?

No, under its influence, the fibroid will not resolve, but it can become noticeably smaller. In addition, blood loss during menstruation will be significantly reduced, which will avoid surgical intervention -.

Indications for use

Treatment of uterine fibroids with a Mirena spiral is prescribed if:

• the patient experiences heavy menstrual bleeding;
• she may have iron deficiency anemia;
• the fibroid is located so that it is not subject to conservative myomectomy (removal of the node while preserving the organ), has a size of less than 3 cm;
• the woman has a desire to maintain reproductive function, but pregnancy is not planned in the near future.

In all other situations, the patient is offered either drug therapy or surgical treatment. With large uterine fibroids, the best option becomes.

The most effective use of Mirena is for small submucosal myoma, when the tumor node is located under the mucosa, but does not deform the lumen of the uterus.

The hormonal and contraceptive effectiveness of this remedy after installation lasts for 5 years.

Uterine fibroids: about the disease, classification and types depending on location, causes, methods of treatment. About this in.

Contraindications and side effects

After the introduction of the Mirena spiral, in 22% of patients, the periods are lengthened, but by the end of the first year of use, this figure decreases to 3%. Irregular menstruation is observed in 67% and 19%, respectively. During the year, a complete cessation of menstruation is observed in 16%, and rare periods - in 57%.

After installing the spiral with fibromyoma, the following side effects are possible:

• more than 10% of cases - headache, abdominal pain, spotting from the vagina,;
• in 1-10% of cases: depressed mood, migraine, nausea, acne, back pain, adnexitis, ovarian cysts, pain in the mammary glands, spiral prolapse;
• in less than 1% of cases: allergic reactions, itchy skin, hair loss, increased blood pressure, uterine perforation.

Contraindications for the installation of Mirena with myoma are quite diverse. Do not use this device if you are pregnant or suspected of having one. Therefore, before the introduction of the IUD, pregnancy is carefully excluded. Do not insert an IUD in children under 18 and women over 65.

You can not enter the IUD for any infectious process in the genitourinary organs - chronic adnexitis, urethritis, cystitis, postpartum endometritis or cervicitis. Also, the drug is contraindicated in any diseases accompanied by immunodeficiency and increased susceptibility to infections. So, it should not be used in women with diabetes.

In addition, contraindications include the following concomitant gynecological diseases:

• cervical dysplasia;
• cervical or endometrial cancer;
• mammary cancer.

Another contraindication is acute hepatitis or liver tumor.

It is highly undesirable to use such therapy if a woman has a migraine, an unusually severe headache, jaundice of any origin, high blood pressure, a stroke or heart attack, valvular heart disease (congenital and acquired).

When bleeding during menstruation, patients are usually slightly expressed, so there is no point in installing the Mirena IUD.

How the system is introduced

Preparation includes a general and gynecological examination, taking a smear from the cervix. Pregnancy and sexual infections are excluded. Any pelvic inflammatory disease should be treated. Before installation, an ultrasound of the uterus is performed.

Immediately prior to insertion of the coil, a speculum is inserted into the vagina and local anesthesia may be used. The cervix is ​​treated with an antiseptic and grasped with forceps. A thin probe is passed through the cervical canal, and then the spiral itself is installed. The introduction of the IUD should not be accompanied by pain.

After the procedure, the patient is asked to rest for 30 minutes. At this time, she may appear pale, dizzy, sweating, fainting. If these symptoms do not disappear after rest, a second gynecological examination is necessary; it is possible that the coil is not installed correctly.

In case of successful insertion of Mirena, a control examination by a gynecologist is scheduled after 1 to 3 months, and then annually until the coil is removed. Immediately after removal, a new IUD can be inserted.

Differences from other drugs for the treatment of fibroids

Mirena is the only intrauterine system that contains a progestogen component and has a therapeutic effect on myoma. Other drugs are prescribed in the form of tablets, injections, patches, vaginal rings. They belong to different pharmacological groups. The Mirena spiral has a stabilizing effect, low-dose oral contraceptives can be used instead. Before using all these drugs, the first stage of drug therapy with gonadotropin-releasing hormone agonists or mifepristone is often necessary.

What works better for fibroids: Nuvaring or Mirena?

Nuvaring is a vaginal ring that releases both estrogenic and progestin components. It is prescribed for contraception, as well as for small myoma nodes to stabilize their size, restore the normal menstrual cycle, and prevent bleeding.

Compared to Mirena, Nuvaring has the following advantages:

• does not require medical attention during the introduction (placed in the vagina for 21 days with a break of 7 days during each cycle);
• restores the normal state of the endometrium, and does not cause its atrophy;
• after removing the ring, pregnancy may occur in the next cycle;
• there is no need to carefully cure all inflammatory diseases of the genital tract, since the ring does not penetrate into the uterine cavity.

Vaginal ring Nuvaring

However, Nuvaring also has disadvantages compared to the IUD:

• the ring is much less effective in treating heavy menstrual bleeding;
• it must be entered monthly, strictly observing the terms of installation and removal;
• to the side effects of gestagens, possible for Mirena, undesirable effects from taking estrogens are added.

The decision on the necessary drug is made by the gynecologist, taking into account the opinion of the patient. Usually, an IUD is recommended for fibroids if the woman does not plan to become pregnant in the near future. This method is more effective for the treatment of uterine fibroids. However, in younger patients with small nodules and no major bleeding, Nuvaring may be a good alternative.

Pros and cons of using the Mirena coil for myoma

When making a choice between various methods of conservative treatment of fibroids, a woman must understand the advantages and disadvantages of the Mirena hormonal coil.

The benefits include the following:

• long term of use (up to 5 years);
• effective reduction of menstrual blood loss and pain syndrome;
• few side effects;
• the absence of the undesirable effect of estrogen - weight gain, swelling, the possibility of use in smokers;
• simultaneous prevention and malignant tumors of the uterus.

Do not forget about the disadvantages of this method of treatment:

• high cost of the spiral;
• the need for installation in a medical facility and regular monitoring by a gynecologist;
• the danger of infectious complications in untreated inflammatory diseases of the genitourinary system;
• the likelihood of increased bleeding and pain in the lower abdomen;
• discomfort during sexual intercourse in both women and men.

The intrauterine therapeutic system Mirena is an effective remedy for the treatment of fibroids up to 3-5 cm in size, accompanied by heavy menstrual bleeding, located under the mucous membrane (submucosal), but not deforming the uterine cavity. The drug has not only a therapeutic, but also a contraceptive effect, in many women it causes a temporary cessation of menstruation without affecting the functioning of the ovaries. In the absence of indications, Mirena is often the first choice for non-surgical treatment of uterine fibroids.

Compound

pharmachologic effect

In terms of its effectiveness as a contraceptive, Mirena is comparable to the sterilization of a woman. It is as effective as today's most effective copper-containing intrauterine devices and oral contraceptives (contraceptive pills). Studies (clinical trials) have found that during the year for every 1000 women using Mirena, there are only two pregnancies. In women with excessive menstrual bleeding, Mirena causes a significant decrease in their intensity as early as three months after insertion into the uterus. Menstrual bleeding in some women stops altogether.

Indications for use

Mirena is used for contraception (prevention of pregnancy), treatment of idiopathic menorrhagia (excessive menstrual bleeding) and for the prevention of endometrial hyperplasia (excessive growth of the inner lining of the uterus) during estrogen replacement therapy.

Contraindications

Mirena should not be used for any of the conditions listed below.

Pregnancy or suspicion of it.

Existing or recurrent inflammatory diseases of the pelvic organs. Lower urinary tract infections.

Postpartum endometritis.

Septic abortion within the last three months.

Cervicitis.

Diseases accompanied by increased susceptibility to infections. Dysplasia of the cervix.

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 diseases or tumors of the liver.

Hypersensitivity to the components of the drug.

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

Migraine, focal migraine with asymmetric visual loss or other symptoms suggestive of transient cerebral ischemia,

unusually severe headache;

Jaundice;

Severe arterial hypertension;

Severe circulatory disorders, including stroke and myocardial infarction.

Pregnancy and lactation

Contraindicated.

Mirena is contraindicated during pregnancy or suspected pregnancy.

Pregnancy in women who have Mirena installed is an extremely rare phenomenon. But if

Mirena leaves the uterine cavity, you are no longer protected from pregnancy and must

use other methods of contraception until you have consulted with your doctor.

While using Mirena, some women do not have menstrual bleeding. The absence of menstruation is not necessarily a sign of pregnancy.

If you are not having your period and have other signs of pregnancy (nausea, fatigue, breast tenderness) at the same time, you should see your doctor for an examination and pregnancy test.

If you become pregnant while using Mirena, Mirena should be removed as soon as possible. If Mirena stays in your uterus during pregnancy, your risk of miscarriage, infection, or premature birth increases. You can also discuss the feasibility 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. At present, 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 application and the local action of the hormone, the possibility of a virilizing effect on the fetus must be taken into account. However, to date, there is no evidence of birth defects caused by the use of Mirena in cases where the pregnancy was maintained until natural delivery.

You can breastfeed your baby while using Mirena. Levonorgestrel has been found in small amounts in the breast milk of lactating women. About 0.1% of a dose of levonorgestrel can enter the child's body during breastfeeding. No dangerous effects on the growth and development of the child when used six weeks after the birth of Mirena have been identified. Mirena does not affect the quantity and quality of breast milk.

Check with your doctor before taking any medications while pregnant or breastfeeding.

Dosage and administration

Before the introduction of Mirena

Before the introduction of Mirena, a swab from the vagina can be taken, an examination of the mammary glands is performed, and, if necessary, other studies are carried out, for example, aimed at detecting infections, including sexually transmitted ones.

To determine the position and size of the uterus, a gynecological examination should be performed.

When to install Mirena

Mirena can be inserted into the uterus no later than seven days after the onset of menstrual bleeding. It can also be installed in the uterus immediately after a medical abortion; while the doctor must be sure that there is no genital infection. Mirena should not be placed earlier than six weeks after delivery. Mirena can be replaced with a new system on any day of the menstrual cycle. Mirena is not used as a contraceptive used after sexual intercourse. To protect the inner layer of the uterus during Mirena, you can install Mirena at any time in women with women with preserved menstruation, Mirena is installed in the last days of menstrual bleeding or “withdrawal” bleeding. amenorrhea (not having periods)

How Mirena is installed 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 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 the introduction, if necessary, you can apply local anesthesia of the cervix.

Some women experience pain and dizziness after inserting the system.

If after a half-hour stay in a calm position, these phenomena do not disappear, it is possible that the intrauterine system 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.

With the 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 a contraceptive for 5 years, is 0.7%. After removing Mirena, you should check the system 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.

Side effect

When using Mirena, as with any other medicines, adverse reactions (HP) may occur, although their appearance is not necessary in all patients. Listed below are HPs that have been reported with Mirena for the indications "contraception (prevention of pregnancy)" and "treatment of idiopathic menorrhagia (excessive menstrual bleeding)".

Possible HP in women using Mirena for the indication “prevention of endometrial hyperplasia (excessive growth of the inner lining of the uterus) during estrogen replacement therapy” was observed with the same frequency, except in cases indicated by footnotes (*,**).

Very frequent HP (> 1/10):

Headache

Abdominal/pelvic pain

Change in bleeding pattern, including increase and decrease in bleeding intensity, spotting, oligomenorrhea and amenorrhea

Vulvovaginitis*

Discharge from the genital tract*

Frequent HP (more than 1/100 and less than 1/10):

Depressed mood / depression

Migraine

Nausea

hirsutism

Backache**

Upper genital tract infections

ovarian cysts

Dysmenorrhea

Breast pain**

IUD expulsion (full or partial)

Infrequent HP (more than 1/1000 and less than 1/100):

Alopecia

Rare HP (more than 1/10000 and less than 1/1000):

Perforation of the uterus

HP with unknown frequency:

Hypersensitivity including rash, urticaria and angioedema

High blood pressure

* "Often" for the indication "prevention of endometrial hyperplasia during estrogen replacement therapy."

** "Very common" for the indication "prevention of endometrial hyperplasia during estrogen replacement therapy".

Additional Information

The partner can feel the threads during intercourse.

If a woman with Mirena placed becomes pregnant, the relative risk of ectopic pregnancy increases.

The risk of perforation is increased in breastfeeding women.

There have been cases of sepsis (very severe systemic infections that could be fatal) at the time after the insertion of the IUD.

The risk of breast cancer when using Mirena for the indication "prevention of endometrial hyperplasia (excessive growth of the inner lining of the uterus) during estrogen replacement therapy" is unknown. Cases of breast cancer have been reported (frequency unknown).

The following adverse events or effects have been noted in connection with the insertion or removal of Mirena:

Soreness of the procedure, bleeding during the procedure, dizziness or syncope (fainting) associated with a vasovagal reaction during insertion. The procedure may induce seizures (convulsions) in patients with epilepsy.

If you develop any of these or other side effects, you should consult a doctor.

Overdose

Interaction with other drugs

If you are using any drugs for a long time (eg, cytochrome P450 antiepileptic isoenzymes involved in the metabolism of drugs, such as anticonvulsants (eg, phenobarbital, phenytoin, carbamazepine) and drugs to treat infections (eg, 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 a mainly local effect.

Application features

Some recent studies show that women taking progestogen-only contraceptives may have a slight increased risk of venous thrombosis; however, these results are not definitive. However, if signs of thrombosis of the veins and arteries appear, you should immediately consult a doctor. Symptoms of venous or arterial thrombosis include: unilateral pain and/or swelling in the leg; sudden severe pain in the chest, whether or not it radiates to the left arm; sudden onset of severe respiratory failure; sudden cough; unusually severe prolonged headache; sudden partial or complete loss of vision; double vision; slurred or difficult speech; dizziness; collapse (sometimes with a seizure); weakness or very significant loss of sensation that suddenly appeared on one side or in one part of the body; movement disorders; sharp pain in the abdomen. Signs of the formation of a blood clot in the vessels of the eye include unexplained partial or complete loss of vision and any other unexplained violations of it.

So far, it has not 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.

nulliparous women

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

infections

The guide tube helps protect the Mirena from microbial contamination during insertion into the uterus, and the Mirena guide 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 over the next four months is increased. Pelvic infections in patients using intrauterine systems are often referred to as sexually transmitted diseases. The risk of infection is increased if a woman or her partner has multiple sexual partners. If a pelvic infection is detected, it should be treated promptly. These infections can interfere with fertility and increase the risk of ectopic pregnancy in the future.

In exceptionally rare cases, a severe infection or sepsis (a very severe infection that can be fatal) can occur shortly after an IUD is inserted. 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 lower abdominal pain, fever, pain associated with sexual intercourse, or unusual bleeding, contact your doctor immediately.

If severe pain or fever continues to develop shortly after insertion, you may have a serious infection that should be treated immediately.

Oligo- and amenorrhea

Oligo- and amenorrhea in women of childbearing age develops gradually in 57% and 16%

cases by the end of the first year of Mirena use, respectively. If menstruation is absent within six 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 of Mirena use.

Expulsion (prolapse of the intrauterine system)

Contractions of the muscles of the uterus during menstruation sometimes lead to displacement of the intrauterine system or even to push it out of the uterus, which leads to the termination of the contraceptive action. Possible symptoms of prolapse include pain and unusual bleeding. If Mirena has shifted in 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 find signs of displacement or prolapse of the intrauterine system, or if you do not 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 fallout of the system.

Perforation and penetrapy

Perforation or penetration of the body or cervix by an intrauterine contraceptive device is rare, mainly during insertion, and may reduce the effectiveness of Mirena. In these cases, the system should be removed. The risk of perforation is increased in women who are breastfeeding, and may occur in postpartum placement or in women with a fixed posterior (intestinal) uterine tilt.

The risk of perforation is increased in breastfeeding women and may also be increased if Mirena is administered shortly after childbirth.

Ectopic pregnancy

Pregnancy when using Mirena is extremely rare. The frequency 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). An ectopic pregnancy is a serious pathological condition that requires immediate medical attention. The risk of an ectopic pregnancy is increased in women who have had an ectopic pregnancy in the past and who have had tubal surgery or pelvic infections. The following symptoms may indicate that you have an ectopic pregnancy and need to see a doctor immediately.

Disappearance of menstrual cycles, followed by persistent bleeding or pain.

Wandering or very severe pain in the lower abdomen.

Signs of a normal pregnancy combined with bleeding and feeling dizzy.

Weakness

Some women feel dizzy after insertion of Mirena. This is a normal physiological reaction. Doctors offer women to rest for some time after the introduction of Mirena.

ovarian cysts

Since the contraceptive effect of Mirena is due to the main 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.

In most cases, 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.

By fates of the heart

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 be treated prophylactically with antibiotics when installing or removing Mirena.

Diabetes

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

Mirena is not used for postcoital contraception.

Available data suggest that 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.

Excipients contained in Mirena

Mirena's T-shaped base contains barium sulfate, which becomes visible on x-ray.

Endometriosis often occurs as a result of an abortion, so after that, a woman needs better methods of protection against unwanted pregnancies. Mirena spiral In addition to the therapeutic effect, it also has a contraceptive effect. At the same time, it is valid for up to five years, showing the same degree of effectiveness. Its benefits have been repeatedly confirmed by gynecologists, since the installation inhibits the growth of endometrial foci and myomatous nodes. Reviews of the Mirena intrauterine device are positive, women like the ease of insertion and a high degree of effectiveness. The method has a number of nuances, you need to familiarize yourself with them before proceeding with the procedure.

Composition and form of release

Mirena coils are made in Finland and Germany. The main active ingredient is levonorgestrel. It is contained in one spiral of 52 mg. Polydimethylsiloxane elastomer is included as an additional substance in the same volume.

The release form of the drug is a spiral. It has a white core of the main substance, is located in the body. The base is in the form of the letter T. It is covered with a membrane, almost ghostly. Membrane protection is needed in order to regulate the supply of the active ingredient. A loop with a thread for removal is fixed on the bottom of the case.

Delivery is carried out in sterile blisters. One package contains one coil.

Mechanism of action

The main active ingredient has a progesterone effect. As a result of the fact that only a certain part of the substance is released, it comes in small doses. The drug is gradually released and at the same time has a constant effect on the body.

The contraceptive for therapeutic purposes contains small doses of the active ingredient, its action is local, that is, it does not enter the system beds. Spiral for endometriosis inserted painlessly into the uterus. Moreover, in addition to the obvious contraceptive effect, it affects the pathology. In particular:

• decrease in the rate of exit of follicles;
• a change in the hormonal balance in the direction of reducing the activity of the hormone progesterone;
• reduction in the size of the walls of the uterus, which affects the frequency of menstruation and volume;
• a decrease in the speed of movement of spermatozoa that have entered the vagina.

The Mirena spiral with endometriosis protects against conception for five years. In addition, it also has a number of therapeutic effects, which are described above. The hormonal system also allows you to adjust the regularity of discharge. During its use, menstruation is not so plentiful, there is less soreness.

Indications for use

Mirena coil protects against unwanted conception for five years. However, this is not the only property. Helps to cure such diseases:

• uterine fibroids;
• endometriosis;
• uterine leiomyoma;
• violations of the female organ after removal;
• endometrial hyperplasia;
• uterine polyp;
• uterine bleeding during premenopause;
• painful critical days;
• profuse menstruation;
• the duration of critical days is more than 5, with the formation of anemia.

Indications are not always a guarantee that the coil will be able to cope with these diseases. Hormonal spirals do not help everyone, a consultation with a gynecologist is required before using them. Only a specialist will be able to understand how suitable a method they are for a particular patient, calculate the risk of complications and decide on the effectiveness and safety of using a medical device.

Contraindications

Mirena coils are not always used. There are a number of contraindications that reduce its effectiveness. It should also be remembered that hormonal therapy, even in small doses, can harm not only female organs, but the entire body as a whole. So, the spiral cannot be used when:

• the likelihood of pregnancy (the active ingredient can cause a miscarriage);
• acute viral and infectious diseases in the active stage (it is not clear how hormones can affect the course of the disease and the body's ability to resist viruses and infections);
• malignant neoplasms in the body (at the same time, they can be localized in any part of the body, on any organ);
• gynecological inflammations;
• genital infections (this includes any infections of this type);
• frequent uterine bleeding, the cause of which has not been identified;
• deformities of the genetic or derived uterine cavity.

Only a gynecologist can identify the risk during the examination. With him, you must definitely agree on your decision to use the spiral as a contraceptive and therapeutic agent.

Preparatory conditions

In order to determine whether the remedy will be effective, whether its use will cause side effects, a woman needs to undergo a thorough examination by a doctor. An intrauterine device is placed only if, after the result of the tests, no viral, sexual diseases are detected. The following studies are required:

• transvaginal ultrasound;
• taking smears for the presence or absence of infectious diseases;
• examination for chronic diseases (gynecological);
• bacterial culture.

Research methods make it possible to identify whether a woman has contraindications. If they are present, then the treatment first passes, and only then you can put a candle. But this does not happen in all cases. For example, if genetic pathologies of the development of the uterine cavity are found, then the remedy cannot be used.

Therapeutic action

The Mirena spiral has a number of therapeutic effects. The package contains an attached instruction for use, which indicates the indications. But there are actually more effects. The use of the drug for fibroids and endometriosis provides therapy for a number of diseases and conditions:

• prevention of pregnancy;
• removal of pain during menstruation and sexual intercourse;
• suspension of the progress of endometriosis and uterine fibroids;
• creation of favorable conditions for intimacy (eliminates the risk of penetration of some infection);
• reduction of blood loss during critical days (even if it is associated with emerging anemia);
• restoration of hormonal balance in the female body (due to the regulation of progesterone levels);
• anemia therapy (as a result of less blood loss, the disease becomes less obvious).

Candles also cope with adenomyosis, which is characterized by frequent pain symptoms, disturbances in the frequency and profusion of menstruation. Candles also control the psycho-emotional state. A woman who is accustomed to them experiences less stress if she does not want to conceive a child at this time.

Main benefits of using

The advantages of using a spiral against endometriosis are confirmed by gynecologists. If there are no contraindications, then this method of contraception becomes the best choice for preventing unwanted pregnancy and treating gynecological diseases. The main advantages of the technique:

• therapeutic effect against endometriosis and fibroids;
• high degree of effectiveness against unwanted pregnancy (up to 98-99 percent);
• reduction of blood loss during heavy periods;
• loss of childbearing function for a while (after the removal of the spiral, the ability to conceive a child is restored on average from three to six months).

In addition, one cannot fail to note the obvious fact of the convenience of using the spiral. You will not need to perform any manipulations other than the installation itself, constantly monitor how it works, and the like. The combination of high contraceptive efficacy and proven curative effect make these coils an obvious choice for women with certain gynecological conditions. Reviews of the Mirena intrauterine device in this regard are positive. The tool is called one of the most effective.

Disadvantages of the technique

Despite the ease of installation, the Mirena spiral has a lot of positive properties and disadvantages. Among them, the main one is the high cost. According to women, the price is quite high. But it is important to understand that this is a one-time investment for five years. On average, the purchase of contraceptives and pills for the treatment of fibroids, endometriosis is more expensive at a price. There are also such disadvantages of protection with a spiral:

• changes in the menstrual cycle in the first months of use;
• some side effects, such as dizziness, change in taste preferences.

Side effects and adverse effects of use are observed only during the adaptation period of the body to the spiral. The adaptation time is different for women, but, as a rule, it is from three months to six months.

Side effects

Side effects occur in the first months of use, their manifestations bother women for no more than six months. During this time, it is important to be observed by a gynecologist, who will note whether the treatment is effective. If the side effects are minor, but have been bothering you for more than six months, then this is a reason to cancel.

Adverse reactions of the body occur mainly due to hormonal changes in the body. Despite the fact that the dose of the active component is small, this can cause ailments. At first, such reactions from the body are possible:

• nausea and change in taste preferences;
• headaches, up to severe migraines;
• impaired ability to concentrate;
• the occurrence of scant bleeding at a time when menstruation should not be;
• violation of cyclicity, frequency of menstruation;
• change in the abundance of secretions during critical days;
• the appearance of rough areas in the mammary glands (may be single or very pronounced);
• changes in the skin (appearance of acne, rashes, blackheads, blackheads);
• increased greasiness of the epidermis and scalp.

There are other negative reactions, but they are extremely rare. These include violations of the psycho-emotional background, in particular, frequent mood swings, the occurrence of depressive and unconditioned conditions. It is also possible to form a small cystic type in the ovaries. If adverse reactions are detected, a woman should immediately contact a gynecologist. In this case, the coil should be removed and another treatment method chosen, for example, hormonal tablets with a lower concentration of the active substance.

There are many negative reactions, but in 98 percent of cases they all disappear after a few months of use. The hormonal background of a woman stabilizes and the body begins to work as before. After six months, the patients forget about the gynecological problems that bother them and get used to the established Mirena contraceptive-medical spiral.

Examinations while using the coil

A woman needs to be examined by a gynecologist at a certain time after installation. This is necessary in order to understand how the spiral works effectively, it will allow to identify the risk of adverse reactions. Visits are preventive, in the absence of pathologies, it is not necessary to take tests or undergo a thorough examination.

After the gynecologist conducts the necessary tests and understands that there is no risk that the spiral will be ineffective, the installation takes place. It will be necessary to make visits to a specialist three times during the first year of use (or more often if adverse reactions are detected). Usually you need to visit a gynecologist:

• seven days after the installation of the spiral;
• one month after continuous wearing;
• six months after installation.

It is worth remembering that the period of use should not exceed five years. After this term, the active active ingredient remains extremely small, or it exhausts itself completely. In this case, the already expired spiral will not have a therapeutic gynecological effect, in addition, the chances of conceiving a child increase many times over. After a period of five years, it is removed or replaced with a new one.

The Mirena intrauterine device is one of the modern contraceptives, which also has a therapeutic effect. The manufacturer of the spiral is Bayer, located in Finland. Like any medical drug, Mirena has its advantages and disadvantages.

What is this tool

The hormonal coil consists of a core filled with hormonal-elastomer content. It is located on a T-shaped body. On top of the hormone is a membrane that promotes the gradual release of the contraceptive in the amount of 20 micrograms per 24 hours. After five years of using the IUD, the amount of secreted hormone is reduced to 10 mcg. At the end of the T-shaped body there is a loop to which threads are attached to remove the coil from the uterus. This design is placed in a conductor tube and has a length of about 30 cm. But do not be afraid of such large sizes: it is only used to introduce a T-shaped body into the uterus.

What effect does it have on the body

The Mirena coil slowly releases the hormone levonorgestrel into the uterine cavity. It does not affect blood clotting, blood pressure and blood sugar levels. That is why the use of a spiral for healthy women is practically safe.

When installing the IUD provides local gestagenic action. The hormone reduces the sensitivity of the sex receptors of the uterus, which leads to the cessation of growth and rejection of the inner layer of the organ, in other words, menstruation disappears in women without suppressing ovulation. The presence of a foreign body prevents a fertilized egg from attaching. The cervix also reacts to the spiral: its mucus becomes dense, which makes it difficult for sperm to move.

Mirena has an analogue - Jaydes. This is an IUD based on levonorgestrel, but it contains a smaller amount of the hormone, and it only lasts for three years.

Pharmaceutical manufacturers have also created a combination drug based on levonorgestrel and estrogen for oral administration. This tool is often used as emergency contraception after unprotected intercourse.

Indications

Hormonal IUD is used not only as a method of protection. The drug is prescribed in the presence of the following pathologies:

• endometriosis;
• uterine fibroids;
• idiopathic hemorrhage;
• endometrial hyperplasia.

Restrictions

1. Pregnancy.
2. Acute and chronic infectious diseases of the genital tract, urethra and bladder.
3. Various pathologies of the cervix.
4. Malignant neoplasm of the breast.
5. Endometritis after childbirth or abortion.
6. Anomalies in the structure of the organ: a bicornuate uterus, the presence of partitions.

Interaction with other drugs

Anticonvulsants and antibiotics can affect hormonal contraceptives, but you can not be afraid of this when using the Mirena spiral. It has the main effect on the inner layer of the uterus, and practically does not affect the body.

Storage conditions and shelf life

The drug should be kept in tightly closed sterile packaging. The removal of the IUD should be carried out immediately before its introduction into the uterine cavity. Subject to all storage rules, the shelf life of the IUD is 36 months.

Benefits of using

Unlike hormonal contraceptives or simple spirals, Mirena has many advantages:

1. IUD prolapse is extremely rare., because the hormone relaxes the uterus, and it does not push out the foreign body.
2. Cessation of menstrual bleeding.
3. Mirena use prevents the development of inflammatory diseases.
4. The contraceptive effect is almost 100%. In five years of use, only seven out of a thousand women become pregnant.
5. Has a local therapeutic effect: prevents the growth and development of endometrioid cysts and fibroids.
6. The onset of pregnancy after the extraction of the spiral occurs within the first year.
7. Used by women of all ages: nulliparous, during lactation and during menopause.

Disadvantages of Mirena

As with any medical drug, hormonal IUDs have their own side effects. These include:

• swelling;
• pain in the lower abdomen;
• increase in blood pressure;
• the appearance of acne;
• weight gain;
• Bad mood;
• irritability;
• headache;
• whites;
• hair loss;
• painful tension of the mammary glands;
• decreased libido;
• hives;
• eczema.

In addition to side effects, the disadvantages of the hormonal IUD include:

1. Price. The cost is about 12 thousand rubles.

However, it must be borne in mind that by installing this spiral, you can forget about contraception for five years. Consequently, only 200 rubles are spent monthly on protection against unwanted pregnancy.

1. For the installation of the Navy need to visit a gynecologist.
2. Does not protect against infections sexually transmitted.
3. The likelihood of an ectopic pregnancy.
4. May affect menstruation: irregular cycle, prolonged spotting or spotting in the first months after installation; the development of amenorrhea - the complete absence of critical days.

Complications

The main difficulties of the introduction of the IUD include:

1. perforation of the uterus. This problem is extremely rare. There is a rupture of the organ, which the doctor will immediately notice. At the same time, he must remove the spiral and send the woman for an emergency operation to stitch the organ. If the gynecologist did not notice perforation during installation, the spiral may continue its movement in the small pelvis and violate the integrity of other organs. All this leads to serious consequences.
2. Spiral drop. This can happen if the doctor installed the product incorrectly or the woman did not listen to the recommendations of the gynecologist, and she had sexual contact during the first week after installation.
3. Infections. Inflammation of the pelvic organs occurs when aseptic rules are violated and bacteria enter the uterine cavity during the installation of the IUD. If the infection appeared 20 days after the introduction of the spiral, this means that the bacteria entered the uterus in another way, for example, during sexual intercourse.

Spiral Removal

In a normal cycle, the IUD is removed on any day of menstruation. If a woman does not plan pregnancy and is interested in further contraception, the doctor can immediately put a new remedy.

It has been proven that the use of several IUDs in a row does not affect women's health.

If for some reason it is impossible to install a new spiral, it is necessary to start taking oral contraceptives a week before Mirena is removed.

After removing the IUD from the uterine cavity, the doctor examines it for integrity. To avoid negative consequences, you need to make sure that the antennae or the core do not remain in the cavity of the organ.

Conclusion

The Mirena hormonal intrauterine device is one of the best contraceptives available today. When choosing this method of protection against unwanted pregnancy, a mandatory consultation with a gynecologist and endocrinologist is necessary. The presence of infections of the pelvic organs can cause failure to install the coil. In addition, before the introduction of the IUD, it is necessary to pass a number of tests. The cost of Mirena is quite high, but if the body adapts to it, a woman will forget about other methods of contraception for a long time.

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 hormonal system Mirena

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

Mirena itself is enclosed in a special tube and packed in a separate plastic-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 secrete a hormone into the uterus. Every day, 20 micrograms enters its cavity, and after five years this amount decreases to 10 micrograms. 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 bloodstream. The release of the hormone begins about an hour after the introduction of the spiral, and after two weeks its maximum concentration is reached.

Of course, this figure is highly dependent on the weight of the woman. With a weight of 54 kg. the content of levonorgestrel in the blood is about 1.5 times higher. Almost all of the substance is broken down in the liver and excreted by the kidneys and through the intestines.

The contraceptive effect when using Mirena is achieved both with the help of 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 damping of the activity of the uterine epithelium, since its natural growth and functioning of the glands are suspended.

After the mandatory removal of the spiral after five years, the next one can be placed immediately without any interruption.

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

Benefits of using Mirena

This hormonal intrauterine system has a lot of advantages, especially when compared with simple spirals or oral contraceptives. Mirena almost never falls out, as it happens with other devices. Her hormone relaxes the muscles of the uterus and does not allow her to push out the spiral. In addition, the use of Mirena significantly reduces the risk of developing inflammatory processes.

Since many women stop menstruating when using Mirena, as soon as this happens, a pregnancy test should be done. After receiving a negative result, a second one can not be carried out, since the probability of fertilization in this state is almost zero.

This hormonal system gives a much higher contraceptive protection than any other method of preventing pregnancy. Its efficiency reaches 100%. At the same time, immediately after the removal of the spiral, the woman's reproductive system is almost completely restored. The desired pregnancy occurs in 80% of couples within a year.

A huge plus 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 outperforms oral contraceptives. Also, Mirena can 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 vs fibroids

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

This deterrent action allows this hormonal system to prevent the appearance of fibroids. If the tumor is already there, then the presence of Mirena will slow down its growth. In many cases, this avoids surgery and even removal of the uterus. Of course, the fibroid itself will not go anywhere, 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 spiral is removed, tumor growth can resume - then a new hormonal system is simply installed.

Side effects

The use of Mirena, like any other hormonal agent, can lead to various side effects. Some troubles may occur immediately after the installation of the spiral. At first, menstruation may become longer and more painful. In addition, due to the restructuring of the endometrium, some women experience irregular spotting. But gradually they become more and more rare and scarce until the complete cessation of menstruation. It should be noted that after the termination of the use of this tool, their characteristics will become the same for several months.

Although levonorgestrol is excreted from Mirena directly into the uterine cavity, some of it is still absorbed into the blood. Usually its concentration in the blood is very small, about seven times less than when using oral contraceptives. However, 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, some increase in body weight, which is explained by fluid retention in the body. Most of the discomfort disappears after a month and a half, occasionally after six months.

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

Often, when using Mirena, ovarian cysts develop. You can suspect them when you experience severe pain in the abdomen, which does not disappear even after taking painkillers. This condition rarely requires any treatment. Cysts usually go away 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 neck. A history of deep vein thrombosis of the legs is also a contraindication to the use of this hormonal system.

This method of protection is not suitable for women suffering from hypersensitivity to infections and from inflammatory diseases of the pelvic organs. The installation of a spiral is also contraindicated for congenital or acquired anomalies in 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 intrauterine contraceptive "Mirena"

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 slow down the growth of uterine fibroids. But before installing it, it is imperative to undergo a medical examination and consult a doctor in order to avoid possible side effects.