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Who is not appropriate for Mirena
Use of Mirena is contraindicated in women with: known or suspected pregnancy and cannot be used for post-coital contraception; congenital or acquired uterine anomaly, including fibroids if they distort... Continue below
No daily, weekly, or monthly dosing routines
Remind her that she should check that Mirena is in place once a month by feeling for the threads
Evaluate patients 4 to 6 weeks after insertion and once a year thereafter, or more frequently
if clinically indicated
80% decrease in median menstrual blood loss vs baseline at 3 months
>95% decrease at 6 months
85% of women using Mirena experienced treatment success
Defined as end-of-study menstrual blood loss <80 mL and ≥50% decrease in menstrual
blood loss from baseline to end of study
*The safety and efficacy of Mirena in the treatment of heavy menstrual bleeding (≥80 mL menstrual blood loss) were studied in a randomized, open-label, parallel-group, active-control trial comparing Mirena (n=79) to oral hormonal therapy with medroxyprogesterone acetate (MPA) (n=81), over 6 cycles. Women with organic or systemic conditions that can cause heavy uterine bleeding (except for small fibroids—total volume ≤5 mL) were excluded from the study.
Tell patients that spotting and irregular or heavy bleeding may occur during the first 3 to 6 months. Periods may become shorter and/or lighter thereafter. Cycles may remain irregular, become infrequent, or even cease. Consider pregnancy if menstruation does not occur within 6 weeks of the onset of previous menstruation
Because irregular bleeding/spotting is common during the first months of Mirena use, exclude endometrial pathology (polyps or cancer) prior to the insertion of Mirena in women with persistent or uncharacteristic bleeding. If a significant change in bleeding develops during prolonged use, take appropriate diagnostic measures to rule out endometrial pathology
Amenorrhea develops in approximately 20% of Mirena users by one year. The possibility of pregnancy should be considered if menstruation does not occur within six weeks of the onset of previous menstruation. Once pregnancy has been excluded, repeated pregnancy tests are generally not necessary in amenorrheic women unless indicated, for example, by other signs of pregnancy or by pelvic pain
In most women with heavy menstrual bleeding, the number of bleeding and spotting days may also increase during the initial months of therapy but usually decrease with continued use; the volume of blood loss per cycle progressively becomes reduced
A separate study with 362 women who have used Mirena for more than 5 years showed a consistent adverse reaction profile in Year 6. By the end of Year 6 of use, amenorrhea and infrequent bleeding are experienced by 24% and 31% of users, respectively; irregular bleeding occurs in 15%, and prolonged bleeding in 2% of users.
If Mirena is removed and the patient does not want to become pregnant, she should use another method of birth control
Patients who do not want to become pregnant should be provided a new Mirena or another type of contraception
If a patient with regular cycles wants to start a different birth control method, remove Mirena during the first 7 days of the menstrual cycle and start the new method immediately thereafter or start the new method at least 7 days prior to removing Mirena if removal is to occur at other times during the cycle