Mirena Coil as a Treatment for Heavy Periods
Of the hormonal coils, the Mirena coil is licensed to be used in those with heavy periods. In this article, we will lay out the problem of heavy bleeding, how Mirena can help to deal with this and a few other questions that patients often have.
During their period, many women suffer from symptoms such as discomfort, cramping, and irregular or very heavy flow. Some signs and symptoms that you may notice are soaking one or more sanitary pads or tampons, or if a pad or tampon needs to be changed every hour to stop bleeding onto clothes. If you find yourself usually using double sanitary protection to control the menstrual flow, or you must wake up through the night to check or change the sanitary protection, then you may suffer from a heavy period.
The medical terminology for heavy periods is menorrhagia. It means heavy periods that occur each month. A heavy period is also considered if your normal period lasts more than 7 days. Chronic (long) or heavy periods might cause health complications such as iron-deficiency anaemia, because menorrhagia (prolonged bleeding) reduces the number of circulating red blood cells. You may feel a lack of energy, experiencing symptoms like pale skin, fatigue, tiredness, and dizziness. Although diet plays a role in iron deficiency anaemia, heavy menstrual periods compound the problem. Along with heavy menstrual bleeding, you may experience painful menstrual cramps (dysmenorrhea), that can be severe in some cases and therefore they require medical attention.
You may notice that your menstrual cycle is restricting you from your daily life activities, like taking time off work or going out with friends – those can also be signs of a heavy period.
How common are the heavy periods among women?
Heavy periods are common in women, and usually, they may be a normal incidence. Studies show that heavy periods affect 9 to 14 out of every 100 women. Prolonged menstrual bleeding occurs when a period lasts more than five to seven days. These two issues frequently coexist since they have the same underlying aetiology. Menorrhagia is the medical terminology for unusually long or heavy periods. According to NICE guidelines about 1 in 20 women aged between 30 and 49 years consult their GP each year because of heavy periods or menstrual problems, and menstrual disorders comprise 12% of all referrals to gynaecology services.
Diagnosing heavy periods
Your health provider will ask you about your medical history and menstrual cycles. For the other part of the exam, one or more tests can be used that will help the clinician to establish the diagnosis and to identify the undergoing cause. Some of the tests might be: a blood test to see if you suffer from iron-deficiency anaemia, Pap test, endometrial biopsy, ultrasound, or hysteroscopy.
What causes heavy periods?
In most cases the underlying cause for heavy periods can be hard to identify. When there is an unknown cause, this condition is called idiopathic menorrhagia. This is the most common scenario. Other causes that are less common are conditions affecting your womb, ovaries or hormones, such as polycystic ovary syndrome, fibroids, endometriosis and pelvic inflammatory disease.
Management and treatment options for heavy periods
There are many options for managing heavy periods including medication, hormonal contraceptives and surgery. Choosing what kind of treatment is the best option for you, depends on whether you are planning to become pregnant. You can try medication for reducing the amount of bleeding, and painkillers to help ease the menstrual cramps. The hormonal contraceptives, the birth control and intrauterine devices (IUDs), they both reduce the bleeding by inhibiting the lining of the womb (endometrium) to grow. If the woman has decided she no longer wants to get pregnant, surgical options are available too. One of them is endometrial resection or ablation, where the lining of the womb is removed using surgical instruments. The other one, called hysterectomy, and it is considered as a major operation, is when the womb is removed.
The hormonal contraceptives will have a temporary effect on your menstrual cycle, while the surgery, which consists of removing the womb (hysterectomy) will have a permanent effect. If heavy periods are not causing anaemia, a woman can choose not to have a treatment. Based on the comparison of the treatment options, the intrauterine systems (IUSs) are most effective at reducing the bleeding and the symptoms of the heavy period. They affect the menstrual cycle permanently and they are not limiting the option to the woman of getting pregnant after the removal of the intrauterine device. The surgical options like hysterectomy and endometrial ablation, are also effective, but they may have some big side effects and they reduce the ability of having a child permanently.
How do I know if the Mirena/Hormonal coil is right for my heavy periods?
Mirena coil is indicated as a treatment for women experiencing heavy periods who also want birth control with intrauterine contraception for up to five years.
To determine if an intrauterine system (IUS) such as Mirena Coil is the right contraception for you, a clinician will ask about your medical history. The IUS may not be suitable if you have breast cancer or have had it in the past 5 years cervical cancer or womb (uterus) carcinoma, liver disease, unexplained bleeding between periods or after sexual activity, arterial disease or a history of serious heart disease or stroke, an untreated sexually transmissible infection (STI) or pelvic infection, or if you have had problems with your womb or cervix.
You can use Mirena coil after giving a birth (vaginal or caesarean). You’ll have to use other contraception until the IUS is installed. In some circumstances, an IUS can be fitted within 48 hours of giving birth. When you’re breastfeeding, an IUS is safe and will not affect your milk supply.
If you are 45 or older when you acquire the IUS, you can keep it until you hit menopause or no longer need contraception.
Mechanism of action of Mirena coil in the treatment of heavy periods
Mirena/Hormonal coil it’s similar to an intrauterine device (IUD), except that the intrauterine system releases the hormone progestogen into the womb instead of copper.
A Mirena coil is a hormone-releasing intrauterine system (IUS) in a T-shape device that is made of soft and flexible plastic. It contains the hormone levonorgestrel, which is a form of progesterone stored in a reservoir. At its end, it has a thin thread that travels through the cervix and allows removing it and doing a monthly self-check by you or your healthcare provider. The hormonal coil is very small in size – about the same height as a set of stacked dice. Mirena works in the way that it releases the hormone steadily, giving you a continuous dose of the hormone over a 5-year period or until it is removed. Only a small amount of hormones enter the bloodstream because Mirena releases hormones locally in the uterus at a very slow rate. This hormone progestin is thinning the lining of the uterus every month. Mirena works by slowly releasing the progestogen hormone levonorgestrel within the womb to treat excessive monthly bleeding and as protection in oestrogen replacement therapy. Levonorgestrel restricts the response of womb lining cells to oestrogen, making the lining insensitive to circulating estradiol. This stops the growth of the lining of the womb, which results in a reduction in the volume and duration of menstrual bleeding. This is the mechanism of action in the treatment of heavy and prolonged bleeding (menorrhagia).
The hormonal coil is placed in the uterus and can be fitted by our clinicians in Clarewell clinics. The placement represents a non-surgical procedure and Mirena can be placed during an in-office visit or 28 days after giving a birth. Our experienced clinicians will educate you and demonstrate how to complete a monthly self-check to ensure that Mirena remains in your uterus. Following the placement, we do not routinely recommend a follow up-visit. If you feel like you need some assistance or have some questions, you can visit us. But if you notice that the bleeding continues, then a different route may need to be sought out.
Strength of hormonal coil
Mirena hormonal coil contains 52 mg of levonorgestrel (LNG) which is a form of a female hormone named progesterone. Initially, this hormone is released at a rate of approximately 20 mcg/day. This rate decreases progressively to approximately 10 mcg/day after 5 years and 8
mcg/day after 7 years. For the treatment of heavy periods and heavy menstrual bleeding, it is advised that Mirena should be replaced with a new one by the end of the fifth year, if continued use is needed.
After how long does the Mirena coil start working?
Mirena coil can take approximately a few months to reach its full effect, but by 6 months after placement, most women will have only light bleeding and sometimes no bleeding at all. The amount of spotting and bleeding days may increase when you first have it inserted but then these usually decrease in the months that follow. Bleeding may also be irregular. The total blood loss per cycle slowly decreases with continued use. Mirena reduced menstrual bleeding by 80% after three months of use in one research study of women who experienced heavy bleeding. The bleeding had been reduced by 90% after six months.
Will there be any changes in how it works?
The hormonal coil Mirena, it is intended for use for 5 years. After that, if you wish to continue with its use, Mirena coil needs to be replaced with a new one. During the period of 5 years, there are no changes in the amount of the hormone treatment releasement.
The Evidence
In a clinical trial of Mirena in women with heavy periods the majority experienced an 80% reduction in bleeding after 3 months, and >90% reduction in bleeding after 6 months. The levonorgestrel releasing intrauterine system is an effective nonsurgical treatment for managing both menorrhagia and dysmenorrhoea, as well as being a contraceptive and alleviating premenstrual syndrome.
This was conducted in a study, where 41 women were taken off the surgery list for hysterectomy or transcervical resection of the endometrium (TCRE) because of the success of their treatment with hormonal coil. In another study, which was evaluating the efficacy and the performance up to 1 year of hormonal coil, Mirena was effective as a treatment for menorrhagia in three of four woman and it was concluded that it can be used as an alternative therapy for women who are who are either contraindicated for or refuse hysterectomy or endometrial ablation.
By comparing levonorgestrel-releasing intrauterine system, hysterectomy, and endometrial ablation for heavy menstrual bleeding in a decision analysis model, researchers found that the hormonal coil had the highest number of quality-adjusted life years (QALYs). They evaluated complications, mortality, and treatment outcomes over a 5-year period in these three methods. They concluded that levonorgestrel-releasing intrauterine system and hysterectomy outperformed endometrial ablation for treatment for abnormal uterine bleeding (AUB).
They investigated the efficacy of levonorgestrel intrauterine system (LNG-IUS; Mirena) in conservative management of abnormal uterine bleeding (AUB). Seventy women between 30 and 55 years with AUB were included in the research study that was conducted over a period of 3 years. The response was assessed on a monthly basis for the first 4 months and then yearly for maximum 2 years.
The levonorgestrel intrauterine system in the management of menorrhagia
This prospective study was obtained in a general hospital in South Wales. The objective was to measure the effect of
levonorgestrel releasing intrauterine system in the management of menorrhagia. A levonorgestrel intrauterine system was used to treat fifty women who had failed medical therapy and were waiting for hysterectomy or transcervical endometrial resection (TCRE).
In this descriptive, prospective and non-comparative study the indication was to assess the efficacy and performance of an intrauterine system releasing 20 μg/day of levonorgestrel (LNG-IUS, Mirena) in the treatment of women with menorrhagia. In the study 44 women (between 24 and 49 years of age) participated with a presenting menorrhagia after medical therapies had failed.
The goal of this study was to estimate clinical outcomes after the placement of a levonorgestrel-releasing intrauterine device (LNG-IUS), laser ablation, or hysterectomy in patients with AUB. Their decision analysis model was based on PUBMED search. Then a decision tree was generated to compare clinical outcomes in a hypothetical cohort of 100 000 premenopausal women with nonmalignant abnormal uterine bleeding (AUB).
In this study, they compared the effects of the levonorgestrel intrauterine system and endometrial ablation. In terms of menstrual blood loss, failure rate, quality of life, and adverse events, this meta-analysis compared the efficacy and safety of the levonorgestrel intrauterine system to endometrial ablation for treating heavy menstrual bleeding. They assessed six clinical trials that met the inclusion criteria for the meta-analysis with a number of 390 participants.
Page last reviewed by Mrs Julie Milsom on 12 January 2023 for general guidance only. It is not intended to replace the advice of your clinician.