Mirena Coil as Treatment for the Menopause

Introduction

Perimenopause is a transitional period in a woman’s life, typically occurring between the ages of 45 and 55, marked by the end of menstrual periods and a decline in the reproductive hormones, oestrogen and progesterone. Menopause is diagnosed by the cessation of periods for over 2 years if under 50 and 1 year if over 50 years old. Whilst reaching the menopause is a natural process, the fluctuating levels of these hormones can bring about a variety of symptoms, including hot flushes, night sweats, mood swings, joint pain, irritability, anxiety and irregular periods.

For many women, managing these symptoms can be challenging. One increasingly popular option to manage the problematic bleeding in the perimenopause, (the run-up to periods stopping) is the Mirena coil, also known as the LNG-IUS. The device is a small, plastic T-shape which is inserted into the uterus, then slowly releases a low dose of the hormone levonorgestrel, a type of progesterone, from the capsule surrounding the device.

This works by thinning the lining of the womb, so it can make periods shorter and lighter. For many, it can also stop ovulation and stop the lining from growing and therefore no periods, which is extremely beneficial and sometimes life-changing, as heavy periods can be incompatible with daily life.

Understanding Menopause and Hormone Replacement Therapy (HRT)

Before diving into the specifics of the Mirena coil, it’s important to understand the hormonal changes that occur during menopause. Menopause leads to a significant decline in the levels of oestrogen and progesterone produced by the ovaries. Oestrogen receptors are present all over the body, which is why the perimenopause and eventually menopause can cause multiple, whole-body symptoms. Hormone replacement therapy (HRT) is used to manage menopausal symptoms by replenishing oestrogen, to support and manage these symptoms. Because oestrogen and progesterone always work together in the menstrual cycle, if we replace oestrogen, we need to add progesterone to protect the lining of the uterus. Giving oestrogen alone can thicken the uterine lining, increasing the risk of endometrial cancer. Progesterone helps counteract this effect by thinning the uterine lining. If there is no uterus present due to hysterectomy (removal of the uterus), oestrogen-only HRT can be safely given. Your healthcare practitioner will take a detailed history to fully understand your HRT needs.

How the Mirena Coil Works in Menopause

The Mirena coil is primarily a contraceptive device, but it also provides a steady release of levonorgestrel, which has several benefits in the context of menopause:

Progesterone Component in HRT

The Mirena coil can be used as the progestogen part of a combined HRT regimen. By releasing a low dose of levonorgestrel directly into the uterus, it protects against endometrial hyperplasia (thickening of the uterine lining) and reduces the risk of endometrial cancer associated with oestrogen-only HRT.

Managing Menopausal Symptoms

Many women experience heavy, irregular periods during perimenopause (the transition phase leading up to menopause). The Mirena coil can help reduce menstrual bleeding and, in some cases, stop periods altogether, offering significant relief from symptoms such as heavy bleeding, irregular periods and painful periods.

Potential Bone Health Benefits

While the Mirena coil itself does not directly impact bone health, its use as part of combined HRT can help maintain bone density, reducing the risk of osteoporosis—a common concern for postmenopausal women.

Benefits of the Mirena Coil for Menopause Management

The Mirena coil offers several advantages for women navigating menopause:

Convenience and Long-Term Use: Once inserted, the coil is effective for up to five years, reducing the need for daily medication and ensuring a continuous, reliable dose of progesterone. This is particularly beneficial for women who prefer a “fit-and-forget” option.

Localised Hormone Delivery

Because the coil releases levonorgestrel directly into the uterus, it requires a lower dose compared to systemic (oral or transdermal) forms of progestogen. This localised delivery minimises the overall hormone exposure, potentially reducing the risk of side effects such as weight gain, mood changes, or breast tenderness.

Reduction of Bleeding and Pain

For women experiencing heavy menstrual bleeding (menorrhagia) during perimenopause, the Mirena coil can significantly reduce or even stop bleeding altogether. This benefit extends to women with endometriosis or adenomyosis, who may find the reduction in bleeding and associated pain highly beneficial.

Flexibility in HRT Regimens

The coil can be combined with various forms of oestrogen therapy (pills, patches, sprays or gels), allowing a tailored approach to managing menopausal symptoms. Women can choose the form of oestrogen that best suits their preferences and medical needs while using the coil for endometrial protection.

Potential Risks and Side Effects of the Mirena Coil

While the Mirena coil is an effective option for many women, it is not without potential risks and side effects. These may include:

Initial Discomfort and Spotting

After insertion, some women may experience discomfort, cramping, or spotting for a few days to a few weeks. In some cases, irregular bleeding or spotting may persist for several months.

Hormonal Side Effects

Although the Mirena coil delivers a low dose of levonorgestrel, some women may still experience systemic hormonal side effects such as acne, headaches, breast tenderness, or mood changes. These should generally be temporary side effects for many individuals.

Device-Related Complications

As with any intrauterine device, there is a small risk of complications, including infection, expulsion (where the device falls out), or perforation (where the device pierces the wall of the uterus). These complications are rare but should be considered when deciding whether the coil is the right option.

Limited Oestrogen Replacement

The Mirena coil does not provide oestrogen, so women experiencing any significant symptoms (like hot flushes, night sweats, mood changes, joint pain, brain fog and anxiety) will likely need oestrogen therapy to address these symptoms.

Comparing the Mirena Coil to Other Progesterone Options

When choosing an HRT method, several factors need to be considered, including personal preference, medical history, eligibility and the specific menopausal symptoms being addressed. Here’s how the Mirena coil compares to other HRT options:

Oral Progesterone

The majority of oral progesterone used today is Micronised progesterone. This is given every day as a continuous dose, or for 2 weeks on and 2 weeks off, in which time they will have a period. As it is taken orally, there is more of a chance of system side effects, headaches, skin changes, mood changes, bloating. These usually settle for many, but if they do not, another formulation can be tried.

Transdermal HRT

These options provide both oestrogen and progestogen elements, as they come in a combined patch form. These are changed twice a week and no other medication needs to be remembered.

If using a patch or oral medication as the protective element, then a method of contraception is still important too.

Progesterone-only pills are licensed for contraception but not for HRT purposes. You would still be required to continue your contraception, as well as oestrogen and progesterone elements of HRT.

This is the same for the contraceptive implants, the contraceptive injection, and the copper coil.

The Mirena, or any other 52 microgram coil, is the only device that provides effective contraception, support with heavy menstrual bleeding and the protective element of progesterone for HRT.

Is the Mirena Coil Right for You?

The Mirena coil may be an excellent option for women seeking a convenient, long-term solution to manage perimenopausal or menopausal symptoms, particularly those related to heavy menstrual bleeding or the need for endometrial protection during oestrogen therapy, plus excellent contraception. However, it is important to consult with your healthcare provider to discuss your specific symptoms, medical history, and personal preferences to determine if the Mirena coil is the right choice for you.

Final Remarks

The Mirena coil offers a unique and versatile approach to managing perimenopause/menopause symptoms, providing both contraceptive benefits and the progestogen component necessary for combined HRT. Its localised delivery system, convenience, and ability to reduce menstrual bleeding make it an appealing option. However, as with any medical treatment, it is essential to weigh the benefits and risks with your healthcare provider, ensuring a personalised approach to managing menopausal symptoms.

If you’re considering the Mirena coil as part of your menopause management plan, consider discussing with your specialist whether this treatment aligns with your health needs and lifestyle.