Mirena IUD…decisions, decisions.

Four days ago, I ended things with my Mirena IUD. I had had this device in place for 2.5 years and I had thought I was happy with it. Since having it removed this week, my perspective has changed significantly and I feel very differently about it. I spent many hours before the Mirena was inserted and again before it was removed trawling through message boards to try and get definitive answers and to make sure I was doing the right thing by my body. I felt quite overwhelmed by all the opinions, and I also felt quite sorry that many women who promised to come back “later” to report on their experiences never did. I really wanted to hear about how things had turned out for them and after this week I felt that I owed it to other women to help make their decisions easier by doing some writing of my own.

Why did I choose the Mirena IUD?

First, a bit about myself. I am in my early forties and have one child. I am not a medical practitioner, but I consider myself well educated around health issues and am quite in tune with my body. Prior to the Mirena, I had used a diaphragm and Toni Weschler’s “Taking Charge of Your Fertility” for contraception, wanting to avoid the hormonal methods I used earlier in my life. I originally had the IUD recommended to me for contraceptive purposes, as well as for the convenience of no periods. The Mirena sounded very appealing because the dosage of hormone is so low and is thought to be localised to the uterus. Most women using it will even continue to ovulate. The doctor also suggested that it might have the effect of reducing recurrent candida flareups and pre-menstrual migraines. Throughout the last two and a half years, I can vouch for the fact that it did all these things very well. I would say that the Mirena certainly has a useful medical role to play, especially for women whose only alternatives are serious procedures like a hysterectomy.

With that said, I would caution women to be aware that it is a drug, and it will have side effects. As with all drugs, you are the only one who can decide if those side effects are going to be worth it in your case. And you can’t determine how you will react based purely on reading the stories you find online. I would recommend, based on my own experience, to be very aware of anything different that is going on in your physical or mental health. It would be worth keeping track of your moods, weight and cyclical symptoms for a month or two before having the Mirena inserted, so that you have something to compare it to afterwards, because the changes crept up on me so gradually that I didn’t realise until much later what was going on. Then if they do – trust yourself, even over your doctor’s opinion. You know your body better than anyone, and if you’ve kept a health record, you will know that it’s not all in your head.

The emotional side of long-acting contraception

Something that I’ve never seen mentioned in discussions about Mirena is the emotional component of the decision. Many women have them placed after a termination of a pregnancy, or maybe they’re putting off having a child they want but can’t afford. Perhaps you don’t want a child and your partner does, or maybe you’re facing surgery for heavy bleeding. As a long-term contraceptive that you need a doctor to insert and remove (don’t do it yourself!) your fertility is out of your control for the duration. I feel that this aspect also impacts strongly on women’s experience of the device. For the first couple of days after it was inserted and again when it was removed, I felt like I was on an emotional roller coaster – this could have been hormonal, but I also think that the emotions we have associated with our fertility, sexuality and gynaecological health could all come up at these times. Be aware.

Highs and lows

The insertion was not fun – I rate it much like going to the dentist. However, it was bearable (I took ibuprofen beforehand as recommended, and continued for the next week or two during the cramps that ensued).  After insertion, I felt an internal “tension” around my cervix which is a little difficult to describe. Because there are other symptoms which follow insertion like bloating and cramps, I didn’t notice this so much at first. But it was always there, and I think that rather than going away, I just became used to it. Mirena took away the peaks and troughs of my cycle. I felt as if I was in the week or two before my period…always. When you have a natural cycle, there is a buildup of tension, and a few days after menstruation begins there is a feeling of release, freshness, and also a loss of water weight. With the Mirena cycle it felt as if that tension was always building but never released. After having it removed, the tension miraculously disappeared within the first hour. It sounds odd to say, but I am actually looking forward to my period now. I can appreciate that women have a cyclical rhythm, and when you alter that there will be certain repercussions to the system as a whole. That may be worthwhile in your case…but pay attention to what is going on. Here’s what else happened to me.

Weight gain

While on the Mirena, I gained about three stubborn kilograms (six pounds) which was very uncharacteristic for me. I regularly exercise, eat a very healthy plant-based diet and have maintained my weight all my adult life. But when I asked my gynaecologist about my weight gain he assured me that the Mirena is not responsible for this, and it is normal for a woman’s metabolism to slow down in her forties. I would like to let him know that in the last four days, despite a fairly sedentary week, I’ve lost one kilogram (two pounds) already. This never happened on the Mirena, there was always and only a gradual upward trend.

Lower back pain

Over the last month, I had been getting increasing pain in my lower back, in the region of the sacrum. I never used to get back pain, but this gradually growing stiffness, tension, and eventually pain made many activities uncomfortable, especially sitting down. Even yoga wasn’t taking the edge off it. It felt as if something was scraping and bruising my spine from the inside, even when I was lying down in bed. I was getting weekly massages and acupuncture just to get through the days. In merely one day after removal, all of this pain was gone.

Abdominal pain

For the last three months I had an odd pain in my lower-middle left abdomen, near my belly button. It would hurt a lot, especially with movement, and prevented me from doing much vigorous exercise in that time. My acupuncturist said it was due to inflammation. It had flared up badly a year before as well and the GP suspected diverticulitis. She ordered a CT and an ultrasound, but nothing showed up. I changed to a low residue diet and the next step was to be a colonoscopy. I had not had a change in bowel habits though, and felt that this investigation might be too invasive given that nothing had shown up on the other scans. I’m glad that I listened to my instincts, because this too has cleared up totally since removal this week.

Eye sensitivity

Over the last couple of years, my eyes have felt drier, puffier and more sensitive. I even took a dry eye test at the optometrist and was considering laser therapy for this condition. My eyes became unable to tolerate any makeup for more than an hour or so without weeping and redness. I had assumed that maybe I had developed an allergy to one of the chemicals, although I was using only hypoallergenic products. This week, however, my eyes have returned to normal and I’ve been wearing eyeshadow and mascara with no problem at all.

Overactive bladder

This was another symptom which I’d ascribed to aging and having given birth to a large baby, although I hadn’t had a problem with it before the Mirena. However, I’ve already noticed that this week my bladder capacity seems to have significantly increased. I am not running to the toilet with an urge every hour. I ascribe this perhaps to the absence of the above-mentioned feeling of constant tension in the pelvis.

Ovarian cysts

On a more serious note, about six months after insertion I was diagnosed with an ovarian cyst, which I’d never had before. I was very anxious about the prospect of surgery so took a watch and wait approach. However, it continued to grow for the next year and I finally required surgery to remove it. Mirena lists one of the potential side effects of the device as ovarian cysts. When I asked my gynaecological surgeon about this though, he said that this information was not correct. I don’t know – all I can say is that it happened to me.

Tiredness and irritability

Despite all of the above, the most debilitating side effect for me was certainly the mental aspect. By the end of the two and a half years I felt drained, irritable, stressed, on edge and tired most of the time. In hindsight I feel this was due in some part to the constant low-grade pain that I had become used to. I did not want to be around anyone, and each morning when I woke up I would immediately feel an exhausting weight descend on my chest which made everything feel like too much effort. I needed a nap every afternoon just to get through the evening and would get quite annoyed if something came up that prevented me from that sleep. Even the thought of cooking dinner was overwhelming much of the time and I had to force myself to move. This symptom, too, vanished within a day or so of removal. These last few days I can honestly say I feel more genuine joy and “lightness” than I have in these last couple of years. I’ve never suffered depression before, but I think that I was experiencing it on the Mirena.

So…what to do?

No matter whether you’re deciding to put a Mirena in or get it taken out, don’t do what I did and overthink it. I became almost paralysed by indecision. It’s not a permanent choice, you can always change your mind. Having it removed in particular was an absolute breeze, no different from a pap smear. If you find that you’ve made the wrong call, you can go and have a new one put in. But I strongly encourage you to keep a close eye on your mental and physical health while you are using a Mirena. These symptoms were not merely in my head, and they literally disappeared overnight when the device was removed. I hope that my experiences will help others to make good choices for themselves.