Menorrhagia Treatment: Is Mirena IUD an Option?

Smita Jain, 45, experienced heavy menstrual bleeding (menorrhagia) for about a year before she finally decided to do something about it. On a friend’s recommendation, she visited Dr Swati Sinha, Consultant Obstetrician-Gynecologist at Sitaram Bhartia hospital in South Delhi  for menorrhagia treatment

“Heavy menstrual bleeding occurs when you lose more than 80 ml of blood every menstrual cycle. It can not only impact your iron levels but also your social life,” says Dr Swati.

What causes menorrhagia?

Menorrhagia may be caused by

But sometimes, there maybe no specific reason for heavy bleeding.

You should consult a gynecologist if you observe menorrhagia symptoms such as

  • The need to change a pad or tampon every 1-2 hours
  • The need to use two pads or a pad and tampon to absorb the blood
  • Staining clothes or bedsheets because of heavy bleeding

Your doctor may conduct a physical exam, a blood test or pap smear (to check for infection in the cells of the cervix) and a hysteroscopy to examine the inside of the uterus to diagnose menorrhagia. 

How long does menorrhagia last?

Menorrhagia usually lasts longer than 7 days and can go on indefinitely until it is treated.

Is menorrhagia curable?

There are many options for menorrhagia treatment that can help reduce heavy bleeding. 

It is not uncommon for teenagers/adolescents also to experience heavy bleeding. The options for puberty menorrhagia treatment are similar to those for adults. 

How do you treat menorrhagia naturally?

Indulging in regular exercise is one of the best ways to reduce bleeding and cramping. 

“Along with exercise, you must also eat food rich in antioxidants and try to curb your intake of oily and fried foods, as those may not only cause weight gain but also make you more lethargic,” counsels Dr Swati.

Smita listened to the doctor’s advice but remained quiet. 

Sensing Smita’s uneasiness, the gynecologist prompted her to ask what was on her mind. Since Smita had been facing a lot of discomfort, due to which she had stopped going out, she wanted to know about any permanent solution.

What are the options for menorrhagia treatment?

“It is important to consider your past history, your responses to medications, symptoms and preferences when determining treatment that is appropriate for you,” says Dr Swati.

Medical treatment options

  • oral contraceptives
  • oral progesterone

Non-surgical options

In case the medication does not work, and you still experience bleeding, you could consider non-surgical methods such as:

  • Endometrial ablation wherein the lining of the uterus (endometrium) is removed. It is difficult to conceive after the procedure but not impossible although the pregnancy will be fraught with complications. 
  • Uterine Artery Embolization (UAE) which is done to shrink fibroids. This is done by blocking the arteries that supply blood to fibroids. 

Surgical treatment

When non-surgical methods are not an option, heavy bleeding may be treated with surgeries such as:

  • Myomectomy in which fibroids are removed from the uterine wall, without touching the uterus. 
  • Hysterectomy which involves the removal of the uterus and prevents fibroids from returning. This option is recommended for women who experience severe bleeding and have completed their family. It can be done laparoscopically, vaginally or abdominally. 

Because Smita had severe bleeding and already had children, her previous doctors had suggested a hysterectomy. Just the thought of a hysterectomy stressed her out. When she expressed her hesitation, Dr Swati suggested Mirena, a hormonal intra-uterine device which is an alternative to hysterectomy. 

Upon hearing that surgery could be avoided, Smita straightened up, leaned forward and asked for details.

Mirena for Menorrhagia Treatment

What is Mirena?

It is a T shaped device that is placed in the uterus. Though it is often used for contraception, it helps in reducing the flow of blood and can be used in women suffering from menorrhagia. 

Smita wanted to understand how it worked, and asks “how does it help control bleeding?”

“The device releases levonorgestrel, which is a hormonal medication, that thins the lining of the uterus and leads to less bleeding and pain,” explains Dr Swati.

Benefits

Mirena IUD can be offered to women across ages and also to teenage girls. It can

  • Lessen heavy bleeding after 3-4 months or more
  • Reduce period pain and pain due to endometriosis
  • Lessen the chances of developing endometrial cancer or pelvic infection
  • Be taken out at any time and does not impact fertility

The doctor wanted Smita to be aware of the risks involved before deciding upon the method of treatment, and went on to elaborate the risks involved.

Risks

A few side effects associated with Mirena include tenderness in the breast, cramps, pain in the pelvic area, headache or acne. Mirena does not prevent sexually transmitted infections. 

According to sources, less than 1% of women will get pregnant if Mirena is used for a year. 

Smita wanted to know if there was any criteria for using Mirena. 

Suitability

Your doctor may not suggest Mirena if you have liver or cervical cancer or breast cancer or have had it previously. You also maybe advised against it if you have pelvic inflammatory disease or vaginal bleeding (without a known cause); have delivered recently or are breastfeeding or if you have fibroids, which may hinder the retention of the device.  

Glad that she was a candidate for Mirena, Smita asked the doctor what to keep in mind while preparing for the procedure. 

Preparing for Mirena Insertion

“We will physically examine you and do a pelvic exam before the procedure,” says Dr Swati. “The device is usually inserted during your periods or right after a termination of pregnancy. You will have to come to the hospital for the insertion.”

Smita then asks, “how is Mirena inserted?”

“Your doctor will clean your vagina and cervix with an antiseptic, after which the depth of your uterine cavity maybe measured. The Mirena is placed inside an applicator tube which is then inserted into the cervical canal, through which Mirena is inserted into the uterus. The device will stay in the uterus after the applicator tube is removed. 

It is normal to feel light headed, pain and a heart rate that is less than normal,” explains Dr Swati.

The procedure is done during the day itself and you can return home and resume your routine activities immediately afterwards. 

Removal of Mirena

Mirena can be placed for upto 5 years and will have to be removed by your doctor. You could experience little bleeding and some pain during the procedure.

Mirena Cost in India

Content with the knowledge about Mirena and how it is likely to help lessen the bleeding, Smita inquired about the cost of Mirena

The Mirena IUD cost in India starts from 10,000 in small clinics.

Call us at +919871001458 to find out the cost of Mirena at Sitaram Bhartia Hospital in South Delhi.

Upon hearing that the cost would be lower than a hysterectomy, Smita began to convey her consent to the doctor.

After letting her complete her thoughts, Dr Swati says “Think over your decision, speak to your husband and make sure you properly understand the benefits and the risks before deciding about Mirena, rather than focusing on one aspect.”

Touched by the fact that the doctor emphasized taking time to decide about the procedure, Smita realized that this kind of unhurried care was something she had not experienced before. 

A few days after her first consultation, she returned to the hospital looking less stressed and confident about the procedure. 

“The procedure took barely a few hours. It was a little uncomfortable because I knew a device was being placed inside my body but the doctor’s calm attitude gave me the reassurance I needed. Within 4 months, the heavy bleeding has reduced considerably, and I am happy to have chosen Mirena as a form of menorrhagia treatment,” concludes Smita in a follow up visit.

This article was written in April 2020 with editorial inputs from Dr. Swati Sinha, Consultant, Obstetrics and Gynecology at Sitaram Bhartia Hospital.

 

Dr. Swati Sinha, MBBS, Maulana Azad Medical College, New Delhi (1996); MD (Obstetrics & Gynaecology), Lady Hardinge Medical College, New Delhi (2001); MRCOG Part 1 (October 2010)

 

 

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