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Sunday, March 3, 2013

Mirena Wins This Round Of Medical Treatments For Women Who Want Children and Have Heavy Menstrual Bleeding

Heavy menstrual bleeding can be treated by many therapies,including birth control pills, progesterone, the Mirena IUD, nonsteroidal anti-inflammatory drugs (NSAIDs), and antifibrinolytics.These medicines may be the right therapy for you, but there are reasons that the Office NovaSure treatment may in fact be a better choice for some. It is important for you and your gyno to discuss which will be right for you. Mirena IUD was the best at the treatments.  supported by National Institute of Health Technology Assessment Programme, called the ECLIPSE study which was headed by Dr. Janesh Gupt of the University of Birmingham in England. The study was then published in the New England Journal of Medicine 1013. In this study the physicians studied heavy menstrual bleeding and most importantly a woman's perception of benefit from their menstrual treatments. They looked at how controlling heavy periods: called menorrhagia, affects six functions of life: practical life settings, a woman's social life, her psychological well being, her physical health, her work and her family. They watched women from ages 25 to 50 over four years. They compared many of these treatments such as birth control pills, progesterone injections (DepoProvera), tranexamic acid to the IUD in a large group of women who were assigned to either have the IUD or get the medical therapies.

As for as the measurements of success based on quality of life, Mirena beat out all the other therapies for heavy menstrual bleeding. Of the women who were not successfully treated they wound up having either an endometrial ablation or a hysterectomy about 10% of the time in both groups. In a review article on non-surgical management of heavy menstrual bleeding in the March issue of Obstetrics & Gynecology they looked at the 26 well done studies of all therapies they could find short of surgery. In this review article they felt 26 studies were not a lot to depend upon, and there was a caviat to be taken into consideration, the research studies look at only heavy bleeding, not "patient experience." It is uncommon for them to look out farther than a few months, although it was studied for up to a year in some studies.

 It is also concerning that there were no real quality of life studies that were large enough to really answer questions like: will you still have PMS, will you still have cramps, will you have wight gain, will you have bloating, will you overall be better enough that you feel better from treating the heavy bleeding with one treatment vs the other. Also studies that combine therapies are lacking, and that is something that just your gyno needs to work out for you on her own. For women who do not want children, endometrial ablation, particularly with NovaSure, can be successful about 90+% of time, and can be accomplished in a comfortable office setting. NovaSure treatment has been shown to reduce PMS, reduce the symptoms around the heavy bleeding so even cramping and bloating are improved.

For women who receive a Mirena IUD some spotting or irregular bleeding in the first three months is very common.  Recent studies have tried to come up with specific treatments for the irregular bleeding, and none was any better than just waiting it out. The hormone levels of Mirena are low, but still some women will report side effects. No hormonal side effects either mood changes or weight gain has been reported for women receiving NovaSure and it appears that at one year there is a bit more data on quality of life. For women considering their options, call 217-356-3736 to schedule an appointment with www.womenshealthpractice, or go to the website and email for an appointment.

2 comments:

  1. I've heard women complaining about Mirena. Though, I also know some who said that their decision of getting an IUD was the best thing they did in terms of birth control. As for me, I'd rather opt for depo if I want to control the bleeding

    ReplyDelete
  2. DMPA, or Depot Medroxyprogesterone Acetate is an excellent long acting contraceptive as well as a control of menstrual periods, as is the Nexplanon 3 year implantable progesterone device. Definitely explore all your options when you go to your gynecologist with questions about contraception.

    ReplyDelete

Thank you for your comments and questions. This blog is not intended to replace medical care, but is informational only. We hope you will become a follower or visit Womens Health Practice. We offer a variety of unique services including MonaLisa Touch, Coolsculpting, Labiaplasty, and Gynecoloigic Clinical Research Trials. For more information on menopause see http://www.amazon.com/Menopause-Make-Peace-Change

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