A Doctor’s Love Letter to Her Mirena IUD

Dr. T puts the “I” in IUD (and TMI)

I love my IUD. For all the skeptics, I thought I would share my personal experience with an intrauterine device and how it saved me from myself.

Every day, I hear my patients say, “But I’ve read so many bad things about IUDs online” or “I know a friend of a friend who had a really bad experience with her IUD.” Don’t get me wrong… everything has its risks and benefits. There are genuinely people who have bad experiences with certain types of birth control, but keep in mind, that one size does not fit all. There are some people for whom certain types of birth control would be a terrible idea (like birth control pills in someone with a history of a stroke or blood clot in their lungs) and others for whom birth control could be life-saving (like birth control pills lower the risk of ovarian cancer in women with hereditary breast-ovarian cancer syndromes or preventing a surprise pregnancy in a woman who survived serious complications during childbirth).

The internet is skewed. People need a place to vent when they have an ax to grind. Fewer people take the time to write a review when they are happy because they just keep living their lives. I have been guilty of NOT writing a good review for restaurants or nail salons or doctors that were fantastic because I just thought, “hmm, that was nice” and kept it moving. 

So now is the time to write my positive review since the internet is so full of bad ones

My IUD has changed my life. I have had horrible periods ever since I was 12. They were heavy. and painful. They lasted forever… ok, usually 10-14 days, but that is still basically needing some kind of flow patrol for half of the year, and that is a lot of wasted money on pads and tampons (this was back in the day before we had decent reusable menstrual cups available in the U.S. and before internet shopping was a thing. That is how old I am). Thank goodness a flannel shirt tied around the waist was fashionable in the 1990s (à la T.L.C. and grunge rock) because that was my Plan B for bleeding through my clothes (TMI yet?). 

After I bled every day for almost a month straight, my mom finally took me to her OBGYN when I was 16. I left with a pack of iron pills for 1 month because I had lost enough blood to become anemic. That’s it. No birth control hormones to regulate my cycles.  No recommendation that scheduling over-the-counter NSAIDs (non-steroidal anti-inflammatory drugs like naproxen and ibuprofen) 48 hours before the onset of my periods could prevent the cramps from getting so severe and reduce my menstrual blood loss by 30%. No solution to my nightmare periods. No one even told me that my “regular” 10-14 day periods were not normal. Even though she herself was a nurse, my loving mother (bless her heart) was one of those moms that believed that “hormones are bad for you” and “birth control pills will make your daughter have sex earlier” (which well-validated scientific studies have proven to be untrue). So I continued to have horrible periods and uncorrected anemia (because no one seemed to think that I needed a refill on iron pills when I continued to hemorrhage on the monthly).

Fast forward to when I am old enough to make my own medical decisions

Most people start with birth control pills because it is cheap, it is easy, and it’s the only kind of birth control/hormone you’ve ever heard about. Birth control pills made my periods much shorter (about 7 days), less painful, and less heavy (just in time for baggy clothes to go out of style). 

Anyone with an unpredictable schedule knows that it is hard to take a pill at the same time every day, and when you take birth control pills inconsistently, you start to have irregular spotting and breakthrough bleeding. Medical school made it very clear that birth control pills were not going to cut it, so I switched to the Nuvaring, which lasts for a whole month at a time. The Nuvaring coordinated perfectly with my 4 week hospital rotations. This worked out pretty great when the Nuvaring was free with my insurance. Then about a year later, it was suddenly $50 a month with insurance, so back to the free birth control pills I went. Before the Affordable Healthcare Act (also known as Obama care), insurance companies were not required to cover at least one brand/version of each kind of birth control option. Back in the day, IUDs were also very expensive, and they used to say that you couldn’t/shouldn’t have an IUD if you have never given birth before. Now we know that restriction was nonsense.

By the end of my third year in medical school, my periods were getting worse despite the birth control pills. I knew that my periods were going to interfere with my ability to do my job as a busy doctor. It’s not like I can just say, “Ma’am, I know you’re trying to bring another human into this world but can you stop pushing for a couple minutes? I really need to go to the restroom because I’m bleeding through my super plus tampon and soaking through my pad.”

I was so desperate that I went to a local OBGyn asking about endometrial ablation (burning the lining of the uterus) or hysterectomy (complete surgical removal of the uterus). These are procedures which should be reserved for women who do not want to ever get pregnant afterwards. My periods were so bad that I did not care. I could be the physician that I have always wanted to be or I could maybe one day in the distant future find my soulmate and have my own baby… I made my choice, and the doctor sent me on my way with an endometrial ablation pamphlet and told me to call back when I was ready to schedule my procedure.  

Now that I am an OBGyn myself, I am absolutely appalled when I think back to that visit for many reasons:

  1. Although endometrial ablation destroys most of the uterine lining, preventing a healthy normal pregnancy, it is not birth control.  An ectopic pregnancy (an abnormal type of pregnancy growing outside the uterus, most commonly in the fallopian tube) after an endometrial ablation can be life-threatening. The doctor  never mentioned that I would still need to be on some kind of birth control so that I would not get an ectopic pregnancy and maybe bleed to death.
  2. Why would you permanently destroy any chance to have a baby in a 23 year old without kids before having a discussion with her about ALL the options?! The doctor  never mentioned that a hormonal IUD is FDA-approved to treat heavy periods in addition to decreasing pelvic pain and working almost as good as tubal ligation (“tying tubes”) to prevent pregnancy. 

Good thing I chickened out and never went back

I tried taking my birth control pills in an extended cycle fashion (skipping the placebo pills to suppress my periods), but unfortunately, I was not one of the lucky ones for whom that worked well.  Every 2-3 months, my periods still powered through the active pills. I just dealt with the breakthrough bleeding until intern year of my Obstetrics & Gynecology residency. One of my fellow residents walked out of the operating room with blood splashed over her lap. The nurse at the desk said, “Doctor, I don’t think that is the patient’s blood…” The resident looked down in horror. She was on her period and realized that she had bled through her pad and onto her scrubs while she was in surgery.  I was a little traumatized and didn’t want that ever to be me. I scheduled my IUD appointment.  

Most of my patients know the story from here. Since I have never had a vaginal delivery, my gynecologist gave me misoprostol (a medication to open my cervix) to make it easier to place the IUD.  I am a weeny when it comes to pain, so I pre-medicated myself with the maximum dose of Aleve and Tylenol. The insertion process was quick. It felt like a pap plus the worse period cramp I ever had, and then it was over in a few seconds. I cramped off and on for 3 weeks, alternating between Aleve and Tylenol as needed (most of my patients tell me they only cramped for a few days after IUD insertion). Because I knew that weird bleeding was expected for the next 3-6 months while my body was adjusting to the IUD, I kept taking my birth control pills for 6 months to suppress my periods. IUD hormones are so low dose and mostly stay locally at the level of the uterus, so my body only really registered that I was taking the birth control pills. Since then, I have not had a full period. I had some spotting for the first year or two, but now I have not had a drop of blood going on 8 years (I replaced my old IUD after 5 years). It has been glorious. I’ll still get a day of cramps now and then when I am ovulating, but it is nothing that cannot be handled by one over-the-counter pain pill. 

So thank you, 52 mg levonorgestrel intrauterine device. This is my love letter to you

For so many women, a bad period can be a pain in your A and your V. I have actually felt your pain. Before going straight to surgery, why not consider a hormonal IUD? I can set it [the IUD] so you can forget it [your period]. I not only recommend the levonorgestrel intrauterine device as a doctor, but as a patient. I trust it enough to put it into my own body (twice so far), and it hasn’t failed me yet. My mantra is going to be “Mirena until Menopause” (and probably even after that for endometrial protection when I start estrogen therapy for my hot flashes… but that will be another story for later). 

 

By: Dr. Stacey Thomas

 

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