You came to your health care provider during your menstrual periods, have few minutes of preparations, see a small box with a thing that is small as a half of your finger in doctor’s hand and see how the doctor gently places it in your uterus (or prefer not to see), in 5 minutes you are free, come back home with a feeling that you have an absolute freedom to have sex without thinking of pregnancy for…five years. Yes, you understand correctly. This small thing that gives you 5 years of contraception is Mirena, a new type of intrauterine device.

Mirena is a plastic intrauterine device (IUD) inserted into the uterus for preventing pregnancy. It is T-shaped frame that contains a small amount of a hormone LNG - 52 mg of levonorgestrel (progestogen hormone) and this device releases certain very small amount of LNG per day directly into the uterus to achieve contraceptive effect. Mirena is rather effective hormonal birth control method for women, approximately less than 1 in 100 women become pregnant while using this type of IUDs – that is 99.9 % of effectiveness.

Levonorgestrel is a chemical form of a progestogen hormone, the same hormone that is used in some birth control pills, the main responsible ingredient of the Mirena that has three mechanisms of action:

1. LNG thins the uterine lining
2. LNG thickens the cervical mucus
3. LNG inhibits mobility of sperm that make sperm penetration almost impossible

Mirena is placed right into the uterus, so the every day dosage of the hormone that is needed for preventing the pregnancy is very small, just the 1/7 of that in the average birth control pill.

So, what you should know, when thinking whether you want to use Mirena as contraception or not. Mind several requirements:

- Mirena must be inserted only by your health care provider in the clinic or your doctor’s office

- Your doctor should know for sure that you are not pregnant (that is why the insertion is made during your periods or right after the abortion)

- It is recommended to use another method of birth control as potential back-up for 3-4 weeks in case the IUD comes out or just moves on.

- You should have your regular check-ups when your doctor watches the Mirena’s behavior and prevents all problems

- To use Mirena a woman must have had at least one previous pregnancy

1. Mirena is rather effective IUD method of contraception. In comparison with conventional copper IUD that gives 96-98 percent of effectiveness Mirena gives about 99 percent
2. Mirena unlike copper IUDs can be used by women with heavy menstrual periods; it does not make the bleeding heavier. Mirena will reduce a woman's periods
3. Mirena can be used by women with small to moderate fibroids or heavy menstrual bleeding, even as additional treatment as it really makes your periods much lighter (again unlike other IUDs)
4. You do not feel Mirena inside – enjoy your sex! It concerns your partner also :)
5. The dosage of hormone is very small unlike that of the birth control pill
6. Mirena’s contraceptive effect is reversible, after the removal of the device 80 % of the women were able to become pregnant within 12 months
7. It remains in place for many years

1. Mirena does not protect you and your partner against STDs (sexually transmitted infections and diseases)
2. Certain risk of pelvic infection because of the insertion procedure (and the risk of being ovarian cysts (a fluid-filled sac in the ovary))
3. Mirena may be difficult to insert in some women
4. It will change your menstrual cycle (for some women it will be difficult to predict when their period will occur)
5. You can experience some side effects during first months of using Mirena - you can experience unpredictable bleeding first three months, after that bleeding may likely to stop; it may also cause you headaches, breast tenderness, water retention, acne or mood changes due to the amount of hormones for the same period of time
   

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6. Some women experience some crampings within the first few days after insertion but it will pass
7. For some women the cost is also a disadvantage – it is about $300
8. You can not use Mirena in case of genital infections, cervical dysplasia, uterine or cervical cancer and undiagnosed abnormal bleeding. Also if you have or had breast cancer

Though Mirena has some obvious advantages from other IUDs – your doctor is the best advisor in this matter. If you and your doctor are satisfied with this method as contraception the next thing to do is the same as after the hard work – enjoying the results of your decision and of simple life full of protected sex.

Valentyna Ant.

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