Pros and cons of the hormonal IUD Mirena. Analysis of adverse reactions when using The left ovary is larger than the right one against the background of Mirena
How effective is the Mirena coil for endometriosis, as one of the methods of treating the disease?
Mirena spiral, what is it?
The Mirena spiral is an intrauterine system that has a contraceptive and local therapeutic effect on the body, and has recently been widely used for endometriosis.
Mirena is a T-shaped design with a cylindrical core. The system is inserted directly into the uterus. The core contains the hormone levonorgestrel, which is released daily into the uterine cavity in a minimal therapeutic dose that does not have a systemic effect on the body, and this is what the treatment tactics are based on. Can be used during lactation.
The action of the Mirena spiral is due to the ability of the hormone to suppress the monthly excessive development of the inner layer of the uterus, the endometrium, while the menstrual cycle is maintained, but their intensity and pain are reduced, including oligo- and amenorrhea, and the manifestations of endometriosis are reduced. Suppression of ovulation occurs rarely, since the concentration of estradiol in the blood and ovarian function are not impaired. Under the influence of the hormone, the cervical secretion thickens, preventing sperm from entering the uterine cavity and fallopian tubes. Mirena is an effective contraceptive.
Indications for use:
- prevention of unwanted pregnancy;
- treatment and prevention of massive uterine bleeding;
- prevention of endometrial proliferation during estrogen replacement therapy;
Recently, the IUD has been used for endometriosis; reviews from doctors using this treatment method are extremely positive.
Contraindications:
- pregnancy or suspicion of it;
- malignant formations of the uterus, cervix and mammary glands;
- idiopathic uterine bleeding;
- inflammatory processes of the genitourinary system;
- pelvic organ infection;
- endometritis (inflammation of the endometrium, the surface layer of the inner mucous membrane of the uterine body).
- reduced immunity and susceptibility to infection;
- congenital or acquired deformation of the uterus;
- dysplastic changes in the cervix;
- intolerance to the components of the drug.
The Mirena intrauterine system should be used with caution in case of migraines, arterial hypertension, diseases of the cardiovascular system, and the presence of hormone-dependent neoplasms. If these symptoms appear after the insertion of the IUD, you must urgently see a doctor and decide on its removal from the uterine cavity and selecting another course of treatment.
Is it possible to insert an IUD for endometriosis?
Each menstrual cycle ends with the rejection of the functional layer of the uterus, the endometrium. The endometrium exits along with the blood through the external genitalia. The abundance and duration of menstrual bleeding depends on the amount of the rejected layer. With endometriosis, the functional layer of the uterus grows and thickens. Bleeding becomes more abundant and prolonged, often accompanied by painful sensations. Due to the ability of the hormone progesterone to inhibit the growth of the endometrium, it is possible to treat endometriosis with the Mirena coil. Acting locally in the uterine cavity, the system suppresses lesions until their complete disappearance of endometriosis. Mirena reduces cyclic pain and the risk of developing iron deficiency anemia.
The intrauterine device has been used for the treatment of endometriosis since recently. For a long time, its main purpose was to prevent pregnancy. Many women have tested how effective the therapeutic coil is for endometriosis.
The Mirena spiral is used for endometriosis in the early stages; the price of the system can vary from 7 to 11 thousand rubles. In advanced forms of the disease, the IUD for the treatment of endometriosis will not be effective.
Introduction of the spiral
Before the procedure, the patient must undergo an examination to exclude all kinds of contraindications and complications.
Mirena is administered to women of childbearing age in the first week of the menstrual cycle. The IUD can be installed 6 weeks after an uncomplicated term birth and after a medical abortion, as soon as the next menstruation has passed. For women who have not given birth, the IUD is not recommended. Mirena is not intended for emergency contraception immediately after sexual intercourse.
Mirena is administered by a doctor during a gynecological examination, and the presence of endometriosis in the early stages does not affect the sequence of all manipulations. Before starting the procedure, the cervix is treated with an antiseptic solution. The system is inserted through the cervical canal into the uterine cavity using a thin elastic tube. The procedure is quick and painless. After insertion of the spiral, discomfort and dizziness may occur, which usually disappear after 30 minutes. If symptoms do not disappear, this may indicate that the IUD is not positioned correctly in the uterus. If necessary, Mirena is removed.
The service life of the Mirena spiral is 5 years. The new system can be installed at the same time as the old one is removed. The IUD can be removed at the woman’s request at any time, regardless of the menstrual cycle. The functional layer of the uterus is restored a year after removal of the IUD, and 80% of women become pregnant.
Today, one of the most common types of contraception both in our country and around the world is the use of intrauterine devices. They have been used since the middle of the last century, but are constantly changing and improving. Today, the usual copper-containing IUDs are being replaced by hormonal systems, the most popular of which is Mirena. It combines the best qualities of the IUD and oral hormonal contraceptives.
What is the Mirena hormonal system?
Mirena looks like a regular T-shaped spiral, which helps securely secure it in the uterus. One of the edges is equipped with a special loop with thread, which is designed to remove the system. In the center of the spiral is a whitish container that contains the hormone. It is slowly released through a special membrane and enters the uterus. Each system contains 52 mg. gestagen or levonogestrel.
Externally, Mirena is practically no different from a regular spiral Mirena itself is enclosed in a special tube and packaged in a separate plastic and paper package. You can remove the spiral from it only immediately before installation. In undamaged packaging, the system can be stored for 3 years at a temperature of 15-30 degrees.
How does it work
Immediately after installation, Mirena begins to release hormones into the uterus. Every day 20 mcg enters its cavity, and after five years this amount drops to 10 mcg. per day, so it's time to change the system. Almost all of the hormone is concentrated in the endometrium, exerting a local effect. Only microdoses of the drug enter the blood. The release of the hormone begins approximately an hour after the introduction of the spiral, and after two weeks its maximum concentration is reached.
Of course, this indicator greatly depends on the woman’s weight. Weighing 54 kg. the content of levonorgestrel in the blood is approximately 1.5 times higher. Almost all the substance is broken down in the liver and excreted through the kidneys and intestines.
The white container contains a medicine The contraceptive effect when using Mirena is achieved both through a local reaction to a foreign body and under the influence of a hormone - this increases its effectiveness by up to one hundred percent. The introduction of a fertilized egg does not occur due to the thinning and suppression of the activity of the uterine epithelium, since its natural growth and the functioning of the glands are suspended.
After the obligatory removal of the spiral after five years, the next one can be installed immediately without any interruptions.
Under the influence of the hormone secreted by the IUD, the motility of sperm in the uterus and its tubes is noticeably reduced, which also enhances the contraceptive effect. In addition, the mucous layer of the cervical canal becomes thicker and less permeable. Therefore, most sperm simply do not penetrate the uterine cavity.
Pros of using Mirena
This hormonal intrauterine system has many advantages, especially when compared with simple IUDs or oral contraceptives. Mirena almost never falls out, as happens with other devices. Her hormone relaxes the muscles of the uterus and prevents it from pushing out the spiral. In addition, the use of Mirena significantly reduces the risk of developing inflammatory processes.
Since many women stop menstruating while using Mirena, as soon as this happens, it is necessary to take a pregnancy test. After receiving a negative result, there is no need to repeat it, since the probability of fertilization in this state is practically zero.
This hormonal system provides much higher contraceptive protection than any other method of preventing pregnancy. Its effectiveness reaches 100%. Moreover, immediately after removal of the IUD, the woman’s reproductive system is almost completely restored. The desired pregnancy occurs within a year in 80% of couples.
Mirena is installed like any other IUD. A huge advantage of the hormonal system is the possibility of its use in patients of different ages. It does not have a noticeable negative effect when used during lactation, therefore it is superior to oral contraceptives. Mirena can also be used by nulliparous girls and women during menopause.
In addition to the contraceptive effect, it also has medicinal properties, can prevent certain diseases, protect the endometrium from hyperplastic processes, and prevent the growth of endometrioid cysts and fibroids.
Mirena against fibroids
Mirena is often recommended as a medicine against uterine fibroids. It really helps curb its growth and reduce unpleasant symptoms. Often with fibroids, menstruation becomes more painful and profuse, which causes discomfort to the woman. The use of Mirena makes periods almost painless and very scanty, and in 20% of women they stop altogether. At the same time, all organs, including the ovaries, continue to function normally, it’s just that the volume of the uterine mucosa is greatly reduced.
Classification of fibroids This inhibiting effect allows this hormonal system to prevent the appearance of fibroids. If the tumor already exists, then the presence of Mirena will slow down its growth. In many cases, this allows you to avoid surgery and even removal of the uterus. Of course, the fibroid itself will not go away, but the symptoms will disappear, the progression of the disease will stop, and the woman will be able to live a full life. After the coil is removed, tumor growth can resume - then a new hormonal system is simply installed.
Side effects
Using Mirena, like any other hormonal drug, can lead to various side effects. Some troubles may arise immediately after installing the spiral. At first, menstruation may become longer and more painful. In addition, due to endometrial restructuring, some women experience irregular spotting. But gradually they become more and more rare and scarce until menstruation completely stops. It should be noted that after stopping the use of this product, their characteristics will remain the same for several months.
Abdominal pain is one of the possible side effects of Mirena Although Mirena releases levonorgestrol directly into the uterine cavity, some of it is still absorbed into the blood. Usually its concentrations in the blood are very small, about seven times less than when using oral contraceptives. But there is still a risk of side effects. They can manifest themselves in the form of a slight decrease in libido, mild pain in the back and abdomen, and some increase in body weight, which is explained by fluid retention in the body. Most unpleasant sensations disappear after a month and a half, occasionally after six months.
Levonorgestrol, which is part of Mirena, affects glucose tolerance. Therefore, patients with diabetes mellitus using this spiral need to more carefully monitor their blood sugar levels.
Ovarian cysts often develop when using Mirena. They can be suspected when severe abdominal pain appears, which does not disappear even after taking painkillers. This condition rarely requires any treatment. Cysts usually disappear on their own in about three months.
Contraindications
Despite the huge number of advantages, there are situations when Mirena cannot be used. This spiral is contraindicated for women with hypersensitivity to any of its components. It is not recommended for patients with a history of severe liver damage, for example, active hepatitis, tumors or cirrhosis. Mirena is prohibited for malignant neoplasms in the uterus or its cervix. A history of deep vein thrombosis in the legs is also a contraindication to the use of this hormonal system.
This method of protection is not suitable for women suffering from increased sensitivity to infections and inflammatory diseases of the pelvic organs. The installation of a spiral is also contraindicated in cases of congenital or acquired anomalies of the structure of the uterus, during pregnancy and postpartum endometritis, cervicitis and uterine bleeding. It is also not suitable for patients who have had a septic abortion within the last quarter.
Video about the intrauterine contraceptive "Mirena"
The Mirena Hormonal Spiral is a highly effective modern contraceptive that has a minimum of side effects. At the same time, it can prevent the development of certain diseases and inhibit the growth of uterine fibroids. But before installing it, you must undergo a medical examination and consult a doctor to avoid possible side effects.
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!
General characteristics
Therapeutic intrauterine system Mirena as an intrauterine contraceptive (IUC)
Therapeutic intrauterine system (hormonal intrauterine system, hormonal intrauterine device, Navy) Mirena refers to intrauterine hormonal contraceptives.In the 60-70s, copper-containing VMCs appeared, the efficiency of which was even higher. However, the problem of metrorrhagia (uterine bleeding) was not solved by the second generation of intrauterine contraceptives.
And finally, in the second half of the 70s, the first hormone-containing intrauterine contraceptives appeared - the new, third generation of IUDs. These medications combine the positive aspects of IUDs and hormonal oral contraceptives.
Hormone-containing intrauterine contraceptives are more effective than others contraception this group. In addition, they do not lead to uterine bleeding. With the use of hormone-containing intrauterine contraceptives, menstrual bleeding becomes less heavy.
Description of the dosage form
The Mirena intrauterine hormonal system has a T-shaped body that ensures stable placement in the uterine cavity. At one end the body has a loop to which threads are attached to remove the system. On the body there is a hormonal-elastomer core, which is a white or almost white substance. The core is covered with a translucent membrane that regulates the flow of the active substance into the uterine cavity.The active hormonal substance of the system - the progestin drug levonorgestrel - is presented in the amount of 52 mg. The excipient is polydimethylsiloxane elastomer.
The Mirena intrauterine hormonal system is located in the cavity of the guide tube. The conductor and body of the drug do not have any impurities.
Each package of Mirena contains one intrauterine hormonal system, placed in a vacuum plastic and paper shell.
Before use, the purchased Mirena dosage form should be kept in a place protected from sunlight, at room temperature (15-30 degrees). The shelf life is three years.
Metabolism of active substance in the body
The hormonal Mirena IUD begins to release levonorgestrel immediately after placement in the uterine cavity. The release rate of the active substance after administration is 20 mcg/day, by the end of the fifth year it decreases to 10 mcg/day.The distribution of levonorgestrol characterizes Mirena as a drug of predominantly local action. The highest concentration of the substance is stored in the endometrium (the lining of the uterus). In the myometrium (in the muscular layer), the concentration of levonorgestrel barely reaches 1% of the concentration in the endometrium. The concentration of levonorgestrel in the blood plasma is 1000 times less than in the endometrium.
The active substance enters the blood approximately an hour after administration of the system. The maximum concentration of levonorgestrel in the blood serum is achieved after two weeks.
Body weight significantly affects the concentration of the active substance in the blood plasma. In women with reduced weight (37-54 kg), the concentration of levonorgestrol in the blood is on average one and a half times higher.
The active substance is almost completely metabolized (broken down) in the liver and excreted through the kidneys and intestines.
Operating principle
The most important contraceptive effects of the Mirena intrauterine hormonal system are due to a weak local reaction to a foreign body in the uterine cavity, and predominantly to the local influence of the progestin drug levonorgestrol.The functional activity of the epithelium of the uterine cavity is suppressed: the normal growth of the endometrium is inhibited, the activity of its glands is reduced, transformations occur in the submucosa - all these changes ultimately prevent the implantation of a fertilized egg.
Another important contraceptive effect is the increase in the viscosity of the mucus secreted by the glands of the cervix and the thickening of the mucous membrane of the cervical canal, which prevents the penetration of sperm into the uterine cavity.
In addition, Mirena inhibits sperm motility in the uterine cavity and fallopian tubes.
In the first months of use, due to the restructuring of the uterine mucosa, irregular spotting is possible. But further suppression of the proliferation of the endometrial epithelium leads to a pronounced decrease in the volume and duration of menstrual bleeding, up to amenorrhea (cessation of menstruation).
Indications for use
The Mirena intrauterine hormonal system is intended, first of all, to prevent unwanted pregnancy. In addition, the drug is used for excessively heavy menstrual bleeding of unknown etiology (in cases where the possibility of cancer of the female genital area is excluded).
As a local progestin drug, the Mirena intrauterine device is used to prevent endometrial hyperplasia (proliferation) during estrogen replacement therapy (this type of treatment is indicated after operations to remove both ovaries, as well as during severe menopause).
Contraindications
Mirena is an intrauterine contraceptive, so it is strictly contraindicated for inflammatory diseases of the female genital area, such as:- acute and chronic inflammatory diseases of the pelvic organs;
- infectious lesions of the lower genitourinary tract;
- postpartum endometritis;
- septic abortion that occurred less than three months before installation.
As an intrauterine contraceptive, Mirena is also contraindicated for cervical dysplasia, malignant neoplasms of the body and cervix, congenital or acquired changes in the configuration of the uterine body cavity (including fibroids).
Since the active substance of the drug is metabolized in the liver, the Mirena intrauterine hormonal system is contraindicated in case of oncological pathology of this organ, as well as in acute hepatitis and cirrhosis. If jaundice of unknown origin has previously occurred, the drug should be used with great caution.
Since levonorgestrol is a progestin drug, Mirena is contraindicated in all gestagen-dependent cancers (primarily breast cancer).
The systemic effect of levonorgestrol on a woman’s body is weak. However, the Mirena intrauterine hormonal system should be used with extreme caution in cases where progestin drugs are contraindicated. This is especially true for severe circulatory disorders (heart attacks, strokes), a history of severe migraine attacks (including those that may indicate severe cerebral circulatory disorders), arterial hypertension, severe forms of diabetes mellitus, thrombophlebitis and a tendency to thromboembolic complications.
In such cases, the degree of risk (the severity of symptoms of the disease, which is a relative contraindication to the use of the drug) should be correlated with the benefits of its use. The question of using Mirena is decided in consultation with a professional, and during the use of the spiral, constant medical supervision and laboratory monitoring are required.
Mirena is contraindicated during pregnancy (diagnosed or suspected) and in case of hypersensitivity to the components of the drug.
Side effects
Common side effects
Common side effects include accompanying symptoms that appear no less frequently than in every hundredth and no more often than in every tenth patient using the IUD. Women using Mirena most often experience unpleasant symptoms from the central nervous system, such as: nervousness, irritability, bad mood, decreased libido, headache.
From the gastrointestinal tract, patients are often bothered by abdominal pain, nausea, and vomiting.
Among the adverse effects on appearance, the most common are acne and weight gain.
Patients often present many complaints about the condition of the reproductive system and mammary glands: pain in the pelvic area, spotting, vulvovaginitis, tension and tenderness of the mammary glands.
Back pain resembling sciatica is relatively common.
All the symptoms described above are most pronounced in the first months of using the Mirena IUD; subsequently, their intensity decreases, and in the vast majority of cases, the unpleasant symptoms completely disappear.
Rare side effects
Rare side effects include accompanying signs of drug use, which appear no more often than in every hundredth patient, and no less often than in every thousand.Rarely encountered adverse side effects of Mirena include the following:
- emotional lability (frequent mood swings);
- the appearance of edema;
- alopecia (baldness);
- hirsutism (increased hairiness);
- skin itching;
Very rare side effects
Very rare effects of Mirena (less than one case in a thousand) include allergic reactions in the form of rash and hives. If such signs appear, other possible causes of skin allergies should be excluded and, if necessary, stop using the IUD.Instructions for use
Installation of the Mirena intrauterine device
The sterile vacuum packaging is opened immediately before installing the system. A prematurely opened system must be destroyed as medical waste. Only a doctor with sufficient experience in performing this type of manipulation can install the Mirena intrauterine system.
Before installing the Mirena spiral, you should consult with a gynecologist and obtain information regarding all the risks and possible adverse side effects.
Having decided to install the Mirena IUD, a woman must undergo a breast examination and mammography, as well as a gynecological examination, including a pelvic examination and colposcopy (or at least a smear test from the cervix).
It is necessary to exclude oncological pathology of the female genital organs, pregnancy and sexually transmitted infections. All inflammatory gynecological diseases must be completely cured by the time of installation.
Before installing the Mirena spiral, it is extremely important to determine the location of the uterus in the pelvis, as well as the size and configuration of the uterine cavity. The correct placement of the IUD in the uterine cavity guarantees the effectiveness of the Mirena system and prevents its expulsion (expulsion).
For women of childbearing age, Mirena is prescribed in the first seven days of the menstrual cycle.
If there are no medical contraindications, the Mirena IUD can be installed immediately after an induced or spontaneous abortion in the first trimester of pregnancy.
Surgery is extremely rarely resorted to.
Amenorrhea
Amenorrhea is a common complication of using the Mirena IUD. As a rule, it develops gradually during the first six months of using the contraceptive.
If menstrual bleeding disappears, pregnancy should be ruled out (perform a routine test). If the test is negative, you do not need to repeat it in the future. The normal menstrual cycle will resume after Mirena is removed.
Removing the spiral
After 5 years of use, the Mirena coil should be removed. In cases where, after removing the IUD, a woman intends to continue contraceptive measures, the Mirena coil should be removed at the beginning of the menstrual cycle. If the IUD is removed in the middle of the cycle, and before that there was unprotected sexual intercourse, then the woman is at real risk of becoming pregnant.If a woman wishes to continue using the IUD, a new IUD can be inserted immediately after removal. In cases where, after removing the IUD, a new intrauterine contraceptive device is immediately installed, manipulations can be carried out at any period of the cycle.
After removing the Mirena IUD, you should check the integrity of the spiral, since if there are difficulties in removing the product, sometimes the substance slips into the uterine cavity.
Installation and removal of the Mirena coil may be accompanied by pain and bleeding of varying severity. In some cases, fainting may occur. In women with epilepsy, insertion or removal of the IUD may cause a seizure.
Mirena intrauterine device and pregnancy
The drug is very effective. In cases where an unwanted pregnancy does occur, ectopic pregnancy should first be excluded. During intrauterine pregnancy, the question of its termination is raised.If a woman decides to keep the child, the IUD is carefully removed from the uterine cavity. In cases where it is not possible to remove the intrauterine system, the woman is warned about the possible risks of pregnancy with an IUD in the uterine cavity (spontaneous premature termination of pregnancy).
The possible adverse effects of the drug on fetal development should be taken into account. There are very few cases of carrying a child with the Mirena intrauterine system due to the high contraceptive properties of the drug. However, it is recommended that the woman be informed that there is no clinical data on the occurrence of fetal pathology under the influence of this drug.
Use during lactation
The active ingredient of the Mirena IUD penetrates into the blood plasma in small concentrations and can be released during lactation, so the content of levonorgestrel in breast milk is about 0.1% of the daily dose of the substance secreted by the system. It is unlikely that such a dose would affect the general condition of the baby. Experts say that the use of Mirena during lactation six weeks after birth is completely safe for a breastfed baby.
Frequently Asked Questions
The cost of Mirena is quite high. I heard that using the IUD is accompanied by many unpleasant side effects. Is there any positive effect of the drug on the body?
The Mirena intrauterine hormonal system has the following therapeutic (not contraceptive) effects:- reduction in the volume and duration of uterine bleeding (idiopathic - i.e. not caused by any concomitant pathology);
- increased hemoglobin levels;
- normalization of iron metabolism in the body;
- general strengthening effect);
- reduction of pain during painful menstruation;
- prevention of endometriosis and uterine fibroids;
- prevention of endometrial hyperplasia and cancer.
Is it possible to use the Mirena coil for fibroids to treat the tumor?
The Mirena therapeutic system inhibits the growth of the fibroid tumor node. However, additional examination and consultation with a doctor is necessary. Much depends on the size of the nodes and their location. For example, submucosal fibroid nodes that change the configuration of the uterine cavity are an absolute contraindication for the use of the Mirena IUD.Does the Mirena IUD help with endometriosis?
The intrauterine system releases a hormone into the uterine cavity that inhibits endometrial proliferation - this is the basis for the ability of the Mirena spiral to prevent the development of endometriosis.In recent years, studies have appeared indicating the therapeutic effect of the Mirena coil for endometriosis. Clinical data are quite contradictory. In addition, it should be noted that treatment of endometriosis with hormonal IUDs is not used in all countries.
From the standpoint of evidence-based medicine, the Mirena coil for endometriosis, like any other hormonal therapy, can only give temporary results. The Russian National Guidelines for Gynecology recommend starting with surgical treatment as the most radical.
However, in each specific case, a thorough examination and consultation with doctors - a gynecologist, surgeon and endocrinologist - is necessary.
My periods stopped completely six months after the Mirena IUD was installed. This is fine? Will I be able to get pregnant after IUD removal?
Amenorrhea (cessation of menstruation) is a normal reaction of the body to the action of the Mirena hormonal system, which occurs in every fifth woman who uses the IUD. Typically, this condition develops gradually.At the first disappearance of menstrual bleeding, pregnancy should be excluded. The effectiveness of the drug is very high, but experts still recommend taking a test. If the test result is negative, there is no need to worry in the future. After removing the Mirena coil, menstruation will be restored and a normal pregnancy can be expected.
Is pain, discharge or uterine bleeding possible after installing the Mirena IUD?
Immediately after Mirena installation, minor pain and spotting are possible. Severe pain and bleeding may indicate improper installation of the IUD. In this case, the Mirena coil must be removed.Pain, discharge or uterine bleeding a significant time after installation of the Mirena coil may indicate the onset of expulsion (expulsion of the drug from the uterine cavity) or ectopic pregnancy. Therefore, if such symptoms appear, you should immediately consult a doctor.
Does Mirena affect weight? I really want to buy a Mirena intrauterine device, but I’m afraid of losing my shape (I have a tendency to be overweight).
Weight gain is a fairly common unpleasant side effect of the Mirena IUD. However, it should be taken into account that not everyone gets fat. According to clinical data, at least nine out of ten women do not notice even a slight weight gain after inserting an IUD.In addition, weight gain is one of the side effects of Mirena, most pronounced in the first months after installation. As a rule, in the future the tendency to gain weight caused by the hormonal drug disappears.
Based on the existing tendency to be overweight, one cannot judge the possibility of weight gain after installing the Mirena spiral, since the occurrence of this side effect and the degree of its severity depends on the individual reaction to the hormonal drug.
I protected myself with hormonal drugs. There are no side effects, but I often forget to take pills. How can I best switch from tablets to Mirena?
If you take the pills irregularly, there is a possible risk of pregnancy, which should be excluded when prescribing the Mirena spiral.In addition, it is necessary to undergo a full gynecological examination (pelvic examination, colposcopy) and check the condition of the mammary glands.
If there are no contraindications to the use of an IUD, the IUD is best inserted on the fourth to sixth day of the menstrual cycle. On the day of installation of the Mirena spiral, contraceptive pills are canceled.
When does pregnancy occur after Mirena removal?
Clinical data indicate that 80% of women who want to give birth to a child become pregnant in the first year after removing the Mirena coil. This is even slightly higher than the normal level of fertility (fecundity).Of course, some time is needed to restore the normal state of the reproductive system, which is individual for each woman.
For patients for whom pregnancy is undesirable, doctors advise immediately after removing the Mirena coil to take measures to prevent conception, since in many women the likelihood of developing pregnancy appears immediately after the system stops working.
Where to buy Mirena spiral?
The Mirena intrauterine device can be purchased at a pharmacy. The drug is dispensed according to a doctor's prescription.Very often, after visiting an ultrasound room, a woman becomes scared and upset because she has discovered some kind of ovarian cyst. Then events develop according to two scenarios: either the woman is put on hormonal contraceptives for at least 3 months, or she is offered to urgently undergo laparoscopy. Laparoscopy in former post-Soviet countries, as in other developing countries where it is used in the private healthcare sector, is abused for commercial reasons - it is an extremely expensive surgical procedure.
The topic of tumor-like formations of the pelvic organs, in particular the ovaries, is very broad and complex, because at one age or in some cases such formations can be a physiological norm and do not require intervention, in others they require examination and treatment, in others - urgent removal.
What should women know about ovarian cysts and tumors? First of all, these are completely different conditions, so the approach to diagnosis and treatment can be completely different. It is also important to remember that diagnosis cannot be based only on one result of one ultrasound. It should include complaints, symptoms (signs) and often laboratory test results.
And one more important point: haste does more harm than good, and if some kind of ovarian formation is detected, the dynamics of observation over a certain period of time is much more favorable than hasty treatment, especially in the absence of any complaints and symptoms.
Now let's look at two different conditions of ovarian formations - cysts and cystomas.
Cyst ovaries are a sac-like formation of the ovary that does not extend beyond the ovary and contains fluid. Any cyst contains a certain amount of fluid.
Ovarian cysts occur in 30% of women with regular menstruation, 50% of women with irregular menstruation, and 6% of menopausal women. Functional cysts are a physiological condition of adolescence (10-21 years), when a girl’s puberty occurs.
What are the causes of ovarian cysts? There are several reasons:
Impaired follicle maturation (common with sudden weight fluctuations, stress, adolescence and premenopause, anovulation)
Hormonal imbalance (can be caused artificially due to improper prescription of hormonal drugs, as a result of stress, against the background of other diseases; often accompanied by impaired follicle maturation)
Pregnancy (corpus luteum cyst, etc.)
Smoking
Obesity (as a result of ovulation disorders)
Infertility (endometrioid cysts)
Decreased thyroid function
Ovarian cancer
Ovarian metastases (chorionepithelioma and others).
Cysts are very rare in newborn girls. Congenital ovarian cysts are observed in girls whose mothers suffered from diabetes or Rh immunization during pregnancy more often than in girls from healthy women. The detection of tumor-like formations of the ovaries in girls of early childhood (before puberty) requires urgent diagnosis to exclude a malignant process.
The most common cysts in teenage girls and young women are functional cysts. Such cysts are called functional because their appearance depends on the menstrual cycle, that is, on the function of the ovaries. Almost every woman has had a functional cyst at least once in her life, although the woman may not even be aware of it.
Distinguish two types of functional cysts: follicular and luteal.
Under the influence of the hypothalamic-pituitary system, the ovaries produce hormones that regulate the growth of follicles and egg maturation. However, with a number of disturbances in the connection of the ovaries with this system, which can be observed under the influence of many factors (for example, due to stress or starvation), the development of follicles is disrupted, and an ovarian follicular cyst (Graafian cyst) appears, which can most often be detected in the first two weeks of the cycle. Often the cycle drags on because it becomes anovulatory. In most cases, the follicle regresses, that is, it gradually resolves.
Follicular cysts can reach large sizes, but most often the diameter of the cyst does not exceed 4-6 cm.
Very often, follicular cysts are confused with an ovulating follicle. It is generally accepted that the normal size of the dominant follicle at the time of ovulation does not exceed 2.5 cm, but in some women they can be larger, which does not negatively affect ovulation. Therefore, follicular cysts are usually spoken of when the follicle size is greater than 3.5-4 cm.
After maturation (ovulation), the follicle turns into the corpus luteum, and if pregnancy does not occur, usually after 21 days of the cycle the corpus luteum slowly dissolves. However, in some cases, this process may stop and lead to the formation of a luteal cyst or corpus luteum cyst. Such cysts are most often diagnosed in the second half of the cycle. The size of luteal cysts can be larger than follicular cysts and reach 6-8 cm in diameter. But even with such sizes, treatment is most often not carried out.
Taking hormonal contraceptives can reduce and, conversely, increase the likelihood of ovarian cysts - depending on their composition, especially the progestin component. Hormonal contraceptives containing only synthetic progesterone can lead to the formation of ovarian cysts. The Mirena intrauterine hormonal system provokes the growth of cysts, which most often resolve after stopping use of this system. It is also important to remember that progesterone not only increases the risk of ovarian cysts, but also ovarian cancer.
What are the signs of a cyst in a woman? In most cases, women have no complaints, and cysts are discovered by chance during a gynecological examination or ultrasound. Cysts often resolve without medical intervention, so many women are unaware that they might have ovarian cysts. Sometimes a woman experiences nagging pain in the lower abdomen. When an ovary is torsed or a cyst ruptures, sudden, sharp pain may occur. Some women complain of pain during sexual intercourse or when exercising. When the cyst becomes inflamed, increased body temperature and weakness may occur. If estrogen levels are low, bloody vaginal discharge appears.
Laboratory methods for diagnosing functional ovarian cysts are uninformative, but in some cases it is necessary to exclude hormonal cysts and cystomas. Using ultrasound, you can determine the size of the formation, its location in the pelvis in relation to other organs, its structure, and monitor changes in size. For the purpose of diagnosis and often treatment, laparoscopy is used in a certain category of women (suffering from infertility, in premenopausal and menopausal periods). In any case, it is necessary to exclude a malignant process of the ovaries.
In most cases, functional ovarian cysts in women of childbearing age disappear within one or more menstrual cycles without treatment. It is advisable to perform a repeat ultrasound no earlier than 8 weeks or 2 menstrual cycles. In women over 40 years of age, cystic tumor and ovarian cancer must be excluded.
Of the drug treatments, the most common treatment for functional cysts (follicular and luteal) are combined oral contraceptives (COCs), but they are recommended only for a certain category of women, in particular, those who are not planning a pregnancy. If women experience pain, it is possible to use painkillers. If an infection is suspected, it is rational to use antibiotics.
Regarding ovarian cysts, the issue of surgical treatment is controversial. Undoubtedly, women who exhibit signs of an acute abdomen most often require surgical treatment. The choice of surgical method (laparoscopy or laparotomy) depends on the doctor’s skills, the woman’s condition, the equipment of the operating room and many other factors. Many doctors believe that the cyst must be removed surgically if the size of the cyst exceeds 6 cm, conservative treatment has been unsuccessful, and the cyst is rapidly increasing in size.
Benign ovarian tumors– these are neoplasms that develop from different ovarian tissues (80% of all ovarian tumors are of epithelial origin). If a cyst is just a saccular formation that accumulates secretions, but without cell and tissue growth, ovarian tumors are always accompanied by cell growth and division.
In general, benign tumors can be cystic (look like cysts) or mixed, hormonally active (produce sex hormones) or hormonally inactive, and they can grow in the body of the ovary.
Ovarian tumors occur in 5-7% of women. Borderline ovarian cysts are tumors that can turn into cancer when factors are favorable for this process. A large number of ovarian tumors are diagnosed in women over 40 years of age, when changes occur in the hypothalamic-pituitary system that regulates the ovaries. 20% of all ovarian tumors are malignant tumors.
The main risk factors contributing to the development of ovarian tumors are the following:
Use of COCs
Late first menstruation
Late pregnancy and childbirth
Smoking
Cases of ovarian cancer in close relatives
Diagnosis of ovarian tumors and cysts is accompanied by the complexity of their classification, because according to histological (tissue) structure they distinguish more 40 types of tumors, which are grouped into 7 main groups:
Dysgerminomas, teratomas, embryonal carcinoma, teratocarcinoma, chorionic carcinoma, melanoma, etc.
Granular cell tumor, thecoma, lipid cell tumor, arrhenoblastoma, Sertoli cell tumor, gynandroblastoma, etc.
Serous cystadenoma, cystadenofibroma, cystadenocarcinoma, mucinous cystadenoma, endometrootic tumor, endometroid carcinoma, rhabdomyosarcoma, mesenchymal sarcoma, etc.
Fibroma, lipoma, lymphoma, fibrosarcoma.
Lymphosarcoma, etc.
Brenner tumor, gonadoblastoma, adenomatoid tumor.
Most of these tumors are malignant, so tissue differentiation of ovarian tumors plays an important role in predicting the outcome of the disease. On ultrasound, many of these tumors will look almost identical, so it is not uncommon for serious tumors to be mistaken for cysts and treated incorrectly. Fortunately, the most common ovarian tumors are epithelial: serous and mucinous cystomas (cystadenomas), all other types of tumors are very rare.
Diagnosis of ovarian tumors is the same as for ovarian cysts: complaints, signs are taken into account and, if necessary, laboratory examination is carried out. Often the doctor differentiates these two qualitatively different conditions of the ovaries - cysts and cystomas, in order to exclude, first of all, a malignant process. In other words, if you detect any formation on the ovary, you need to make sure that it is not cancer. The age criterion and the presence of complaints are two important keys in making the correct diagnosis.
Treatment for ovarian tumors depends on the results of the examination, but in most cases they must be removed surgically (using laparoscopy or laparotomy).