Dr Glenda McLaren
Obstetrician & Gynaecologist

A Hormonal Intra-Uterine Device, Like the Mirena in Australia, Can Be an Option to Help Women Suffering From Heavy Menstrual Bleeding (HMB)

Long-acting, pill-free contraception, such as intra-uterine devices (IUDs) is becoming very popular with women around the world including Australia. There are currently two types of hormonal IUDs available to women in Australia, Mirena and Kyleena. Kyleena is slightly smaller than Mirena and contains a slightly lower amount of hormone.

This article discusses Mirena specifically, however, if you have questions about Kyleena, please contact Bloom Women’s Health to arrange a consultation, or you may also ask your GP about Kyleena.

The great benefit of Mirena is not only contraceptive cover – the Mirena also is one of the recommended treatments from Bloom Gynaecologists for Heavy Menstrual Bleeding (HMB), because, over time, it can reduce your heavy periods by thinning the lining of the uterus. For women who have heavy periods, the Mirena can be a good option as it usually makes bleeding much lighter and sometimes stops periods altogether.

The other good news is that Mirena is listed on the PBS, which means that if you have a Medicare card it is subsidised by the Australian government.

What is a Mirena made from, and how does it work?

A Mirena IUD is a tiny plastic device in the shape of a ‘T’ that contains 52mg of hormones in its stem. It is inserted (via a simple procedure performed by a GP or Gynaecologist) inside the woman’s uterus (womb).

The hormone-releasing Mirena IUD can stay in place for up to five years and works by giving women a slow, continuous dose of a hormone called progestin into the lining of the uterus.

Mirena is an option offered by Gynaecologists at Bloom Women’s Health, as a generally safe and effective treatment for HMB. According to Bloom’s Dr Safa, since its introduction into practice in Australia in 2000, Mirena has ‘revolutionised the way doctors treat women with HMB.’ Mirena is currently recommended as a first-line treatment option for HMB by most international guidelines. This is excellent news for 95% of women as they can ‘set it and forget it’ and not worry about remembering to take various pills or consider surgical options for management.

However, Dr Safa said that in about 5% of women, Mirena will not be effective or not well-tolerated, and consideration for Endometrial Ablation or hysterectomy may need to be discussed as alternative HMB treatment options.

Who performs the Mirena insertion procedure?

In Australia, it is typically either a Women’s Health GP or Gynaecologist who manages the recommendation and insertion of a Mirena. Some additionally trained Nurse Practitioners (NPs) have also recently been approved as credentialed practitioners for insertion of Mirena.

You may be referred to a Gynaecologist like Bloom Women’s Health in instances where you have a history of HMB or Persistent Pelvic Pain, including endometriosis and adenomyosis, or simply, you are after a reliable method of reversible long-acting contraception. Or, it may be your choice to have the insertion procedure performed by your Gynaecologist. A Mirena can be inserted during a normal gynaecological visit.

Bloom Women’s Health Gynaecologists perform multiple Mirena insertions a month and ensure their patients feel comfortable, informed, and safe.

Does a Mirena insertion procedure hurt?

We know pelvic examinations can be uncomfortable. The insertion of a Mirena is very quick, and most women will only feel a small amount of discomfort as it is placed. Bloom Gynaecologists normally recommend having two tablets of Ibuprofen or Panadol before the appointment. If you’ve previously had a Pap Smear or Cervical Screening Test, it might be fairly similar to that sensation. After placement, some women may feel cramping, but it doesn’t usually last more than a few minutes. In some complex cases, your doctor might also inject a local numbing medicine around your cervix to make you more comfortable.

You will usually be provided with a panty-liner in case of any light spotting after the insertion. There is usually minimal vaginal bleeding after insertion that may last for 24 hours. Experiencing heavy bleeding or significant pain post-insertion is not normal and we encourage women to call the Bloom consulting rooms if that occurs.

Do women experience side effects with Mirena?

As with all medications, Mirena isn’t right for everyone. Before making a decision, you and your GP or Bloom Women’s Health Gynaecologist will discuss your medical history, preferences, and any concerns to work out if a Mirena is a good option for you. They will also discuss common side effects before the procedure.

Of the women who have side effects, most are very minor. Some of the common side effects might include:

  • Pain, bleeding, or dizziness during and after placement
  • Changes in bleeding – periods may be lighter, and may be irregular
  • No menstrual periods after 12 months
  • Abdominal or pelvic pain
  • Inflammation or infection of the outer part of your vagina (known as vulvovaginitis – this is rare)
  • Headache or migraine
  • Vaginal discharge

Will a Mirena make you put on weight?

There is no strong evidence that shows that IUDs unequivocally cause weight gain. This is something that you can talk to your Bloom Women’s Health Gynaecologist about. Some weight gain can be due to the hormone progestin which causes water retention and bloating.

Dr Huda Safa tells her patients the following information:

“Although weight gain is reported with many hormonal contraceptive methods, Mirena is a topical long-acting hormonal contraceptive, meaning only a small trace of the hormone progesterone manages to escape into the bloodstream from the uterus to exert any significant contribution to weight gain, which is more likely explained by lifestyle changes over the lifetime of the device.”

If you are concerned about your weight and overall health and wellbeing, and need some additional support, then consultations with Bloom Women’s Health dietitians may be useful. Ask your Bloom Gynaecologist or our friendly reception team to give you more information about how to make an appointment with a Bloom dietitian.

Is Mirena effective at reducing heavy bleeding?

Mirena is generally highly effective at reducing heavy periods and improving the quality of life for HMB patients. In an American clinical trial of Mirena in women with heavy periods, the majority experienced an 80% reduction in bleeding after 3 months and over 90% reduction in bleeding in 6 months.

At Bloom Women’s Health, our Gynaecologists follow up with Mirena patients about 12 weeks after the insertion procedure to check in on how effective Mirena has been at reducing HMB. If it isn’t working as well as needed, your Doctor may escalate options of management and discuss other treatment options with you. While the Mirena may work well for many women, in others it may not. It is simple to remove a Mirena during a gynaecological consultation.

How long does a Mirena last, and when would a Mirena need to be removed when treating HMB?

A Mirena IUD is generally effective in treating heavy periods for up to 5 years.

Mirena can be removed by your GP or Gynaecologist at any time. It may be removed for the following common reasons:

  1. You need a new one (after 5 years is the recommended time for replacement for Bloom Women’s Health patients).
  2. You want to get pregnant (you can start trying as soon as it is removed).
  3. You may wish to stop using it and use another form of birth control.