Poster presented at British International Congress of Obstetrics and Gynaecology - 2007

1. Is Mirena Good Enough?
Suzanna Daud - Specialist Registrar in Gynaecology,1 Manju Sant - Specialist Registrar in Gynaecology,2 Sucheta Lilakutty – S. Senior
House Officer in Gynaecology,2 Mohammed Allam - Consultant Gynaecologist,2 Ayman Ewies - Consultant Gynaecologist1
1 = Ipswich Hospital NHS Trust 2 = Monklands Hospital, Lanarkshire NHS Trust
Background
• Mirena (The levonorgestrel-releasing intrauterine system) is
commonly used by gynaecologists and general practitioners
as a contraceptive and to treat menorrhagia.
• The continuation rate of Mirena in Finnish population was
reported to be 93% and 87% in the first and second year,
respectively.1
Objectives
• To identify the continuation rate and symptoms associated
with early removal of Mirena before the 5 years effective life-
time recommended by the manufacturer.
Setting
• Ipswich Hospital NHS Trust, Suffolk and Monklands Hospital,
Lanarkshire, UK.
Sample
• 269 women who had a Mirena inserted from 1st January
2000 till 31st December 2003.
-Ipswich Hospital : 160 women
-Monklands Hospital : 109 women
Design
• Retrospective case-notes review, and a questionnaire was
sent to all women as regard the bleeding pattern, the side
effects experienced and the length of use.
• The number of questionnaires returned was 151 (response
rate 56%)
-Ipswich Hospital : 102 (64%)
-Monksland Hospital : 49 (45%)
Results
• The analysis of the data was only done for 166 women
Ipswich Hospital : 104 women
Monklands Hospital : 62 women
• 103 women were excluded because incomplete data, Mirena
spontaneous expulsion or removal for conception.
1.Indication for Mirena insertion (n=166):
2.The continuation rate of Mirena use (n=166):
• 74 (45%) women had Mirena removed early.
• The median duration of use in women who had it removed early
was 252 days (range 4 – 1790).
• Early removal rate was significantly higher amongst women who
used it for menorrhagia when compared with those used it for
contraception (p=0.007).
3. Main reasons of early removal of Mirena (n=166):
• Some patients had more than one reason of early removal.
• Progestogenic side effect includes bloatedness, headache,
weight gain, depression, breast tenderness, excessive hairiness,
greasiness of skin and sexual disinterest.
Conclusion
• The continuation rate of Mirena use in the studied population is
less than that in Finnish women.
• The progestogenic side effects could be attributed to the high
systemic absorption of the progestogen since serum levels of
levonorgestrel has been recorded around 511pmol/L.2 Therefore,
the idea that Mirena works entirely as a local source of
progestogen should be revised.3
• Adequate counselling before insertion is essential, and women
should be informed about the rates of adverse effects and
removal reported so far.
• A large study is required to quantify the continuation rate and
women satisfaction in The UK population.
References
1.Backman T et al. Length of use and symptoms associated with premature removal
of IUS: a nation-wide study of 17,360 user. BJOG 2000; 107(3): 335-9.
2.Xia B et al. Therapeutic effects of IUS in treatment of idiopathic menorrhagia. Fertil
Steril 2003; 79(4): 963-969.
3.Wahab M, Al-Azzawi F. The use of IUS for treatment of menorrhagia in women with
inherited bleeding disorders. BJOG 2005; 112: 1455-6.
94
9
1
52
10
0
146
19
1
0
20
40
60
80
100
120
140
160
Menstrual Problem Contraception HRT
Indication for Mirena insertion
Noofwomen
Ipswich
Monklands
Combined
84
72
63
58
54
81
66
64
60
58
83
70
63
58
55
0
10
20
30
40
50
60
70
80
90
6 12 24 36 >36
months
%ofwomen
Ipswich
Monklands
Combined
33
16
1412
5 5
45
21
19
0
5
10
15
20
25
30
35
40
45
50
Unscheduled bleeding Abdominal pain Progestogenic side effect
Main reasons of early removal of Mirena
Noofwomen
Ipswich
Monklands
Combined
Monklands Hospital