GynoFiles

Long acting contraceptive ( LARC ) methods are staying in the news, and both the best and now, the e newest, contraception available for women. The CDC states that Nexplanon contraceptive is the best contraceptive with the fewest failures. The Newest contraceptive is an IUD which was approved yesterday  by U.S. Food and Drug Administration. The new IUD is called Liletta , it is a levonorgestrel-releasing IUD (as are Mirena and Skyla ). The approval was based on the data in the largest hormonal IUD trial, ACCESS IUS, conducted in the U.S. with 1,751 enrolled women receiving the device. It, like Skyla is a 3 year device, Mirena IUD is approved for 5 years of use in the US and 7 in Europe. There are no restrictions based on body weight. Although Liletta IUD is already approved, it is not available in the US quite yet, and may take a couple months to get to your gyno. There is a new organization that offers support services for contraception. Bedsider.org women may find helpfu...

Determining one's cancer risk from hormone exposure is difficult as hormones both protect against and cause cancer. A levonorgestrel-releasing intrauterine device (IUD) like Mirena or Skyla may protect users against cancers of the endometrium, ovary, pancreas, and lung, but increase their risk for breast cancer, according to a new study by Tuuli Soini, MD, from the Department of Obstetrics and Gynecology, Hyvinkää Hospital, Finland, and colleagues write in an article published in the August issue of Obstetrics & Gynecology . Among women in Finland, Dr. Soini and coauthors analyzed data on all Finnish women between 30 and 49 years of age who were reimbursed for the levonorgestrel-releasing IUD between 1994 and 2007 for the treatment of  heavy menstrual bleeding or menorrhagia.  The breast cancer incidence among users of the hormone-releasing IUD was 7% higher than expected compared with women who did not use the IUD, with an excess of 188 cases. Among wo...

Women report a variety of symptoms that are due to "hormonal symptoms."  Often these are symptoms gynos consider hormonal, and sometimes they are not likely hormonally mediated at all. Bleeding for increased days of your menstrual period can be due to the menopause transition and women can expect at least 10+ days of bleeding during this time according to a new study. Hormonal symptoms is also a term applied to a variety of circumstances, including symptoms caused by our natural hormones, a change in our natural hormones, or in the hormones we use to control our hormones with!If you think your symptoms are hormonal due to your contraception, changing the hormone type or delivery system can favorably impact your condition. But, it can be confusing to decide if switching will help. Often women will wonder if hormonal symptoms due to birth control pills can be controlled by switching to an IUD, even one with some hormones in it. Switching to a Mirena IUD will potentially contr...

Getting an IUD placed is an important decision, and getting the IUD removed is also an imporant decision, and not to be taken lightly. For women with IUDs and vaginal infections, pelvic infections, bleeding, pains, complaints from the partner may have a way to solve the condition without just taking out the IUD if it's not reached the date your gyno said to replace it. Years ago, guidelines, in part driven by the older types of IUDs and the strings they had at the time, recommended IUD removal for women with pelvic infections. Now the guidelines have changed and the CDC recommendation changed that guideline a while ago. It is no longer the recommendation to remove your IUD if you have chlamydia; and if a woman is diagnosed with Pelvic Inflammatory Disease (PID), it's is also recommended to treat the infection, and not immediately remove the IUD. If the infection is not able to be resolved, some women will have to have their IUD removed. In a recently poll it was found that ove...

Self Test For IUD Health, and reasons to see the gyno 1. Have your menstrual cycles changed suddenly? 2. Can you feel your strings? 3. Do you have a negative pregnancy test? 4. Has the expiration date passed? 5. If you have a new partner do you have a negative STD test? 6. Do you bleed after sex? 7. Do you have heavy menstrual periods? 8. Do you have pelvic pain? 9. Can your partner feel your strings with sex?

Uterine cancer is curable by hysterectomy in most cases. But is there an alternative to hysterectomy in women who have been diagnosed with uterine cancer? It is one of the most common cancer s in women. If you exclude Breast Cancer as a female cancer, it is the most common cancer of the female reproductive organs . And first off, most women will need hysterectomy as part of their treatment. Uterine cancer is often found in the early stage, when it is very curable. Hysterectomy, although not typically a surgery that is too risky to perform, for most women, can be a risky procedure to women with complex medical problems that make them at high risk for surgery. WE know that precancerous conditions of the uterine lining, before formal diagnosis of endometrial uterine cancer, have been successful with progesterone medication. It turns out that the Mirena IUD can be the delivery mechanism for uterine lining progesterone treatment. And for women at most high risk for the surgery, or for a ...

It is not often we get to turn to Jerry Garcia for gynecological advice, but when discussing the Mirena IUD decision with my patients I can't help put hum those opening phrases form Uncle John's Band! Well, those first days are the hardest when it comes to the Mirena IUD as over 2/3rds of women will have irregular bleeding in those first months (to a year!) after placement of the the device for contraception. By a year, almost 20% of women are having irregular bleeding.We have written about this before, and any manner of treatments have been tried to provide a quick fix for what usually self corrects with time. Birth control pills, estrogen, tranexamic acid, NSAIDs and even DepoProvera has been tried to correct the early bleeding on Mirena IUD, and in fact they all will work in individual cases. As most happy Mirena users discuss (and over 8% of the contraceptive users are happy users) just take Jerry's advice: think this through with me; the first days are the hardest;...

Heavy menstrual bleeding can be treated by many therapies,including birth control pills, progesterone, the Mirena IUD, nonsteroidal anti-inflammatory drugs (NSAIDs), and antifibrinolytics.These medicines may be the right therapy for you, but there are reasons that the Office NovaSure treatment may in fact be a better choice for some. It is important for you and your gyno to discuss which will be right for you. Mirena IUD was the best at the treatments.  supported by National Institute of Health Technology Assessment Programme, called the ECLIPSE study which was headed by Dr. Janesh Gupt of the University of Birmingham in England.  The study was then published in the New England Journal of Medicine 1013. In this study the physicians studied heavy menstrual bleeding and most importantly a woman's perception of benefit from their menstrual treatments. They looked at how controlling heavy periods: called menorrhagia, affects six functions of life: practic...

Hormonal contraception provides ovulation suppression and eventually this correlates with overall hormone control as well. Hormones have the ability to affect weight, affect weight gain, affect weight loss and cause fluid shifts that ultimately shouldn't alter the scale; and all these wight issues can affect the hormonal levels in turn.When the blood level of your contraceptive hormones change, the effect in a woman can be that she sees change in both her symptoms and even effectiveness of her pills. If levels of your hormonal contraception dip low escape ovulation can occur, and this is how the production of estrogen, progesterone and testosterone from the ovaries can alter,and patients can then develop bleeding or other undesirable side effects, such as pregnancy.  The levels have been known to change secondary to medications such as antibiotics or other medicines, and some foods could cause issues. At the time of vomiting or other minor illnesses, you may not actually get t...

Women often are encouraged to not get a Mirena Medicated IUD if  they have had hormonal problematic symptoms on oral contraceptive pills. It is true, that some hormonal symptoms may be due to the progesterone component in birth control pills, and in fact these symptoms may be elicited by the progesterone component of the medicated IUD. OC users, once stable on their pills, don't typically get hormonal symptoms. So if you are stable hormonally on your pills, then the switch to an IUD should mean a boost to effectiveness and convenience and not a new set of hormonal problems. If  and IUD user had gotten suddenly new symptoms of moodiness, breast soreness, acne, hair growth or libido changes, these symptoms may be due to a change in your hormones, and getting a medicated IUD can cause that. If you have had this problem with a previous IUD, you are more likely to get this with the next IUD as well. One of the reasons women have hormonal or cycle related symptoms on the Mirena IU...

Mirena IUD Protruding into Abdominal Cavity Mirena IUD, After Being Freed From Scaring, Within the Pelvic Cavity, Left Ovar, Back of Uterus and Part of the Bowel Showing IUDs are an excellent form of contraception, and most of our posts have discussed significant health benefits. But there are risks to IUD use , and perforation of the IUD from the uterus into the abdominal cavity has been known to occur. When the Mirena protrudes this way, it's important to remove it, but oddly, since it can still leak it's hormone, it's still very likely there was good contraceptive protection from the device. This one was successfully removed, by a laparoscopic surgery, and the patient did well, and had her uterus and fertility preserved.

The quick answer as to when to remove your IUD is when the expiration date is up! But it is true that if you wait for one year after the final menstrual period the copper ParaGard IUD can be removed as you are in menopause and no longer fertile. For women with the Mirena IUD or the new smaller sister Skyla also a progesterone containing IUD, if your periods have ceased and you are menopausal, most gynos will say that you can stop all contraception, including removing your IUD between the ages of 51 and 55 as spontaneous pregnancies at that time would be very remote. Mirena IUDs can also provide the progesterone protection for women beginning on menopausal estrogen hormone therapy, so you might benefit from keeping it a couple of extra years! But don't confuse STD protection and contraception. Condoms will still be your best STD protection whether you are menopausal or premenopausal, young or old. 

Women are protected against pregnancy the day of insertion of their Mirena IUD. Many who use the IUD want to know just exactly how the Mirena IUD works to be a contraceptive. Failure rares are extraordinarily low with a pregnancy rate of about 0/2% in Mirena users!  Immediately the IUD, which has a progesterone called levonorgesterel (or nick named the LNG-IUS) begins immediately to release the hormone at a rate of about 20 mcg/day. For most women the hormone dose is down by about half at the end of the five years. And the blood level of the hormone itself can range quite a bit between women. There are some women who have much higher blood levels, for instance endometriosis is a condition that leads to higher levels, which may in fact be why women with endometriosis do get some relief from this Mirena device. The hormone release changes the cervical mucus and the cervix itself rapidly becomes impenetrable by sperm. This amount of progesterone hormone is not enough to affect the le...

Making a decision regarding which IUD to get is not necessarily easy. Prior experience, plans for pregnancy, and the decision to control your periods or not are some of the more common consideration. Side effect profiles of both IUDs are extremely favorable, but understanding some of the side effects may help you decide which IUD to get. The most common side effects of the Mirena IUD have to do with uterine or menstrual bleeding. Almost 25% of women will report no periods, and almost 25% have been shown to have spotting between their periods or bleeding between their periods. Almost 50 % of Mirena patients will also report a change in their menstrual cycle, for ParaGard IUD users the rates are similar early on, but menstrual cycles tend to normalize for the ParaGard users over time. The newest pill on the market, Skyla, a three year medicated IUD, has less a chance that periods will stop over time, and generally the side effects are the same as with the Mirena IUD which has the same...

We have often quoted Dr. David Grimes (as well as other experts) who applaud the IUD for being "forgettable" contraception; of course meaning that once you have your IUD, you are protected and it doesn't require the constant attention of daily pill use. It is important for women using oral contraception to understand their non-contraceptive benefits ; but we do not really talk enough about the non-contraceptive benefits of the Mirena IUD. The Mirena IUD is approved for control of heavy menstrual bleeding, and this is the non-contraceptive IUD benefit we have focused the most on . In fact a non-contraceptive benefit of the Mirena is less expense of menstrual protection like pads and tampons for most women.We have talked a bit about the possibility that the Mirena IUD can have a beneficial effect on uterine fibroids. We have also talked about the possibility that Mirena can aid the treatment of endometriosis. And we have mentioned that it might work to prevent polyps of ...

Surgical treatment for endometriosis usually resolves the pain, either partially or completely, for at least months, and possibly years. Women who undergo surgical treatment of endometriosis are still very likely to have recurrence.  A study by Vercellini in the British Journal of Obstetrics and Gynecology stated that after endometriosis surgery about 60% have recurrence of pain and that it's very important to take medical therapy after the surgery to make sure the pain doesn't return. They have showing in other studies that just using medical therapy for under 3 months after surgery is of no benefit at all.. Actually the type of surgery that people have is important. If you had a cyst of endometriosis called an endometrioma removal of the whole cyst rather than just cauterizing it, delayed the recurrence of pain and sped up the time to pregnancy in one study conducted in the late 90s. But a study in AJOG in March 2014 showed that 20% of women have a recurrance of an endo...

Women some times ask if they will accidentally pull out their IUD when their tampons are removed.  And the answer is no. Dr. Ellen Wiebe at the University of Britsh Columbia looked at the IUD use in their patients and found that tampon use with IUDs is perfectly acceptable and did not increase the rate of infections or the rate that the IUDs became dislodged or expelled. So their conclusion was that tampon use is still very safe and acceptable for those using an IUD for contraception. In Canada where the study was done they were looking at information for the four IUDs they have available, we have only two available in the US. Patients will also be happy to note that her research also said that the use of menstrual cups is acceptable. The current package information on Mirena IUD says that the use of tampons is fine, but the information doesn't currently say that you can use the menstrual cups. In her study about 75% of the patients used tampons, and only about 10% used menstrua...

Women who think that their periods are too heavy, need to get in and talk to their gyno because there are a number of excellent solutions to the problem. There are now several medical and surgical choices, and in fact there is a way to stop heavy menstrual bleeding with a contraceptive choice.  Indeed you can fix your heavy periods and get great long term contraceptive protection, that rivals the success rate of pregnancy protection that tubal ligations offer.  In 2009 the FDA approved the Mirena IUD for treatment of heavy periods, also called menorrhagia. The Mirena was said to show a , "showed a statistically significant reduction in menstrual blood loss," by  Scott Monroe, MD, director of the Division of Reproductive and Urologic Products in the FDA's Center for Drug Evaluation and Research, in a prepared statement. It is important to remember, in this trial women did not have large uterine fibroids or medical conditions, such as bleeding disorders,...

The most common side effect from the Mirena on your periods is for bleeding to stop. For many the bleeding can be unscheduled spotting. About 25% of women will have this side effect to begin with and after a year only about 1/10 women will have the spotting, and for most it's so light as to not be bothersome. The first question we ask when a woman has irregular bleeding on a Mirena is the IUD in place? Feeling your strings can give you a good hint as to whether it's both there and in place. Only an ultrasound with your physician can really tell you if the IUD is in place, but feeling the strings is a start. Then make sure you are not pregnant, home pregnancy tests are very accurate. If you are pregnant you need to see your gyno right away. The next question is to find out what medications that you are taking that could be increasing bleeding or prolonging periods that you may still be having: aspirin is the most common offender, but other medications and herbals can cause th...

At the end of one year of trying for pregnancy about 85 out of 100 couples will be pregnant. If they contracept using spermacides, with typical use, about 29 of 100 women will be pregnancy, actually worse than the 27 that will get pregnant with spermacide use. A new study published in the June 2012 issue of the American Journal of Obstetrics and Gynecology from researchers rom Merck Implanon Clinical Training Program and the Bayer Research Award grant showed that many women overestimate the effectiveness of their contracption. Perfect use, like in the contraceptive studies and in the contraceptive package inserts are not necessarily the same statistics that we seen in women who have 'typical use'...meaning us humans are a bit more falible when it comes to our contraception! Fertility awareness methods (either the standard days method the two day method or the ovulation tracking method also improves contraceptive effectiveness over spermacides alone and only 1/4 of couples w...