The T-shaped Mirena, which is similar to the copper intrauterine spiral we commonly use, is a specially produced intrauterine device with 52 mg of the progesterone hormone levonorgestrel in its body.
Due to this special structure, it releases 20 mg of hormone into the uterus daily for 5 years. Mirena, which can release hormones, releases the levonorgestrel hormone into the uterus 15 minutes after its application. It is popularly known as "hormonal spiral".
The contraceptive rate is almost as high as that of tubal ligation. Levonorgestrel hormone is also an oral medication.
It is a hormone that has been used for many years in the treatment of uterine diseases and birth control drugs, and its effects are well known. The progesterone hormone, which we use to reduce excessive menstrual bleeding, has nowadays been able to be applied directly to the uterine bed thanks to the opportunities offered to the service of medicine with the developing technology.
This eliminates the side effects of oral administration. The hormone attached to the Mirena spiral is slowly released into the uterus. The absorption of this hormone by the intrauterine tissues is rapid. However, systemic side effects are very rare.
Two out of every ten women who visit the gynecology outpatient clinic daily consult a physician because of menstrual irregularities and heavy bleeding. Nearly half of these women undergo surgical operation. Approximately two thirds of these women with bleeding irregularities suffer from iron deficiency anemia.
Mirena is frequently used for reasons other than contraception in the treatment of uterine bed (endometrium) problems such as menstrual pain, excessive menstrual bleeding, prolonged menstrual bleeding, thickening of the uterine wall, which are very common in the society.
Before Mirena, women with these problems had to be treated with a series of surgical interventions such as hysterectomy or burning of the uterine lining. Mirena is an easy to apply, successful and effective treatment method for this type of disease.
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It has shown very successful results in the treatment of diseases originating from the uterus. In addition to the success in treatment, it can also be used to reduce bleeding.
Other bleeding diseases that are not related to uterine diseases may cause excessive menstrual bleeding and irregularities. In the treatment of conditions that cause disorders in blood clotting mechanisms (Von Willebrand, platelet disorders, coagulation factor deficiencies, women taking excessive anticoagulants, etc.),we use mirena, i.e. hormonal spiral, as the first option in treatment to reduce the amount of bleeding.
We can also apply Mirena treatment to women with fibroids in appropriate cases to reduce bleeding. In fact, Mirena does not eliminate or shrink fibroids. We apply it because it has been found to reduce the amount of bleeding, which is successful in most of our patients. In cases where the size of the fibroids, the size of the uterus is very large or in cases of heavy bleeding, Mirena can be expelled with the bleeding.
Mirena can also be used for the treatment of patients with menstrual irregularities in the pre-menopausal period, ovulation disorders, polycystic ovary syndrome, insulin resistance and for the prevention of endometrial hyperplasia.
Mirena is similar in size and shape to a routine copper spiral and is very easy to insert into the uterus. Like other intrauterine devices, Mirena is easily inserted into the uterus vaginally, without anesthesia and with local or mild sedation.
There is less chance of infection and expulsion from the uterus compared to other copper spirals.
Prolonged bleeding in the form of spotting usually occurs in the first year. After one year, about 6 out of 10 women with Mirena develop menstrual failure. When women are told before the application that this situation may develop, these women, who are already overwhelmed by bleeding, accept and even want this situation created by Mirena.
Some women may experience breast tenderness, a feeling of fullness, acne, headache, bloating, and mood changes in the first year. These changes do not occur in some women. In women who do, they are mild. These problems are temporary and most women gradually get used to this situation and these mild problems disappear after a while.
There is therefore no need to remove the Mirena hormonal spiral. The discomfort resolves spontaneously within a few months. In my 21 years of professional life, I have never encountered unexpected situations such as infection, uterine rupture and pregnancy due to Mirena, but there is information in the literature that these situations may occur.
Mirena is the contraceptive of choice for younger women who do not want to take oral pills and who want their menstrual bleeding to be low and painless, and for most women in their 40s for protection against both pregnancy and uterine diseases.