I use the coil, but not for contraception: here’s why
While the forms of contraception available to women have their pros and cons, and there is no single one that works for all women, the choices we have available are many (relatively to, say, 40 years ago). Plenty of women swear by the pill and always have done, whereas others find it affects their mood, or causes other side effects, and choose to opt for a non-hormonal copper coil, or condoms.
While it is a given that contraception should act as a contraceptive, less recognised is that it can also be used to treat symptoms of certain conditions. One type of contraception in particular that is used to treat a number of conditions is the Mirena coil.
The Mirena coil is a long-acting, reversible form of contraception (LARC), also known as an intrauterine system (IUS). The small, plastic, T-shaped device is inserted into the womb where it slowly releases the hormone levonorgestrel (a type of progesterone) over the course of around five years.
The Mirena works to prevent pregnancy in many ways, namely by bringing about changes to the cervical mucus making it hostile to sperm, and by thinning the lining of the womb so that should an egg get fertilised it is unable to implant. One of the benefits of the effects it has on the womb, is that it can be used to treat heavy periods (dysmenorrhea), endometriosis, and in some cases even premenstrual dysphoric disorder (PMDD).
The Mirena coil for endometriosis
Helen McLaughlin, a 33-year-old financial controller, is one woman who found that the Mirena coil was effective in the treatment of her endometriosis, for example. She was diagnosed with the condition in 2011, and is now on her second Mirena coil.
“In my view the Mirena has slowed the growth of my endometriosis and allowed me to live my life as fully as I can. I wish it worked for everyone like it works for me.”
“A general gynaecologist told me that if after having a laparoscopy to ablate (burn off) the endo the pains were to return, then I should have a Mirena coil inserted to help the slow growth of the disease,” she says. “I had such a horrific, painful, and traumatic time between 2010 to 2012 that I was desperate to never return to that and was prepared to try anything.”
Helen points out that her endo has continued to grow even with the Mirena in place. It isn’t a cure for the condition, but rather, as it suppresses the cyclical rise and fall of hormones, and works on the womb lining to stop it growing each month, it simply stops the disease from proliferating as fast as it would otherwise. “In my view it has slowed the growth and allowed me to live my life as fully as I can. I don’t even know I have it and I don’t think about it. I wish it worked for everyone like it works for me,” she says.
The Mirena coil for PMDD
In terms of PMDD, a hormone-related mood disorder which causes extreme symptoms in the luteal phase (final two weeks) of the menstrual cycle including rage, depression, anxiety and extreme fatigue, the Mirena coil is sometimes prescribed as a treatment as it suppresses the natural rise and fall of hormones.
While many doctors are opposed to its use as a first line treatment (namely because PMDD often involves an extreme sensitivity to progesterone and therefore treating it with more progesterone seems counter-intuitive), it does work to reduce symptoms in some women.
Alice, a 26-year-old medical writer, was diagnosed with PMDD when she was 24. She had tried both the combined and mini contraceptive pills to reduce her symptoms, as well as antidepressants, and CBT, but nothing worked.
“At that point, my GP and my gynaecologist both advised that I try the Mirena coil,” she says. “It was the next step in the PMDD treatment pathway as I had already tried antidepressants and the pill.” Knowing that she didn’t want to go back on antidepressants, Alice felt like it was her only option and she wondered if it might have an effect on the mental symptoms she was having, including anxiety and troubling thoughts.
“Having had PMDD since the age of 14, it feels like a miracle to not have to worry about what day of the month it is — about 90% of my days are good days now, compared with about 30% before treatment.”
After she had the Mirena inserted, Alice did notice an improvement in her PMDD symptoms. While it took a few months for everything to settle down after insertion, she found her periods stopped and her troubling thoughts “faded away”. However, she also uses an oestrogen gel every night (commonly prescribed alongside the Mirena for PMDD) which she believes helps to balance out the progesterone in the Mirena.
“Having had PMDD since the age of 14, it feels like a miracle to not have to worry about what day of the month it is – about 90% of my days are good days now, compared with about 30% before treatment,” she says. While she is happy she got the Mirena, she adds that all women with PMDD are different. “PMDD is just that kind of condition where you have to try things for yourself and see what works,” adds Alice.
Why the coil won’t work for everyone
Indeed, as mentioned above, many women with PMDD are very opposed to using the Mirena for treatment, often speaking after having tried it. Dr Tory Eisenlohr-Moul is one clinician who exercises caution before prescribing the Mirena. “Mirena has not been tested for PMDD, and it actually makes no sense as a treatment for the primary (emotional) symptoms of PMDD, since those are caused by ovulation and the Mirena does not reliably prevent ovulation,” she says. “However, Mirena could help if your premenstrual symptoms are primarily physical,” she adds.
Aside from antidepressants taken cyclically, other recommended treatments for the condition are cycle suppression drugs, including a monthly injection of a GnRH antagonist, which shuts down hormone production by the ovaries, causing what is essentially a reversible menopause.
“There are also other reasons to be careful with using the mirena IUD in women with a documented emotional hormone sensitivity,” adds Dr Eisenlohr-Moul. “Anecdotally, many women with PMDD say that they cannot tolerate the hormonal IUD (Mirena) because it makes their emotional symptoms much worse. Therefore, the hormonal IUD does not seem like a good place to start for PMDD treatment.”
“Anecdotally, many women with PMDD say that they cannot tolerate the hormonal IUD (Mirena) because it makes their emotional symptoms much worse.”
Indeed, actress and documentary director Kathryn Shasha believes the Mirena coil actually caused her PMDD. “When I first got the Mirena, I was thrilled with it,” she says. “It wasn’t until six months in that I started having ailments.” Her symptoms began with menstrual cramping daily, then came severe nausea, breast soreness, weight gain, and pregnancy.
Eventually her doctor diagnosed her with PMDD but said it could not be related to the IUD. It was only after experiencing blurred vision, anxiety attacks, personality changes, and more, which saw her hospitalised four times, that Kathryn made the connection between her symptoms and the Mirena. Her case isn’t the norm, but equally it definitely isn’t unheard of.
While the Mirena may work for some women with endometriosis and some women with PMDD, everyone will react differently, so all women should discuss their personal situation with their doctor before trying a treatment.
Nonetheless, bear in mind that the Mirena coil isn’t necessarily always used purely as a form of contraception, and can prove extremely useful, especially when it comes to decelerating the progression of endo, and treating heavy menstrual bleeding. Contraception isn’t just contraception — women use it to treat everything from acne to PCOS, and it is important that all these options are kept available.