The Bridge Clinic The Bridge Clinic, Oldfield Lodge, Bridge Road, Maidenhead, Berkshire, SL6 8DG. Telephone: 01628 760900 Facsimile: 01628 760909 email: email@example.com www.bridge-clinic.com Patient Information - Insertion of Mirena Coil What is Mirena? It consists of a small T-Shaped frame made from a plastic called polyethylene. This carries 52 milligrams of levonorgestrel, a hormone used in many contraceptive pills. The hormone is contained within a substance called polydimethylsiloxane. This is surrounded by a membrane (skin) also made of polydimethylsiloxane. The T-shaped frame also contains barium sulphate so that it can be seen on x-rays. There are two fine threads, made of iron oxide and polyethylene, attached to the bottom of the frame. These allow easy removal and allow you or your doctor to check that the system is in place. What is the system for? Contraception Mirena ia an effective, long term and reversible method of contraception. It is placed inside the uterus (womb) where it slowly releases the hormone levonorgestrel over a period of 5 years or until it is removed. Menorrhagia Mirena is useful for reducing menstrual blood flow and so it can be used if you suffer from heavy menstrual bleeding (periods). This is called menorrhagia. How does the system work? The hormone in mirena prevents pregnancy by: • Controlling the monthly developments of the uterus lining so that it is not thick enough for you to become pregnant. • Making the normal mucus in the cervical canal (opening to the uterus) thicker, so that the sperm cannot get through to fertilise the egg. • Preventing ovulation (the release of eggs) in some women. • There are also local effects on the lining of the uterus caused by the presence of the T-shaped frame. The hormone in Mirena reduces menstrual bleeding by: • Controlling the monthly development of the ueterus lining, making it thinner, so that there is less bleeding every month. What if I want a baby? If you want a baby, ask your doctor to remove Mirena. Your usual level of fertility will return once the system is removed. Can I breast feed using Mirena? Very small amounts of the hormone found in mirena are found in breast milk. If you want to breast feed your baby, you should discuss this with your doctor. Can I become pregnant whilst using? It is very rare for women to become pregnant with Mirena in place. Missing a period may not even mean that you are pregnant. Some women may not have periods whilst using the system. If you have not had a period for six weeks then consider having a pregnancy test. If this is negative there is no need to carry out another test, unless you have signs of pregnancy (e.g.) sickness, tiredness or breast tenderness. However if you become with the system in place you should have it removed as soon as possible. Your doctor or clinic will advise you. How quickly should Mirena work? Contraception You are protected from pregnancy as soon as the system is fitted. Menorrhagia Mirena usually achieves a significant reduction in mistral blood loss in three to six months of treatment. How often should I have the system checked? You should have the system checked usually 6 weeks after it is fitted, again at 12 months and then once a year until it removed. It can stay in place for five years. What happens if the system comes out by itself? If the system comes out either completely or partially you may not be protected against pregnancy. It is rare but it is possible for this year to happen without you noticing during your menstrual period. An unusual increase amount of bleeding during your period might be a sign that this has happened. Tell your doctor or clinic if there are any unexpected changes in your bleeding pattern. How can I tell whether the system is in place? After each menstrual period, you can feel for the two thin threads attached to the lower end of the system. Your doctor will show you how to do this. Do not pull the threads because you may accidentally pull it out. If you cannot feel the threads, go to your doctor. You should also go to your doctor if you can feel the lower end of the system itself or you or your partner feel pain or discomfort during sexual intercourse. Can I change my mind? Your doctor can remove the system at any time. The removal is easy. Unless you plan to have a new system or an intra-uterine device fitted immediately, it is important to use another form of contraception in the week leading up to removal. Intercourse during this week could lead to pregnancy after Mirena is removed. How will Mirena affect my periods? Mirena will affect your menstrual cycle. You might experience spotting, shorter or longer periods, painful periods, lighter periods or no periods at all. If you have had Mirena fitted for contraception: Many women have spotting (a small amount of blood loss) for the first 3-6 months after the system is fitted. Others have prolonged or heavy bleeding. You may have an increase in bleeding however in the first 2-3 months after the system is fitted, before a reduction in bleeding is achieved. Overall you are likely to have fewer days bleeding in each month and you might eventually have no periods at all. This is due to the effect of the hormone (levonorgestrel) on the lining of the uterus. If you have had Mirena fitted for menorrhagia: Mirena usually achieves a significant reduction in menstrual blood loss in 3-6 months of treatment. You may have an increase in bleeding however, usually in the first 2-3months, before a reduction in blood loss is achieved. If a significant reduction in blood loss in not achieved after 3-6 months, alternative treatments should be considered. What about side effects? Taking any medicine carries some risk of side effects. With Mirena these are most common during the first months after the system is fitted and decrease as time goes on. Apart from menstrual changes, possible side effects might include headache (also rarely migraine), lower abdominal or back pain, acne, rashes, itching or skin problems, tender, lumpy breasts, increased discharge from the vagina, vagina itching or pain on passing urine, depression or other mood changes, a feeling of sickness, bloating, or swelling of your legs and ankles. Ovarian cysts and pelvic inflammatory disease have been reported so tell your doctor if you have lower abdominal pain or if you experience painful or difficult sex. Other side effects such as weight gain, hair loss, or greasy hair have rarely been reported. Ectopic pregnancy (development of fertilised egg outside the uterus) is possible with Mirena but highly unlikely. The risk of this happening is lower than for women using no contraception. You should tell your doctor if you have lower abdominal (tummy) pain especially if you also have a fever or have missed a period or have unexpected bleeding. This might be a sign of ectopic pregnancy. If you think you are reacting badly to Mirena or are having any other problems, please tell your doctor or clinic.