Mirena and birth control pills together for endometriosis

Although there is no definitive cure for endometriosis, there are several options that provide relief from pain, fatigue, and discomfort. Pain medications (over-the-counter or prescription), hormonal therapy (oral contraceptives or injections), or surgery can be helpful. The intrauterine device, or IUD, is another treatment alternative for endometriosis.

What Is an IUD?

An IUD is a T-shaped device that is inserted into the uterus by your health care provider as a form of long-acting birth control. When a foreign object is placed in the uterus, it produces an inflammatory response, which can disable both the sperm and the egg. IUDs prevent sperm from fertilizing an egg by killing sperm and thickening the cervical mucus. In addition, these devices can prevent an egg that has been fertilized from implanting into the uterus. IUDs are not thought to prevent a pregnancy from developing that has already implanted in the uterus. However, they are known to interfere after fertilization. If a pregnancy were to occur, it does come with an increased risk of serious complications, including miscarriage and ectopic pregnancy. IUDs may contain hormones that are slowly released over three to five years, but not all IUDs use hormones.

Types of IUDs Available

In the United States, five types of IUDs are currently available and approved by the U.S. Food and Drug Administration (FDA) for contraception:

• Paragard
• Kyleena
• Mirena
• Skyla
• Liletta

Only Paragard, a copper IUD, does not release hormones. Because it does not have hormones, it can last from 10 to 12 years.

Hormone-releasing IUDs have shorter life spans, from three to five years depending on the type. All release progestin to prevent pregnancy. An IUD can be removed at any time before its natural useful life is over, and fertility is typically restored soon thereafter.

What Type of IUD Is Used for Endometriosis?

Other hormonal treatments can help some women with endometriosis. Many birth control pills, patches, and vaginal rings release a combination of hormones that can lighten or stop menstrual periods. These types of remedies sometimes bring relief to women with endometriosis. Copper IUDs such as Paragard do not release hormones, so they are not seen as an effective treatment for endometriosis. Hormonal IUDs, on the other hand, may provide relief from the pain and various symptoms of endometriosis, similar to other hormonal birth control agents.

Although many birth control pills and rings offer a combination of the hormones estrogen and progestin, a hormonal IUD contains only progestin, released over years. Currently, Mirena is the only IUD approved by the FDA to treat heavy menstrual bleeding, so it may be more commonly prescribed than other IUDs. Other forms of progestin-only contraceptives are the Depo-Provera injection and a specific kind of birth control pills. Any progestin-only contraceptive can lighten or stop menstrual periods, which may relieve the pain and other associated symptoms. However, side effects are reported, including irregular bleeding, mood changes (depression), weight gain, and bloating.

How Are IUDs Used To Treat Endometriosis?

Because it is not certain what causes endometriosis, it can be difficult to treat anything but the symptoms. As noted above, the IUD uses a steady stream of the hormone progestin to prevent pregnancy. One side effect of progestin is that it thins the uterine lining. Progestin may also help shrink endometrial adhesions in other parts of the body, reducing overall pain and inflammation. It remains definitively unclear how that hormone works to alleviate the symptoms of endometriosis, however, it may help some women with endometriosis. Amenorrhea (when menstruation is absent during the reproductive years) is possible when progestin IUDs are used to treat endometriosis.

Who Is a Good Candidate for an IUD?

Most women can safely use an IUD. It is important for your doctor to conduct a thorough exam, including testing for sexually transmitted infections and pregnancy, before you consider using an IUD. Women who have recently had a child should wait six to 12 weeks after giving birth before having an IUD inserted. Additionally, women who currently have multiple sexual partners, a history of pelvic inflammatory disease, ectopic pregnancy, liver disease, breast cancer, unexplained vaginal bleeding, or any of these additional conditions may not be candidates for an IUD or may be at higher risk of complications.

It was believed that women who had not had a child were not good candidates for an IUD. However, modern IUDs are safe, effective, and convenient for almost all women, including those who have never had a child.

Possible Benefits of IUDs

Why use an IUD instead of another form of progestin to help with endometriosis symptoms? Many women choose the IUD because they do not want to take a daily pill or schedule shots on a quarterly basis. If placement is successful and without complications, one appointment for an IUD insertion might be the only necessary treatment for years, other than annual pelvic exams.

Similar to other progestin treatment options, the hormonal IUD might have the following benefits to some women:

• Reduces heavy menstrual bleeding
• Provides contraception, if desired
• Reduces endometriosis pain after surgical procedures
• Does not affect bone density as much as other treatments

Several MyEndometriosisTeam members have said the Mirena IUD has helped them with some symptoms. “I have one and it helped a bit. I’ve had it for nearly 12 months. The spotting is a little annoying, but I guess we take the good with the bad,” said one woman.

Another member describes a positive experience with her IUD for several years. “I have now had the Mirena in place for almost four years, so it must be doing something right! I wouldn't say it has had a groundbreaking impact on my pain, but my periods are MUCH lighter (albeit completely irregular),” she said. “These are easier to deal with, and the side effects are much, much less than any I have ever experienced on other forms of hormonal treatment for endometriosis.”

“At first, I had a lot of heavy bleeding, but that was pretty much my only side effect. My pain and bleeding has settled down heaps. It's probably the best decision that I've made regarding my endo journey,” said another member.

“I use Mirena and it stopped my periods altogether!” said another user of the site. “It has helped quite a bit, but make sure every few months it is still in place by getting your doctor to check. I still have pain, but I have seen at least a 40 percent difference.”

Possible Drawbacks of IUDs

Although you have read positive feedback, using an IUD can have important drawbacks as well. Some women who use the IUD for endometriosis reported quite a few downsides. For example, there were reports of greater pain than expected on insertion and removal, difficulty with the device remaining in place, and increased bleeding or spotting during the first few months of use. Weight gain, depression, nausea, and bloating are all IUD side effects. Serious, although rare, complications include severe infection and perforation of the uterus requiring surgery. In the unlikely event that you do get pregnant with an IUD in place, the likelihood of miscarriage, complications during pregnancy, and an ectopic pregnancy — which can be a life-threatening emergency — is much higher. The mechanism of action of today’s IUDs is well known and their long-term implications have been observed to be safe over the past 40 years.

Unfortunately, not all women with endometriosis find relief from a hormonal IUD. Some users of MyEndometriosisTeam reported increased pain, heavier bleeding, ejection of the device, and other difficulties.

“I always describe my experience with Mirena as a ‘massive life ruiner.’ Worst year ever and then had it removed,” said one user.

Another woman reported, “It's great if you don't have a preexisting condition, but if you do, the IUD can aggravate it. I tried it and my condition got worse. I went back to my gynecologist to remove it, and the strings broke. I had to have it surgically removed because it was embedding itself in the uterine wall.”

“I had the worst experience with mine,” explained another user. “I was having pelvic pain so much I was in and out the emergency room just for them to tell me nothing was wrong. I ended up having to get it taken out.”

Unexpected side effects were reported by another woman who tried a hormonal IUD to help her endometriosis. “I tried Mirena. It helped with the endo pain, but I had other side effects that made it not worth keeping. I liked that I stopped getting periods, but I was still getting ovarian cysts, so my doc put me on birth control pills on top of the Mirena. I also experienced really terrible cramping and pain, acne, and weight gain,” she explained. “I did notice my symptoms slowly coming back after I took the Mirena out, so I think it was effective on that front. For me, it’s all about weighing the good/bad and I didn’t like needing to take pain pills for a side effect of a treatment that was supposed to treat pain.”

You Are Not Alone With Endometriosis

By joiningMyEndometriosisTeam, the social network for women living with endometriosis, you will join a support group of more than 112,000 people. Treatments for endometriosis, including IUDs, are just one of the many topics members talk about. New topics are posted every day.

Have you had an IUD as a treatment for endometriosis? What has been your experience? Have you found ways to manage the pain and other symptoms? Share your tips and experiences in a comment below or on the Activities page. You will be surprised how many other members have similar stories.

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