Mirena and Menopause

“Mirena stopped my periods- how will I know when I’ve reached menopause?”

Menopause is recognised by the absence of periods for 12months or more, but what if you don’t have any periods? Many women using the Mirena IUD for contraception or control of heavy menstrual bleeding enjoy a completely period-free existence. This does make it a bit trickier to work out how far along the menopausal transition you are, but in most cases it’s not really that important to know. Here are the main considerations…

What symptoms do you have?  

Typical perimenopausal symptoms include hot flushes, night sweats, mood changes, sleep disturbance, musculoskeletal pain, vaginal dryness and sexual or urinary problems. Treatments offered for these symptoms are the same whether you are pre- or post-menopausal.

The key message here is that we treat the symptoms, not your hormone levels or stage of menopause. That’s why there’s usually no need for blood tests, apart from some specific situations described below. And here’s some great news for women who choose MHT (Menopausal Hormone Therapy) for their hot flushes: Mirena really simplifies your combined MHT regimen and is not known to increase your breast cancer risk.

What age are you?

45-55 this is the classic time when most women reach menopause, but perimenopausal symptoms can start many years before that. If you’re much younger than this your GP may recommend a blood test to confirm perimenopause and exclude other causes for you symptoms.

Do you need contraception?

The contraceptive effect of Mirena lasts 5 years. If you are under 50 and your Mirena is expiring you should have it replaced to ensure ongoing contraception, or use another contraceptive. If you’re over 50 when it expires then you have a decision to make. Before having it removed your doctor should check that you’re definitely post-menopausal; if not you may be at risk of an unplanned pregnancy (rare, but not impossible). If you’re not menopausal your periods will also return, possibly heavier and more frequent or prolonged than before.

Your GP can check whether you’re menopausal with a hormone blood test (follicle stimulating hormone, or FSH). Two tests 6 weeks apart that are both in the menopausal range confirms that you are menopausal. You should still leave the old IUD in place for another 12 months to be sure though. If your Mirena was inserted after age 45 it can be left in for contraception well past age 50, not just the usual 5 years.

Thinking about getting a Mirena for the first time?

We recommend it to perimenopausal women for a variety of reasons:

• It’s inexpensive, very reliable contraception.
• It’s suitable for women who can’t take oral estrogens due to a high risk of unwanted blood clots, such as smokers, those with “classic” migraines (with visual disturbances) or high blood pressure;
• It is a low-dose hormonal contraceptive which can often be tolerated by women who have unwanted side effects on other types.
• It’s used as a treatment for heavy periods, and can stop periods completely for some women.
• It’s also a safe choice when used with estrogen patches or gel for combined MHT (eg. for hot flushes).

It won’t be suitable for everyone though, and like any medical treatment Mirena does have potential unwanted side effects and complications.

If you are considering using Mirena or replacing your old one then speak to a doctor who is qualified to insert them for all the risk/ benefit information. Good information is also available from your state’s family planning organisation, like this one from Family Planning NSW.

Dr Teagle does not receive any gratuities or inducements related to Mirena. This article is intended to be informative only; women should consult with a doctor for individualised medical advice.
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