Dear Alice,

I have recently been advised that my on-going migraines might be caused and/or increased by the use of contraceptives containing estrogen. To that end, I have been recommended to switch to a progesterone only form of birth control. Which in turn basically means I get to choose between Implanon and Mirena (I really can't stand needles so Depo is out for me!). I am only 23 years old, and have not yet started a family. I do want to have children someday, and am very enticed by the idea of Mirena lasting to the point when I might want to begin trying to get pregnant. However, all of the advertisements for Mirena state that ideal candidates have already had children.

Is Mirena still safe for use in women who have not yet given birth? If so are there any additional side affects to consider in this instance?

Dear Reader,

Despite the popularity of long-acting birth control methods in other parts of the world, relatively few American women use intra-uterine devices (IUDs) like Mirena. This may be due to several misconceptions about IUDs and who should use them. Today, the American College of Obstetricians and Gynecologists (ACOG) and the World Health Organization (WHO) both approve IUDs, including Mirena, for women who have never given birth. However, the decision to use Mirena is you and your health care provider.

In the past, IUD use in younger women without children was mistakenly linked to complications like pelvic inflammatory disease (PID), infertility, and other side effects related to the placement of the IUD. However, recent research debunks these claims and concludes that the IUD is a safe and highly effective birth control option for women of all ages, with and without children. One concern about the IUD is that sometimes it can slip partially out of the uterus, a process known as expulsion. If this happens, the IUD is no longer effective and a woman can become pregnant. Expulsion is more likely in women who have never had a pregnancy — even women who have had a miscarriage or abortion appear to have better IUD retention rates compared to those who have never been pregnant. The possible risk of expulsion is not a contraindication for Mirena in women who haven't had children, but it is something to keep in mind and discuss with your health care provider.

Another worry about IUD use in women without children is the increased risk of PID. According to current research, higher rates of sexually transmitted infections (STIs), not IUD use, are to blame for the increased risk of PID in this group. Women who have not had children tend to be younger and generally have higher rates of STIs like chlamydia and gonorrhea, which can lead to PID. Contrary to popular belief, Mirena and other hormonal contraceptives may actually protect against PID by thickening the cervical mucus and decreasing menstrual flow. On the other hand, Mirena does not protect against STIs so condoms are still a good idea. Your provider will need to make sure that you don't have any STIs before inserting an IUD.

Like most contraceptives, Mirena does have some side effects. Side effects of using Mirena may include:

  • Cramping, pain, or infection after insertion
  • Expulsion (your health care provider can reposition the IUD properly)
  • Peforation of uterus (rare, and in most cases, happens upon insertion)
  • Reduced menstrual cramps
  • Light or absent menstrual flow (some women may welcome this change while others might worry about a possible pregnancy)

A common belief has been that an IUD can increase the risk of having an ectopic pregnancy (a pregnancy where the fertilized egg implants in the fallopian tube, which can be dangerous for the woman). In fact, IUDs do not increase the risk of ectopic pregnancy. However, the IUD is better at preventing a pregnancy in the uterus than it is at preventing pregnancy in the fallopian tubes, meaning that ectopic pregnancy is somewhat less likely to be prevented by this method of birth control than a uterine pregnancy.

If you are looking for progestin-only birth control, the "mini-pill" is another option. For more information about the mini-pill, check out What are the differences among birth control pills? and Norplant vs. progestin-only pill. In addition, you might consider the copper-T IUD, which functions similarly to the Mirena, but uses no hormones. A health care provider can help you choose a suitable birth control method. At Columbia, students can call x4-2284 or log on to Open Communicator to make an appointment with a clinician at Primary Care Medical Services (PCMS). Off-campus, some health professionals are still reluctant to prescribe IUDs to women without children, so you may need to ask around to find a provider who is familiar with the new safety guidelines.

Good luck finding a birth control method that puts your mind at ease!


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