Mirena coil and the menopause: everything you need to know

Can you get a Mirena coil at 50?

Mirena is a type of intrauterine system (IUS) that’s placed inside the womb (uterus). It’s mostly known as a long-term method of birth control, but it has a few other uses too – including during the perimenopause and the menopause, which usually occurs between the ages of 45 and 55.

Firstly, it can help manage heavy periods, which are often a symptom of the menopause. It can also be used as part of hormone replacement therapy (HRT).

How does the Mirena coil affect menopause?

The Mirena coil can help ease the effects of one often bothersome symptom of menopause: heavy periods.

It does this by making the womb lining thinner, resulting in less bleeding every month. While it can reduce the amount of blood flow, it’s important to note that it may take 3 to 6 months before you notice its full effect.

It may also be hard to know when your periods have stopped altogether when you’re using a Mirena coil. If the Mirena has stopped your periods, it can be hard to know if they've also stopped for good due to the menopause. As with other forms of birth control (like the pill), the hormones released by the coil may even be helping your body to maintain its regular ‘pre-menopause’ cycle so you may continue to have bleeds even though you’re menopausal.

Side effects of the Mirena coil are not common and often settle down after a few months.

They can include irregular vaginal bleeding (spotting) and irregular or light periods.

They have also been reported to cause

, , and , although the rates seem to be the same as non-hormonal coils, so these may be unrelated to the hormones in the coil. Other problems can occasionally include or , as well as – cysts don’t usually cause any symptoms and go away by themselves.

Your doctor will be able to discuss the full list of possible side effects and suggest ways of managing them.

Find useful information on other areas of menopause with our

.

The Mirena coil and HRT

During the menopause, your oestrogen levels naturally fall. When you take oestrogen-based HRT to increase them and to help manage menopause, it can sometimes lead to the abnormal thickening of the womb. Rarely, this thickening can lead to cancer.

A hormone called progestogen can help protect the lining of the womb against thickening. However, your body stops producing progestogen during the menopause.

The Mirena IUS can be used to release levonorgestrel, a type of progestogen, into your body to ‘counter-balance’ your oestrogen levels, protect the lining of the womb and reduce the risk of cancer.

This is why the Mirena coil is often used alongside oestrogen as part of HRT.

Your doctor will also look at your individual menopause symptoms and assess any impact on them. They will also consider what oestrogen medication may be best to use alongside the Mirena coil.

When is the best time to have a Mirena coil placed?

As a contraceptive, the Mirena IUS can be used up to the age of 55 (when contraception is no longer needed). However, it can be used after this as the progesterone part of HRT. Your doctor will be able to advise whether a Mirena coil may be a good option for you.

Before you use a Mirena coil, your doctor will need to assess you to ensure it’s suitable for you. You will also be checked for infections prior to placement.

If you’re still having periods, the IUS is usually placed during the first 7 days of your menstrual cycle, but it can be inserted at any time as long as there's no chance you’re pregnant. You may need to use other contraception or avoid sex for the first 7 days after placement. If you’re receiving HRT and no longer have your periods, it can be fitted at any time of the month.

When should you remove a Mirena coil during the menopause?

When being used as a contraceptive, the Mirena coil is usually taken out or replaced after five years. If you're using it for contraception only (and not as part of HRT) and it’s inserted after the age of 45, it can sometimes be left in until you are 55 and no longer need contraception.

If you’re using it alongside oestrogen as part of HRT, it should be removed after 4 years (not 5). This is because the level of protection it offers the womb after 4 years is not fully understood.

Your doctor may also remove your IUS after placement if you have side effects or health problems like a pelvic infection or a sexual transmitted infection.

Note that it’s possible to get pregnant as soon as the IUS is removed. You should use other contraception as a precaution if you’re still having your periods and you’re under 55 years old when it’s removed.

When to see a doctor about your Mirena IUS during menopause

You should call an ambulance or go to your nearest emergency department if you think you may be experiencing any of the following after your Mirena IUS placement:

• severe lower abdominal pain
• any combination of confusion, shortness of breath, a high heart rate, fever, shivering, feeling very cold, extreme pain, or sweaty skin (this may be a sign of
  sepsis
  )

You should speak with your doctor as soon as possible if:

• you experience mood changes or feelings of
  depression
• you think your IUS has moved out of place
• you develop vaginal bleeding after you have been through the menopause

You should check with your doctor if you develop any new medical problems or any of the following symptoms after your Mirena coil has been placed:

• abnormal vaginal bleeding
• an unusual or smelly discharge
• yellowing of your skin or the whites of your eyes (
  jaundice
  )

Key takeaways

• Mirena is a type of intrauterine system (IUS) that’s placed inside the womb (uterus)
• it’s a long-term method of birth control, but it can also help manage heavy periods and be used alongside oestrogen in HRT
• it can be used from puberty through until the age of 55 when contraception is no longer needed
• the mirena coil should be taken out or replaced after five years (or after 4 years if you’re using as part of HRT)
• as with other hormonal birth control options, it may also be hard to know when your periods have stopped altogether when you’re using a Mirena coil