A: I have heard it one time too often. “I don’t need to know about birth control. I am done with that.” She or he could go on to say “I am too old” or “I’ve had my tubes tied.”
But there are medical conditions for which the best approach today is one of our current contraceptives. By preventing of ovarian cancer or endometrial cancer, providing contraceptives may be life-saving to some women who do not need birth control. Decreasing the number of missed days of work or school due to severe menstrual cramps, pain or bleeding, may benefit women from 10 to 50 years of age whether or not they need contraception. Our current contraceptives are a many-splendored group of drugs. They are So Much More than just contraceptives.
Painful menses (Dysmenorrhea) In one study of young women attending an FP clinic 72% reported having experienced dysmenorrhea; for 15% the symptoms were severe enough to interfere with normal activities [Nelson A. and Baldwin S. IN Hatcher Contraceptive Technology 20th ed. 2011]. Dysmenorrhea may be secondary to adenomyosis, endometriosis, pelvic adhesions, neoplasia and pelvic infections.
CONTRACEPTION: Contraceptives that may improve dysmenorrhea include the LNG IUD (Mirena), Depo-Provera, Depo-sub Q 104, combined pills, NuvaRings, patches, and progestin-only pills.
If a woman, her daughter or her grand-daughter is plagued by heavy menstrual bleeding, the single most effective non-surgical approach to heavy menstrual bleeding (HMB) is the levonorgestrel IUD called Mirena.
Heavy menstrual bleeding (HMB) affects 9-14% of women but closer to 30% of women consider their bleeding to be heavy[Nelson A. and Baldwin S. IN Hatcher Contraceptive Technology 20th ed., 2011]. Because of missed work, women with HMB earn an average of $1,692 less annually than women with normal menses[Cote I., et. al., Obstet Gynecol, 2002]. Diseases that may cause HMB: fibroids (leiomyomata), adenomyosis, endometrial and uterine polyps, endometrial hyperplasia and cancer, and diseases of disordered hemostasis. However, only about half of women with HMB have an anatomical pathology identified at hysterectomy [Clark A., et. al., Br J Obstet Gynecol, 1995].
CONTRACEPTION: The LNG IUD (Mirena) was found to be more effective than prostaglandin inhibitors combined pills, progestin only pills and Depo-Provera at decreasing HMB [Gupta, NEJM, 2013].
Menstrual Pain: Menstrual cramps and pain are serious. How common in 19 year-olds? 72% report painful periods. 15% had to limit daily activities, 8% missed school or work every cycle, 38.2% regularly used medical treatment. [Fritz, Sperouf, Clinical Genealogic Endochronology and Fertility. 8th ed. Page 579]
Dr. Kate Miller (Univ. of Pennsylvania) encourages women to recognize that “this monthly discomfort (cramps, pain, fatigue, irritability) is simply not obligatory”. All these contraceptives definitely may help: the Mirena IUD, birth control pills, rings, patches, injections and implants.
1. Most women’s cycles are exactly 28 days. Absolutely NO. Only 12.8% to 15% of cycles are 28 days. About 20% of women using Mirena completely stop having periods.
2. IUDs cause abortions. NO, both Mirena and ParaGard IUDs prevent fertilization, thus preventing both spontaneous abortions (Miscarriages) and the need for induced abortions due to unintended pregnancies.
3. Condoms are not effective at preventing sexually transmitted infections. WRONG: According to the CDC, condoms are highly effective vs. STIs, providing an essentially impermeable barrier to particles the size of STI pathogens. Women using IUDs, implants, pills, rings, patches, or injections should use condoms, too!
4. Hormonal contraceptives cause cancer. DEFININTELY WRONG! Pills prevent colon, ovary and endometrial cancer. Pills do not increase a woman’s risk for breast cancer. Mirena IUDs prevent endometrial hyperplasia and endometrial cancer. Speroff & Darney 2001 A Clinical Guide for Contraception, 4th edition; WHO Collaborative Group Lancet 1996.
5. Women with fibroids cannot use a Mirena IUD. WRONG! In fact, Mirena IUDs decrease fibroid bleeding and perhaps, fibroid size.
6. Women cannot use an IUD until they have had a baby. NO, both the World Health Organization WHO MEC 2009 and the Centers for Disease (CDC) CDC, US MED 2010 consider the IUD an acceptable choice for women who have not had a baby. IUDs do NOT cause pelvic infections or ectopic pregnancies.
7. IUDs are just too expensive. Well, they may cost lots, but over time, IUDs are definitely the most cost effective reversible contraceptive.
To learn more about the advantages and disadvantages of the Mirena IUD, birth control pills and Depo-Provera injections; go to: www.managingcontraception.com and click on Choices 2013 edition. You can also order this wonderful new educational book from our website or by calling 404-875-5001. Do you have your copy yet? It is now available in English and Spanish.
Key Words: heavy menstrual cramps, pain, bleeding, effective, levonorgestrel IUD, Mirena, periods, activities, treatment, discomfort, Mirena IUD, birth control pills, fatigue, irritability, myths, cycles, infections, hormonal contraceptives, STIs, fibroids, cancer
Contraceptive Technology 20th Edition
Managing Contraception 2014-2015