Hate it for a month, then love it for 5 years

Robert A. Hatcher MD, MPH

The going tends to be stressful or difficult at the start of a new job, as you start to learn a new skill (think of golf) or when you first are exposed to a new group of people (think of the first week of college). It can be exactly the same with a new medication or medical device.

 The most commonly used reversible contraceptive worldwide is the intrauterine device (IUD).  It is not that way in the United States where but 2% of contracepting women use IUDs.

IUDs are small plastic objects that are placed up into the uterine cavity (the womb) where a baby would develop were an IUD not there. There are two IUDs in the United States. One type gives off very low levels of a progestin (a hormone) and is called Mirena.  The other, ParaGard, gives off very low levels of copper.

A woman has almost nothing to do once her IUD is in place and once she finds she is able to tolerate that foreign body in her uterus. So, blessedly, the IUD eliminates almost all human error. Human error causes half of all the unintended pregnancies and abortions in the United States. People have called the Implanon implant and the above two IUDs the “you can’t forget me” contraceptive methods.   Of 1,000 women who have an IUD inserted one or two become pregnant in the first year, making an IUD the most effective reversible contraceptive. Of 1,000 women who start pills, 80 will become pregnant in the next year.

But there can be problems. Both of these IUDs may need to be removed because of cramping pain, spotting, bleeding, or expulsion of the IUD out of the uterine cavity.  In the case of the hormonal IUD, Mirena, removal may even happen because a woman does not like her very light periods or that she is having no bleeding at all.  Here is what may happen to a woman who chooses to use a Mirena IUD:

  1. In the first several months Mirena can cause bleeding and cramping and pain patterns women simply do not like at all.  Other women may not have these problems just after Mirena insertion. .  
  2. Then over time the number of days of any vaginal bleeding will become less and in the long run women using Mirena bleed 90% less than women of the same age not using Mirena. Women using Mirena are far less likely to be anemic.
  3. This difference between the first month or so and what happens later on has led one clinician to counsel women in a very honest but apparently not an overly threatening manner. 

Terri Wynn-Hipps is a nurse midwife in Ft. Bragg, North Carolina. She has inserted close to 200 IUDs in the past year; 85% of her insertions are Mirena IUDs. Clearly whatever she is telling women in advance of inserting an IUD is not discouraging her patients from choosing Mirena. 

        SHE TELLS WOMEN:  “You may hate Mirena for a month but then you’re going to love it for 5 years!!!” 

       Imagine telling a woman “You’re going to hate it for a month.” People at the conference encouraged her to soften these words a bit. A more gentle way of saying what Terri is telling women might be: “You may not like Mirena for the first month but you’re going to love it for 5 years.”  The point is, she is telling women very honestly about the good and the bad of an important health intervention.     

Of course, we always hope that women choosing Mirena move quickly into the “Iove it” phase and most do. Mirena has a much higher continuation rate than most contraceptives.

Robert A. Hatcher MD, MPH
Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, Georgia