Mirena & Heavy Bleeding: Understanding Post-Insertion Changes

Question
Hello,
I've had a Mirena for a little over one year now.  I had the typical three months of spotting following insertion, then a few months of amenorrhea while breastfeeding my son.  Shortly after weaning, I resumed menstruation with longer, heavier periods that I was used to.  Initially they were two weeks apart, lasting 10-12 days.  I also encountered spotting between periods.  They were accompanied by painful cramping and nausea, and this lasted for three months - until the 9 month mark post-insertion.

I scheduled several visits to my obstetrician's office, but we could not connect for reasons beyond our control (delivering babies, my children were ill, etc.).  As it stands, I am scheduled for an appointment on Thursday - my annual check up.  I'm still haing 10 day, painful, heavy periods, although this month was the first in which I escaped the spotting that has plagued me since November.  
In any case, my experience is the opposite of what the Mirena literature dictates.  My OB is very pro-Mirena, and I suspect he will encourage me to stick with it a little while longer, as my cycles are slowly becoming better.  I'm inclined to stick it out, but my husband is frustrated (for himself and for me!) and would like me to have the device removed.

In your experience, what are the odds that this is 'normal' and will improve over time?  After a year can I expect this to continue?  

Thank you for your help!
Kristin  

Answer
Dear Kristin,

Mirena users typically experience a lessening of the flow of their periods within the first six months of use. Many times it is within three months, but sometimes it can take as long as six months. Usually by then your body has adjusted to the hormones and the presence of the IUC and often periods will be quite light or disappear all together.

One of the conditions which is noted in the Mirena literature to be reported to your doctor is heavy or prolonged vaginal bleeding. That is because this is not an expected effect of use. It can also sometimes indicate a more serious side effect called PID (Pelvic Inflammatory Disease). Other symptoms of PID besides long-lasting or heavy bleeding are: unusual vaginal discharge, low abdominal or pelvic pain, painful sex, chills, or fever.

I can understand the frustration - for you both. Make sure you share this with your doctor as well. He should understand that waiting out nearly constant vaginal bleeding is not only uncomfortable, but a hindrance to normal life activities. If he is insistent, you can put a reasonable, yet short, time frame on it. If you WANT to compromise, then you can tell him that you will give it another 3 months only. And that if your symptoms have not improved significantly by then, you want it removed. That would be more than 15 months after insertion, which should be more than enough time for your body to have adjusted to this form of birth control.

I hope this information has helped you and answered your question. I wish you well.

Brenda