Is There An Alternative To Mirena Treatment Other Than Surgery?

Posted on Tue, 31 Dec 2013

Question: I have fibroids which have resulted in heavy bleeding. I am 53 and contraceptives is not recommended but I was placed on microgynon for 6 mths. My doctor will review the level of bleeding without the pill in January and is recommending a mirena for about 2 years at which time he thinks I should experience menopause. I have always been told I have a bulky uterus. Is a mirena an appropriate treatment or are there other recommended treatments besides surgery?

Answered by Dr. Dr. Soumen Patra (1 hour later)

Brief Answer: MIRENA CAN BE USED BUT NEED MONITORING. Detailed Answer: Hello, Thanks for writing to us. First of all, your uterus is quite bulky (size of 16 weeks) with multiple fibroids (9 in number) and you are presenting with heavy bleeding at 53 years age. In this circumstance, best and definite treatment option is TOTAL ABDOMINAL HYSTERECTOMY with removal of both sided ovaries and fallopian tubes (TAH + BSO). It is the gold standard procedure at this stage and age group. Uterine artery embolization, radio frequency ablation etc are the other option. However, only PROGESTERONE therapy (no combination) can be tried initially in the form of pill or IUD (like MIRENA) to regress fibroid and control bleeding. You need periodic follow-up and overall assessment until bleeding is controlled. OTHER MEDICAL THERAPY: 1) GnRH Agonist (like Goserelin) 2) Anti Progesterone (like Mifepristone) 3) Aromatase Inhibitors are very much effective in reducing size of the fibroid along with symptoms. These group of drugs should be continued for 3-6 months duration for effective results. Tranexamic acid is quite useful to control bleeding in combination with any above group of drugs. There may be some tolerable side effects. SUGGESTION : MIRENA can be used in your case to arrest bleeding. However, in the failed case or late menopause, you have to go for definite treatment as mentioned above. Kindly, consult with your GYNECOLOGIST regarding this for proper management. In the mean time, you would take healthy diet with IRON & CALCIUM supplement and maintain genital hygiene properly. Hope, it will be helpful for your information and understanding. Let me know, if you need clarification. Wish your good health and take care yourself. Regards, Dr Soumen For future query, you can directly approach me through WWW.WWWW.WW

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Soumen Patra (11 hours later)

I forgot to mention that I am hypertensive which is well controlled with norvasc 10 mg tabs. WOuld this affect any of the suggested treatment?

Answered by Dr. Dr. Soumen Patra (11 minutes later)

Brief Answer: TREATMENT WILL BE SAME AS BP IS CONTROLLED. Detailed Answer: Hello, Thanks for follow up query. Above said treatment protocol will be same for you as your BP is well controlled at present. Kindly, consult with your doctor for proper guidance. Hope, I have guided you properly. Kindly, close the discussion if you don't have any other query. All the best and good luck. Regards, Dr Soumen

Above answer was peer-reviewed by : Dr. Vaishalee Punj