12 Aug Mirena or endometrial ablation for heavy periods?
Heavy periods are extremely common, affecting up to 1 in 5 women. They have a significant physical, emotional, social and financial impact on women and their family. There are different treatment options for different causes of heavy periods, and each treatment needs to be tailored to individual patient. Mirena intrauterine device and endometrial ablation are 2 options frequently offered to those wanting a long term solution without having a hysterectomy.
What is Mirena?
Mirena is an intrauterine contraceptive device, a small T shaped plastic device inserted into the uterus, which releases progesterone. Progesterone is a hormone which thins out the internal lining of the uterus, and therefore reduces or stops menstrual flow. Mirena lasts for 5 years and needs to be changed every 5 years.
What is an Endometrial Ablation?
Endometrial ablation is a minor procedure where the endometrium (internal lining of the uterus) is ablated (burned) and therefore destroyed. This reduces or stops the menstrual flow. Endometrial ablation is normally performed as a day case in a hospital under general anaesthetic. It is permanent and irreversible.
Once abnormal pathology (such as polyps, fibroids, infections, precancerous or cancerous cell changes, abnormal shaped uterus) is ruled out, both Mirena and endometrial ablation offer excellent results in treating heavy periods. More than 90% of women after Mirena insertion or endometrial ablation have lighter bleeding and are satisfied with the outcome. Choosing one option over the other, or another treatment for heavy periods, depends on personal circumstances and preference.
What is the difference between an Endometrial Ablation and Mirena?
Mirena is simple to insert and is reversible. It can be inserted in your doctor’s clinic, or as a day case in theatre under general anaesthetic and can be removed easily if side effects are not tolerated. Most women tolerate the initial side effects well, and most will not be aware of the Mirena other than having lighter periods. Some of the more common side effects are irregular bleeding (usually for the first 3 months) and mild cramping, bloating, breast tenderness, which usually subside after 1-2 months. Most hormonal effects of Mirena are local within the uterus, with less systemic side effects compared to other progesterone treatments such as the pill or the implantable rod. A very small number of women feels more ‘hormonal’, moody and anxious with the Mirena, and if this occurs, it can be removed. Mirena has not been linked to weight gain and is an excellent contraceptive method.
Endometrial ablation is a minor procedure, but requires general anaesthetic in hospital. This is offered only to women who have completed their family. It is not a contraceptive, and in fact, future pregnancy is contraindicated in women who have had ablation due to the risk of pregnancy complications. Tubal ligation or removal of fallopian tubes is often performed at the same time for permanent contraception unless the partner has already had a vasectomy. Endometrial ablation has no hormonal side effects. It is a permanent irreversible one-off procedure.
What are the other treatment methods for Heavy Periods?
Other treatment options for heavy periods include hormonal and non-hormonal medications and surgery such as hysterectomy. The advantages and disadvantages of each suitable option need to weighed up against another and in particular, potential side effects require careful consideration. Treatment plans should be individualised through thorough discussions with your doctor and gynaecologist. Treatment is not always required if no abnormality is found, blood counts and iron levels are normal, and the menstrual flow is not affecting day to day activities.