WOMENS-HEALTH Messages for July, 1998: Re: Methods of contraception

Re: Methods of contraception - for contraceptive users to reply

From: Thomas (anonymous@obgyn.net)
Fri, 31 Jul 1998 13:48:19 -0500 (CDT)

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For vimule and dumas please refer to my previous reply.

The intrauterine system is now readily available thoughout the world. In my opinion it is one of the most exciting new (relatively) forms of contraception presently available. It looks like a coil (a Nova-T to be precice). However instead of copper it contains a hormone called levonorgestrel. It is marketed under the name of Mirena. It is widely available in the UK, Europe and I think USA and only available in specialist family planning centre over here in OZ.

The reason this device is so exciting is this. A traditional coil works by preventing implantation and has copper that causes local irritation to the lining of the womb. This may cause heavy and painful periods in some women. In addition, we all know about the fertility and infection scares with the coil. The Mirena contains a progesterone. Unlike the minipill and depot only a small amount of progesterone reaches the circulation and therefore doesn't cause so many side effects. This progesterone thins the lining of the womb and actually protects against infection.

Here are the good points. At 6 months the average monthly menstrual blood loss is reduced by 90%. A large number of women have no periods at all. (THIS HAS CAUSED GREAT CONCERN FROM SOME GYNAECOLOGISTS AS THIS DEVICE MAY OBVIATE THE NEED FOR HYSTERECTOMY IN SOME WOMEN AND THEREFORE GYNAECOLOGIST'S INCOME). Secondly, this device is as effective as the pill and may even be more effective than sterilisation. Any woman of any age whether or not they have had children may have it. Like the pill, you have to persevere for a good three months before you get all the advantages.

THIS IS NOTHING NEW. IT IS READILY AVAILABLE IN MOST WESTERN COUNTRIES AND HAS BEEN AROUND FOR MANY YEARS. ONLY RECENTLY HAS IT COME INTO FAVOUR.

I have inserted over 100 of these but mainly in women who have wanted a hysterectomy rather than for women wanting primary contraception. Nearly 60% of the women I have given it to have changed their mind. However, it is expensive.

The implant is a similar device and as it is not available where I come from I have no experience with it. It is similar to the intrauterine system but instead of just sitting in the uterine cavity it is a longitudinal device that is punctured into the uterus muscle. I have difficulty seeing the advantage of this over the IUS.

--
Dr Thomas Ind MB BS MD MRCOG
St George Hospital
Kogarah
Sydney
NSW 2217
AUSTRALIA

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