I am a 31 year old female who has been diagnosed insulin resistant (also called sometimes "metabolic syndrome"). I am treated with Glucophage 500mg twice daily - which has done wonders to manage my blood sugar levels.
After many years on triphasic birth control pills (Ortho Novum 7/7/7), I am experiencing severe menstrual migraines. My doctor is recommending a Mirena IUD, however I am concerned about the effect of the levonorgestrel on blood sugar levels. Will the Mirena adversely affect insulin/blood sugar levels?
1. Your severe menstrual migraine headaches suggest that you should stop estrogen containing birth control pills (Ortho 777).
2. Mirena contains no estrogen and is an extremely low-dose progestin-only method.
3. Severe menstrual migraine headaches is not a reason to avoid using a Mirena IUD.
4. Nor is insulin resistant diabetes a reason to avoid using a Mirena IUD which does not affect blood sugar levels.
5. If preventing an unintended pregnancy is a high priority, use of a Mirena IUD is the most effective reversible contraceptive ever developed.
6. Women with diabetes are at increased risk for endometrial hyperplasia and endometrial cancer and Mirena IUDs protect a woman against both endometrial cancer and endometrial hyperplasia.
7. What is your current thought about having a Mirena IUD inserted?
From the 19th edition of Contraceptive Technology:
Intrauterine Devices (IUDs) by David A. Grimes, MD
One of the most intriguing aspects of intrauterine contraception is the evolving story of cancer prophylaxis. Seven case-control studies around the world have examined the potential association between non-medicated or copper IUD use and development of endometrial cancer. Six of the seven found protection against endometrial cancer from devices, and the effect was statistically significant in two (including the Cancer and Steroid Hormone Study of the Centers for Disease Control and Prevention). The only study not to find benefit related to a steel ring used in China, which is not relevant to Western practice. While the mechanism of action is unknown, it may relate to the altered endometrium associated with intrauterine contraception. Similarly, progestin-releasing intrauterine contraceptives should also protect against this cancer, as is true of contraceptives that deliver a progestin systemically.21 Indeed, the levonorgestrel device has been used to treat endometrial hyperplasia and adenocarcinoma.Two studies have addressed cervical cancer, and both found a 40% reduction in risk associated with IUDs, which was not statistically significant.
Medical Benefits of the Levonorgestrel Intrauterine System
Topical delivery of progestin to the uterine cavity has exciting therapeutic uses aside from contraception. Some are well-established and approved indications overseas, while others are still being explored. Although average menstrual blood loss increases among users of the TCu 380A, the opposite occurs among users of the evonorgestrel system. Overall blood loss drops about 90%, and 20% or more women stop bleeding altogether. This translates into clinically important increases in hemoglobin and iron stores. Some evidence supports a benefit in treating heavy bleeding associated with adenomyosis and leiomyomas.
Indeed, the levonorgestrel system can be used to treat heavy menses, not just prevent them. Trials have compared this approach to medical treatments with an oral progestin, a nonsteroidal anti-inflammatory drug, or tranexamic acid (not available in the United States). The levonorgestrel system proved superior to the other alternatives. In addition, this system has been found an acceptable (and inexpensive) alternative to endometrial ablation or hysterectomy.
Another logical use of the levonorgestrel intrauterine system is as part of hormone replacement therapy in menopause. Many women suffer from unpleasant side effects of oral progestins given along with estrogen. In addition, nuisance bleeding is the primary reason women abandon hormone replacement therapy. Use of the levonorgestrel system leads to profound suppression of the endometrium, which then ceases to bleed. Lack of uterine bleeding during hormone replacement therapy is desirable for the woman and her clinician.
DISADVANTAGES OF THE MIRENA IUD:
Bleeding problems constitute one of the more common IUD complications. Altered bleeding patterns may be a normal side-effect of intrauterine contraception or may signal pregnancy, infection, or partial expulsion. Irregular bleeding is common in the early months of intrauterine contraception with either device. Women using the TCu 380A usually have heavier menses, and irregular bleeding can occur during early use. Irregular but light bleeding or spotting is the norm in the early months of the levonorgestrel intrauterine system, since endometrial suppression takes several months to achieve. Thereafter, a marked decrease in bleeding occurs. Women should be thoroughly counseled about these effects, which tend to be self-limiting.
Excessive bleeding with the TCu 380A can be treated with non-steroidal anti-inflammatory drugs; trials have not demonstrated the superiority of one product over another. Since local prostaglandin production is involved with excessive bleeding, any prostaglandin synthetase inhibitor should help; in contrast, aspirin and acetaminophen do not. Starting in advance of menses does not give better results than starting with the onset of flow. If hemoglobin levels drop, oral iron supplementation can be started.
Not all nuisance bleeding can be attributed to the contraceptive. For example, other gynecologic disorders, such as endometrial polyps, may be responsible. Alternatively, an accidental pregnancy (including an ectopic pregnancy) can present with bleeding. In addition, bleeding may accompany endometritis. Of note, with the use of small catheters, the endometrium can be biopsied with the device remaining in place. Persistent abnormal bleeding requires clinical evaluation. If no explanation is found and if the woman’s threshold for tolerance is passed, the device can be removed.
Cramping and Pain
Discomfort may be felt at the time of IUD insertion and may be followed by cramping pain over the next 10 to 15 minutes. One approach is preventive therapy with oral non-steroidal anti-inflammatory drugs, local anesthesia, or both. Prophylactic administration of a non-steroidal anti-inflammatory drug around the time of insertion has not been found to be helpful. The most common analgesia approach used for insertion in the United Kingdom is intrauterine anesthesia with a solution of 2% lidocaine (Instillagel), which is not commercially available in the United States. For paracervical anesthesia, use of a long-acting local anesthetic, such as bupivacaine, may be preferable to shorter-acting drugs, such as lidocaine. Should a woman have pain or vasovagal symptoms immediately after insertion, a paracervical block can be placed at that time. Rarely, the IUD needs to be removed at the insertion visit. Pain that develops later may reflect threatened or partial expulsion, dislodgment, infection, or a complicated pregnancy.
This answer came almost entirely from the 19th edition of Contraceptive Technology, a book that describes how all the contraceptives work, the advantages and disadvantages of each and much more! The chapters are by nationally recognized experts.
Click here to see how to order this important reference book and other important books for clinicians, counselors and women and men wanting the latest contraceptive information.
Key words: diagnosed, insulin resistant, metabolic syndrome, Glucophage, blood sugar level, triphasic birth control pills, Novum, effect, migraine headaches, levonorgestrel, Mirena, estrogen, low-dose progestin-only method, diabetes, unintended pregnancy, endometrial hyperplasia, cancer, Contraceptive Technology, Intrauterine Devices, Dr. David A. Grimes, cancer protection, medical benefits, disadvantages, menstrual problems, cramping, pain
Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J, Nelson AL, Stewart FH, Cates Jr. W, et al Contraceptive Technology 19th edition, pages 121-124: Ardent Media Inc. 2008