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I recently had a lapse in health insurance.  During this period, I hit the 5-year mark with my Mirena IUD.  When I went to the doctor, they assured me my Mirena was too expensive to replace until my insurance became active again.  So, the alternative was to keep it in place and take a low-dose birth control pill as well.

Is this a reasonable decision?  Or should I be more concerned that I have this foreign object in my body past the experation date?

Good morning!

Chapter 7 in Contraceptive Technology Intrauterine Devices (IUDs)

By David A. Grimes, MD

Both of the intrauterine contraceptives in the United States rank in the top tier of contraceptive effectiveness (along with surgical sterilization, implants, and injectable contraceptives).  In combined World Health Organization and Population Council trials, the first-year discontinuation rate of the TCu 380A for accidental pregnancy was only 0.7 per 100 women, and even lower rates occurred in years two through ten. In World Health Organization trials, the cumulative 12-year failure rate with the TCu 380A was 2.2 pregnancies per 100 women.  In three trials conducted by Leiras, the Finnish manufacturer of the levonorgestrel system, the first-year cumulative failure rate was 0.14 per 100 women, and the cumulative five-year failure rate was only 0.71 per 100 women. In the Population Council’s randomized trial of the levonorgestrel intrauterine system vs. the TCu 380A, the seven-year cumulative failure rates were 1.1 and 1.4 per 100 women, respectively.  In contrast, the overall ten-year failure rate with all methods of tubal sterilization in the United States is 1.9 per 100 women.  Thus, contemporary intrauterine contraceptives rival the effectiveness of tubal sterilization.

Cancer Protection

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.  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 levonorgestrel 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.

If you would like to, please do pass this on to your doctor.

To learn more about the advantages and disadvantages of the Mirena IUD, go to our website: www.managingcontraception.com and click on Choices.  You can also order this wonderful new educational book from our website or by calling 404-875-5001.  Do you have your copy yet?

Key Words:  health insurance, lapsed, Mirena IUD, expired, expensive, backup contraceptives, low-dose pills, foreign object, expiration date, duration, effectiveness, dangerous, uterus, Dr. David Grimes, Contraceptive Technology, Speroff and Darney, Contraception-1993, intrauterine devices, cancer protection

Reference:

Grimes DA. Intrauterine devices (IUDs) IN Hatcher RA, Trussell J. Nelson AL. et al Contraceptive Technology 19^th edition, pages 119, 120,121 and122: Ardent Media Ind. 2008

Posted 7-24-2011, Updated 8-13-2011, Updated 8-26-2011, Updated 9-5-2011