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Is 47 years old too old to have an IUD or to have another IUD inserted? #528/12

I am 47 years old and my doctors say it is time to remove the IUD for good.  They want me to have a tubal ligation.  Is there an age limit on when a peroson should not have an IUD inserted or keep one that is already there?

 

I need a quick answer as my doctor called for me to make an appointment fo get my IUD removed.  HELP!



If the IUD is a Mirena IUD it may lead to:

Less cramps and pain

Less bleeding

Decreased risk for endometrial cancer or hyperplasia

Decreased size and decreased bleeding from fibroid tumors

 

Lots of advantages to leaving it in and it may be left in place for 7 to 10 years.

                                                           

Her reply on 6-11: “I had it in for 10 years the first time and this one now for 7 years.  The doctor says at 47, it should be taken out. What age should it be taken out or not have an IUD anymore?”

 

Well, it is not dangerous to leave in and the hormone it is giving off is probably preventing pregnancy and endometrial cancer.

 

Speroff and Darney, in their text say Mirena is probably effective for 10 years. 

 

HERE IS MORE INFO THAN YOU PROBABLY NEED.  READ TO THE VERY END!! PRINT IT UP FOR YOUR CLINICIAN IF YOU LIKE

 

I need evidence to support use of the Mirena IUD for more than 5 years.

 

Q:        I have met a great deal of resistance regarding advising patients of Mirena IUD efficacy up to 7 years.  Our  chief subgroup of a large HMO, reviewed ALL the published literature (including the published statements in Contraceptive Tech and Up to date) and concluded there was insufficient evidence to recommend using the Mirena IUD (which has 52 LNG which is less than the 60 LNG used in the most compelling but small study) for 7 years. This may be released as a blanket statement to a large HMO organization.

So, as a huge proponent for IUD use as well as accurate and up to date information, I am hoping you can provide me with more references/evidence I can bring back to the group to encourage more accurate counseling for our patients.  I think it is unreasonable to state that it is not effective at 7 years when expert opinion suggests otherwise. I have reviewed and discussed that expert opinion advises up to 7 years (and even longer duration of action), but I would appreciate any evidence (more references) to further support equal efficacy of the Mirena at 7 years. 

 

Thank you and I am always appreciative of your excellent comments and willingness to educate!!!

 

 

A:        Good morning!

If your group feels there is inadequate evidence to recommend use of the Mirena IUD for more than 5 years, so be it.  Kaiser Permanente is a data driven organization that I respect immensely.

 

I would simply recommend that you consider several ways of saying this to women using this IUD:

·        “Your IUD is effective for at least 5 years.”  NOT “Your IUD must be removed after 5 years of use.”

·        Also consider the possibility of telling women: “If you choose to leave your Mirena IUD in for 7 years, we would recommend that you use condoms as a backup method.”

·        I would prefer that women be told: “There is data that suggest strongly that Mirena is effective for 7 years.  The decision is up to you.  If you choose to leave your Mirena IUD in beyond 5 years, then you may want to consider using condoms as well.”

                                                          

Women should also be provided several paragraphs of information from the 19th edition of Contraceptive Technology.

 

Chapter 7 in Contraceptive Technology Intrauterine Devices (IUDs)

By David A. Grimes, MD

The approved life span of the levonorgestrel system is 5 years, although the protection with the system in place may last at least 7 years. While contraceptive effectiveness is discussed in more detail in Chapter 27, a simple formula explains why today’s IUDs provide superior contraception (Figure 7-2). The effectiveness in the community of any contraceptive is related to a number of factors. These include the inherent ability of the method to prevent pregnancy (efficacy) and the user’s compliance (adherence to the regimen, such as pill taking) and continuation (ongoing use over time). Factors impairing effectiveness include a woman’s fecundability (reflecting age, body mass index, prior salpingitis, etc.) and frequency of coitus. Although combined oral contraceptives have excellent efficacy, compliance is only fair—as is continuation. Hence, the contraceptive effectiveness of combined oral contraceptives falls in the middle tier.  In contrast, IUDs have excellent efficacy and users exhibit high compliance and high continuation rates (about 85% to 90% at one year). This translates into superior protection against unintended pregnancy.  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.

 

SPEROFF AND DARNEY BOOK:

A Clinical Guide for Contraception Fifth Edition, page 249

"The levonorgestrel IUD can be used for at least 7 years and probably for 10 years" (with references)

 

JOHN GUILLEBAUD IN Contraception Your Questions Answered  Fifth Ed, 2009, states on page 457 

"For all women under age 35, because of their greater fertility, replacement after the first 5 years would be advisable."

 

Guillebaud notes that "Sivin's study in which 174 users continued to use Mirena to the end of the seventh year and another study from Brazil, provide data that it is effective as a contraceptive for at least 7 years."

 

TOUGH QUESTION and my hope is that better data are forthcoming so that we can without hesitation recommend use of Mirena for 7 (perhaps more) years. This will be studied in women using Mirena in the St. Louis CONTRACEPTIVE CHOICE PROJECT.

 

Her reply on 6-12:  “I have endometriosis and is wicked right now.  Not sure if it is that or the IUD that has me in so much pain after my period and the tummy pains and headaches.  The doctors think that it’s both.”

 

If your Mirena IUD is contributing in a major way to your pain, you and your physician (or nurse practitioner) will need to decide if that IUD should be removed.

 

To learn more about the advantages and disadvantages of Mirena IUDs and ParaGard IUDs, 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: 
IUD, removed, tubal ligation, age, cramps, pain, endometrial cancer, hyperplasia, bleeding, fibroid tumors, advantages, disadvantages, dangerous, hormones, pregnancy, Speroff, Darney, A Clinical Guide for Contraception, effective, Contraceptive Technology,  Dr. John Guillebaud, Contraception Your Questions Answered, period, tummy pains, headaches

Robert A. Hatcher MD, MPH
Emeritus Professor of Gynecology and Obstetrics
Emory University School of Medicine
Atlanta, GA
---2012-06-15

The directors and owners of this website and any publications and information concerning health matters offered here advise a person with a particular problem to consult a primary-care clinician or a specialist in obstetrics, gynecology, or urology (depending on the problem or the contraceptive) as well as the product package insert and other references before diagnosing, managing, or treating the problem.
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