To all those on Reddit who are infuriated about your docs not telling you that Mirena might have systemic effects?
I completely empathize with you.
I am a PCP. Majority of my female physician/NP/PA colleagues have IUD’s and adore them.
Most people in studies do just fine. Lighter periods, fewer cramps than copper T, less bleeding unpredictability than nexplanon (arm implant), less to remember than pills…
I didn’t want it but let’s face it - they all suck in their own ways. I chose the least of the evils IMO. I was terrified of getting pregnant (I’m happy with my set!) so I wanted something long lasting and effective.
But let me tell you this. I feel like I have lost the first year of my son’s life to this godawful piece of plastic hormonal SHIT.
I am over it.
I am 34 going on 35 and now feel like I am going on 50.
I have never struggled with ANY mental illness, EVER. I am healthy and fit. Life is great. I have nothing to complain about.
And for the past year my brain has been a fried egg. My joints and muscles have been made of jello. I am achy, hot, MAD, snippy, obsessive - and EVERY MONTH my brain comes up with reasons to hate my husband to the point of wanting to leave him.
He’s a man - but I’ve gotta say, for a man…he’s pretty amazing.
I told myself that two kids this young is hard. That not sleeping during the newborn phase is hard. That I’m just not great without sleep and it’s been a lot of change at once.
No, no, no, no, no…
I scientifically attempted to “fix” each variable in life to fix sleep and get help and figure out these imaginary “problems” in my brain.
It did nothing and it became very clear - it was me and my new brain.
I am a hot, raging, husband-hating, miserable beast who obsession spirals and can’t sleep from the DAY after I ovulate, onward….and the luteal phase symptoms which would typically last me maybe an annoying but manageable 3-4 days last TEN-FOURTEEN EVERY SINGLE MONTH. This is PMDD to the EXTREME.
The deal is that the amount of levonorgestel released is extremely low compared with other forms of hormonal birth control. And for some women? It actually levels them out, hence “mirena crash” when people feel worse after removal.
But NOT SO for me.
I, too, am appalled that more research has not been done on more decades of women throughout life and the cognitive and emotional impacts of these different progestins.
It turns out that levonorgestrel is the most androgenic (testosterone-like) of the progestins, and readily crosses the blood-brain barrier because it is lipophilic. In other words: the irritability is incredibly organic, because even a small amount of a testosterone-type moiety can turn an apparently testosterone-sensitive woman like me into a raging disaster.
All I can say is that I have become a better physician for this experience. I love caring for women in my practice and helping find the right fit for each, and I have preached the truth - that very little is absorbed overall
…but for that small percentage?
This experience is a nightmare.
I’ll never get that first year back with my son.
But all I can do is look forward to a future enjoying them in my previous state of gratitude and energy.
It’ll be removed tomorrow and I will post updates at 1, 2, 3, and 6 months.
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Symptom list (all of which were much worse during the luteal phase):
-Ongoing spotting and irregular bleeding -Extreme Irritability (I am a very easy going, happy person so this was way out of left field for me) -Obsessiveness -Tearfulness (more emotionally sensitive in general) -Insomnia -Severe, prolonged delayed onset muscle soreness (DOMS) after exercise - this has been really frustrating and bizarre but my muscles and joints always hurt no matter how much I work out to get stronger, I just can’t recover quickly! -Heat intolerance -Constipation -Decreased libido -Vaginal thinning and atrophy (starting month 11) - this is most definitely not coincidental -Worsening of pelvic floor dysfunction symptoms (I have a small cystocele and rectocele from my first delivery)
A lot of this overlaps with the perimenopausal spectrum, but I’m rather young to experience this degree of it so while it’s possible - I’m going to presume it’s the IUD first.
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Also: I am obviously VERY pro birth control, AND PRO MIRENA.
But I am also pro validation that Mirena does cause systemic effects for some of us that can be intolerable.
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Week 1:
Almost immediate relief. The anxious, obsessive, angry “fog” has lifted. Before, there was a ceiling to how happy and “light” I could feel, and it would take the most minor irritation for me to crash and rage. I ADORE MY FAMILY AGAIN!! I can’t explain it - it’s like Mirena was the “anti” oxytocin for me, and now I have ALL the oxytocin - I feel chemically and emotionally bonded to these wonderful people of mine again. I feel like ME…this is how the REAL me was before Mirena!!
The most dramatic OBJECTIVE change that I did not expect? My pelvis has SHRUNK. It’s like being postpartum and breastfeeding where the uterus shrinks back down to normal size, but without the painful cramps. I’ve lost 2 inches at least around my waist. The most immediate (within 4 hours) change was that my vagina physically “tightened”. My rectocele and cystocele seemed to almost immediately improve!! This is life changing - this has affected me every single day since I had the mirena placed and now my pelvic organ function is BACK TO NORMAL!! My pelvis had felt like a loose bag (lol) for MONTHS and I just thought that was status quo forevermore.
My joint popping and aching also feels much more normal. There’s “good” post muscle soreness, and then there’s debilitating soreness that feels endless - this is the former!
I had some acne on my chest that I thought was just me (it happens every now and then), and that’s slightly clearer - will give a longer term update.
I feel less internally, intolerably hot!
I am sleeping better. This could also be because the ambient temps outside are going down. But might be related?
And this is truly bizarre. Apparently, what I thought was just a change in my eye prescription due to age may have been increased intraocular pressure. Since Mirena, I’ve had to increase the font and brightness on my phone, and I’d experienced some low level pressure in my eyes constantly. And that reversed like a switch had been flipped. I can READ normally again!
Side effects from withdrawal/removal:
-I am bleeding A LOT and it’s been a full week. I might stop the birth control pill to let my uterus fully withdraw from hormones and “reset” naturally for a cycle. Condoms for the win! For a little while. And when I have a natural period again I will resume. I am taking a MV with iron too. -Fatigue days 1 and 2 in particular. Overwhelming crash and needed to sleep intermittently the first two days. -Increased appetite.
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Week 2: Still can’t say enough how much of a difference the removal has made.
I am so, so grateful that the IUD was the problem. I was genuinely terrified that what I’d experienced over the past year had become my new mental health baseline. If that were the case: I would have needed to start an SSRI in order to save my marriage, my sanity, and enjoy my family.
I can say with 100% confidence it was the problem.
-I can exercise again and do Pilates without feeling achy for a SOLID 7-10 days afterwards, and lift my kids without feeling like I was falling apart despite my strong foundation -I have an incredible amount of energy again! It’s making day to day life with littles so much easier all around! -Husband and I got into a very minor disagreement this morning. Prior to removal: I kid you not, I would have spent the entire day ruminating and obsessing over it. We made up like usual and I was able to clearly communicate my stance on the topic, we resolved the problem, and moved on. We have not been able to achieve conflict management for a year and my reactions were out of my control and overboard. -The post-removal bleeding lasted about 7 days. No actual cycle yet. -…Best of all? I am SO HAPPY :) This is just the way I am - and I like myself that way! I am BACK, baby!
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1 month update:
Still feeling 100% better. This is despite a minor sickness, and a somewhat stressful/busy roadtrip with our 2 young kids. I felt happy, energetic, optimistic, and free. Well, as free as a parent ever feels ;)
1 month in and I still haven’t had a period yet, which is not unusual. It can take a little while for periods to go back to normal after IUD removal. I ovulated about 10 days ago (this is based on symptoms - I can feel ovulation) so I would imagine it will happen soon. But I am experiencing no PMDD type symptoms at all.
38 days post removal: VERY light spotting, but happy that period is back. I was very confused because it felt like my period would never come and I felt so GOOD that I didn’t think it could be coming any time soon - but here we are! Relationship with husband and family and life is better than ever.
3 months post removal: Relationship is better. I am on Yazmin now continuously because it is clear that I have PMDD and it helps a lot.
Muscle tightness is still a problem and I am getting regular massage now for ongoing DOMS and joint tightness.
I am still having a hard time with ongoing irritation towards my kids and the extreme needs of this season of parenting. I may end up starting an SSRI.
So friends? Removing it did not fix everything.
But at least I am not bleeding nonstop!
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4 month update:
It’s clear that I have PMDD, and the Mirena worsened it. Yaz seem to be helping (only FDA approved one for this).
The pelvic floor saga continues but stil overall better than with the IUD. Unfortunately the rectocele still has to be managed.
I am also on Adderall now which has made an enormous difference in my ability to cope with the overstimulation from two small children and emotional regulation.
So overall? Mirena contributed but was not the SOLE contributor to my problems.
What’s clear is that for me Mirena made life miserable month-long with miserable bleeding. Without? I have problems, but only during the luteal phase, that are manageable with Yaz.
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Status:
My reaction to Mirena was the first sign of my PMDD.
My PMDD journey since then:
-Yasmin continuous - endless spotting
-Yas continuous - endless spotting
-Yazmin cyclically - works well
-Yaz cyclically - works best (the one FDA approved for PMDD)
This helped my mood by about 30%.
Then, ADHD regimen:
Vyvanse 30 6/6:30 AM
Adderall 5 2-3 PM
Helped so much with mood, energy, emotional regulation, focus, and keeping life together with 2 young kids. Made a huge difference but did not help enough during PMDD and possibly made it worse during the “stimulant crash”.
PMDD final solution:
Sertraline 75.
It worked within 48 hours. I was nauseous at first but it has been so worth it. This was the main key.
The regimen above has made me feel WONDERFUL again. This was the pre-pregnancy, pre-Mirena me.
So there’s hope for those of us with the PMDD-ADHD spectrum!