Background info — FAAB, 18 years old, not currently sexually active but wanting to plan to be. I’m considering various birth control methods — I’m likely to start whatever I’m trying in August when I’m back at school. I’ve asked on here about hormonal birth control, and gotten some good info about that, but since my major depression gets significantly worse with the hormonal changes before my period begins, pill-format hormonal birth control might not be for me.

The nurse at my college’s health center is strongly recommending an IUD right now, but I’m very frightened by the thought of perforation/expulsion. From what I can tell, the risk of an expulsion is higher if you’re young, at least for the Mirena. (The Mirena is also hormonal — I know very little about copper IUDs, so I’m looking at the ParaGuard, but the lengthened/heavier periods are also a deterrent.) Apart from those fears, the Mirena sounds right up my alley, but with the same concerns about the hormones involved interacting with my depression.

Are there any young people who’ve tried the Mirena who’d be willing to talk about their experiences with it? As well as people with depression/other mood disorders. Or is there any data out there, especially about the mental illness question.

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13 Responses to Concerns about perforation/expulsion and depression issues with Mirena

  1. OozRu says:

    I’m far from young, but I do have bipolar disorder and I have a Mirena. I have not noticed any significant mood swings from the hormone in Mirena. I’ve had it for a little over a year now and everything has been pretty steady for me.

    Good luck with whatever option you choose.

  2. Knious says:

    As always, you should check out the LJ community IUD_divas, where they’ll have tons of info.

    I got my Paragard in when I was 21 and haven’t had any problems with it at all. I did notice the risk of expulsion, but a little reading showed that the “higher risk of expulsion” means that it’s at about 10% rather than 2%. Which, granted, is still a significant risk, but I guess when I was considering birth control, that was one I was willing to take. If you check your strings every month after your period and they feel the same, you’re good to go. In any case, expulsion never particularly worried me, since (from what I’ve read) it looks like what typically happens is your IUD falls out/gets misplaced and your have to use another form of birth control until you can get to your doctor to deal with it. Didn’t seem like too big of a deal to me, if the issue ever came up.

    Perforation is obviously way scarier. I don’t have any experience with it (or even know anyone who’s experienced it) but according to this website (http://depts.washington.edu/hhpccweb/article-detail.php?ArticleID=102&ClinicID=1) the rate is way less than 1% a year. That was a risk I was willing to take for birth control that wasn’t hormonal, and so far I haven’t regretted it.

    It might also be worth mentioning that IUDs are relatively underused in the US compared to other countries. (Check out this article: http://www.guttmacher.org/pubs/gpr/10/4/gpr100419.html) As far as I’m concerned, 27% of Norwegian women can’t be wrong! ^_^

    Anyway, I’m a huge proponent of it. I suffered from depression all four years in college, and no matter what HBC I tried, it would inevitably make it WAY worse. I totally love my Paragard–it’s easy and convenient and non-hormonal and lasts TEN FREAKING YEARS and it’s more effective than typical pill use and ahhhhhhh IT’S SO GREAT. I even persuaded my best friend to get a Mirena, and she loves it.

    I guess my point is that of course IUDs have risks and you should be aware of those, and keep an eye out for anything that feels out of the ordinary when you have one, but on the whole, those are risks that I decided are worth the conraceptive and hormone-free benefits. And it’s up to you to decide whether or not those risks are acceptable to you as well. 🙂

  3. 8idko says:

    These are all good concerns and ones that you should discuss with your nurse/doctor.

    Also ask what their policy is if you choose it and then decide it’s not right for you. Do you get a discount on whatever you choose next? What if that doesn’t work out either? What if you want to go back? What’s this all going to cost you?

    I’ve had a long series of IUDs including non-hormonal and hormonal. I didn’t see much difference in my periods but others have seen significant changes.

    Emotionally, I recently had the last of a series of Mirenas removed and I don’t know if it’s related or if I’m otherwise hormonal (very possible) but I’ve been experiencing weeks of on and off RAGE!!! So that brings us back to that you should discuss what effects the Mirena might have on your depression with your health professional.

  4. Ttefornia says:

    I got my Mirena when I was 18, because my periods were extremely painful (then-undiagnosed enometriosis, as it turns out). I was extremely reluctant to do this because my depression is much worse in the week before my period, and my previous experience with progesterone-only pills suggested very strongly that my depression is exacerbated by even slightly elevated progesterone levels.

    For me, the Mirena DID worsen my depression — but it did it so gradually that, well, it crept up on me – I didn’t really notice until I’d had it for a year and realised I couldn’t remember the last time I’d been happy. (Other ‘obvious’ symptoms of depression didn’t really occur to me at the time as, well, being obvious.)

    It also caused truly godawful pain at the beginning of the two periods I had with it in (we are talking breathing-hurts and blacking out), but, hey, undiagnosed endometriosis.

    Regarding mental illness, according to the Patient Information Leaflet, 1-10% of people will experience depression or nervousness while using the Mirena. I don’t have hard stats for you, but my gut feeling/personal experience/anecdotal evidence is that people with a known progesterone sensitivity/known history of depression are disproportionately likely to be in that one to ten per cent.

    I’m happy to go into more detail about any of this, or answer other questions if you’ve got ’em.

  5. 29dWoman says:

    When they say nervousness…is that the same thing as anxiety?

  6. Ttefornia says:

    Yes, they do.

  7. 29dWoman says:

    Thank you 🙂

  8. Kdgle says:

    I’m 34, and I got the Mirena a year ago to help with my super-heavy, super-painful periods. I’ve also got severe depression. The Mirena does not seem to have had an effect on my depression, although what DID have an effect is the Cymbalta I’ve taken for three years crapping out on me. I’ve switched to Pristiq and the improvement is so dramatic that other people (including those who don’t know about the illness) have noticed and commented. (“It’s like you’re a different person” is the trend at the moment, and I FEEL like a different person…that is to say…a person without depression.)

    Anyhoo–the point is that I got depressed while I was on it, but the depression was not strictly the Mirena’s fault and it’s being managed well with a med adjustment. I firmly believe that NOT losing massive amounts of blood (described by my doctor as ‘dangerous’) and NOT being in horrific pain once a month probably is doing good things for my mood.

    whoops–ps (sorry brain fog…this is the ONE side effect from Pristiq I’m not over yet) I had a Paragard inserted first. I’m nulliparous, and my uterus shot that little bugger out like it was launching the Space Shuttle. For whatever reason, the Mirena stayed put. I suspect the practitioner’s skill and the fact that I did NOT have my period when it was inserted made the second try a success.

    Just my experience. Let me know if I can be of further help. My meds issues are long and complicated — the depression is ‘treatment resistant’ and have included hospitalizations, horrible reactions, etc. Fun timez!

  9. 29dWoman says:

    the improvement is so dramatic that other people (including those who don’t know about the illness) have noticed and commented. (“It’s like you’re a different person” is the trend at the moment, and I FEEL like a different person…that is to say…a person without depression.)

    It’s hard to read this and not feel really, really happy for you 🙂

  10. 29dWoman says:

    I went from combo HBC to the Mirena. I had been under the care of a psychiatrist, and when I reported that it seemed I was more…upset than usual (there was a noticeable difference that I tried to ignore!) it turns out that estrogen in the combined HBC acted as a mood stabilizer for me (in addition to an SSRI) so that’s why my mood took a hit. We added another medication, and my body settled, and everythings great! And that was the only bad side effect whatsoever.

  11. SseNope says:

    I have generalized anxiety (mostly under control thanks to a year of CBT), and a history of depression. When I got my Mirena, I had been mostly clear of depressive episodes for ~5 years, not counting a messy breakup.

    The transition from NuvaRing to Mirena threw me into severe, scary depression for a week, and then it disappeared. I suspect–and my gyno agreed–that the withdrawal from estrogen was to blame. I have had a few minor depressive swings in the almost two years since, and increased anxiety that caused me to seek counseling again.

    However, I do not think that the Mirena caused this return of psych issues. I started grad school (and full time employment) within two months of getting the IUD! That change threw me into a much more stressful world than my previous scenario, and stress and academia are huge triggers for both my anxiety and depression. It’s possible that the estrogen in the NuvaRing was stabilizing my somewhat, but ultimately I think the blame rests on grad school.

  12. While Mirena has been known to cause depression or induce it in people known to have it, it’s only a chance shot at best. Some women get depressed who have never had depression, while some who have been diagnosed do not exhibit depression while on Mirena. It’s the same story with uterine perforation or expulsion – Your mileage may vary. Whichever birth control you choose, you will have to live with the possibility that the side effects associated with your chosen contraceptive may manifest. It’s an unfortunate fact, although studies suggest that uterine expulsion and perforation supposedly has a less than 1% chance of occurring. So you may tolerate Mirena really well, or you won’t, there’s no way to know otherwise unless you try it. Good luck with your choice though.

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