Ask Dr. Marla: Mental Health and Contraception

By Dr. Marla Shapiro on August 11, 2014

Question

I am bipolar. Is the new Mirena contraceptive okay for me? I really don't want to tie my tubes, and we are done having kids (we have two). My husband doesn't want a vasectomy either.

Answer

The Mirena is a form of long acting reversible contraception, similar to the IUD (intrauterine device) but is referred to as an IUS (intrauterine system).

Mirena is a T-shaped insert that releases a hormone called levonorgestrel. It works by thickening the cervical mucus and by causing thinning of the uterine lining, or the endometrium. Its failure rate is about 0.09 per 1,000 women-years of use. It is replaced every five years.

Potential risks of the IUS are similar to the IUD:

  • Uterine perforation (can occur in about 0.6 to as many as 1.6 per 1,000 insertions);
  • Infection (risk is greatest in the first 20 days after insertion);
  • Spontaneous expulsion;
  • Irregular or unpredictable bleeding.

The benefits of Mirena are its near perfect compliance, a 75 percent to 95 percent reduction in menstrual bleeding, and less painful periods.

You have asked specifically about being bipolar and the use of Mirena. Patients with a history of mental health issues, especially the depressive type, may be more prone to have a recurrence of depression while using Mirena. In cases of a serious recurrence of depression with a Mirena in place, consideration should be given to removing Mirena, since the depression may be drugrelated.

According to the CDC, classification of Mirena is category 1 for LNG-IUD (ie. Mirena). Category 1 means it can be used in women with depressive disorders and the clarifications is as follows: “The classification is based on data for women with selected depressive disorders. No data were available on bipolar disorder or postpartum depression. Drug interactions potentially can occur between certain antidepressant medications and hormonal contraceptives.”

As a result, you would have to get individual advice about safety of Mirena usage based on your known illness and any medications that could have a potential interaction.

Another IUS has just entered the Canadian market – Jaydess. This is the smallest IUS available and offers contraception up to three years. It has a silver ring that allows it to be distinguished on ultrasound from other uterine devices. It is smaller at three centimetres. In addition it has less levonorgestrel at 13.5 mg.

 

Originally published in ParentsCanada magazine, August/September 2014.


By Dr. Marla Shapiro| August 11, 2014

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