Mirena Benefits as a Contraceptive

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All: “I am Olav Istre from Oslo, Norway; I’m Bjorn Busund from the same department in Oslo, and I am Anton Langebrekke from Ullevaal University Hospital. We are all working in the same department.” 

Roberta Speyer: “And you are all here at the ISGE meeting in Cancun.”

Olav Istre, MD: “Correct.”

Roberta Speyer: “Today you are going to talk to us about dysfunctional uterine bleeding.”

Olav Istre, MD: "Dysfunctional uterine bleeding has been treated with hysteroscopy techniques and also recently in the United States with the Mirena coil; and it seems like Mirena could reduce the need for intervention by 60 to 70%.

Bjorn Busund, MD: “It is a major advantage if we can avoid surgery in that many cases I would say.”

Anton Langebrekke, MD: “As you probably know Mirena has been out in Scandinavia for lalmost ten years?”

Bjorn Busund, MD: “Yes, more than that I think.”

Anton Langebrekke, MD: “So we’ve had quite a lot of experience there with this and most of the women are very happy with this. Reversible, completely reversible treatment of menorraghia.”

Roberta Speyer: “What’s been your experience? Is this something that’s easily reversed? How easy is this to insert? How do women feel about it?”

Olav Istre, MD: “It is like a coil you are using for contraception mostly and it contains gestagenic progestegin inside and it’s released and can be there for five years. Recently we also found out we can treat some moderate atypia of the endometrium in the same way with this hormonal treatment. “

Roberta Speyer: “How does that work?”

Olav Istre, MD: “It works in some women, especially younger women, with infertility problems and they have a polyp which shows up to be complex atypia and we can take that away and keep it without atypia for years.”

Bjorn Busund, MD: “In some cases you can avoid hysterectomy in younger women with atypical hypoplasia inside the uterus.”

Roberta Speyer: “So is this something that came about anecdotally just from the number of patients you were treating – that you noticed this ability or were you looking for this?”

Anton Langebrekke, MD: “Well, we started this treatment first with elderly patients that were non-fit or high risk patients for operations, and thought that the local progestogenic effect inside the uterus would be enough and then we transferred to younger women, with, like infertility problems for example.”

Roberta Speyer: “So you weren’t looking to see if you could find a solution? It just made sense?”

Bjorn Busund, MD: It’s an old experience that high dose progestins can reduce the development of cancer so this was why we were looking for this thing to happen when we had cases that were suited for it.”

Olav Istre, MD: “The problem with the high doses was that it was connected with a lot of side effects. Gestagenic side effects like acne, oedema, etc, but now it is locally administrated inside the uterine cavity and it is not taken up so much into the bloodstream. It’s better and the patients tolerate it. It is high doses inside the uterine cavity but not in the blood. So it is better tolerated.”

Roberta Speyer: “Are the problems that came about years ago with the IUD in the United States and the subsequent lack of use, how is that being perceived in Europe? Do you think it’s different, and if so, how?”

Bjorn Busund, MD: “Very much different. I think we have documented that the use of the IUD doesn’t cause any more infections than other kinds of contraceptives. So the ordinary IUDs have been used in Scandinavia all the time. The special thing about this IUD is the hormonal effect, which are several effects. One is it reduces the risk of infections by making the cervical mucosa more difficult to penetrate for micro-organisms. It has the contraceptive effect compared to tubal sterilisation and it reduces bleeding by more than 80%.”

Roberta Speyer: “So there’s a great reduction? So this makes it ideal then for a woman in her 40s perhaps that doesn’t remember to take a pill every day?”

Olav Istre, MD: “Yes, and it has other effect also. When a woman goes into the menopause they very often need some additional treatments of oestrogen and they can continue to go on the oestrogen mono therapy because they have the local inside the uterine cavity. That’s also a good thing to think about.”

Roberta Speyer: “So you think this would be a good treatment. What is the age range this is especially attractive for, or is it all age ranges?”

Bjorn Busund, MD: “Yes – and no, we don’t use it very much on the youngest women I would say.”

Anton Langebrekke, MD: “Usually we use it after delivery.”

Roberta Speyer: “Do you insert it?”

Anton Langebrekke, MD: “Yes. It is a little bit more – it’s a tiny millimetre thicker than a normal coil. So usually after a vaginal delivery it’s quite easy to insert.”

Roberta Speyer: “So otherwise it’s inserted like an IUD traditionally?”

Anton Langebrekke, MD: “Like a regular coil.”

Roberta Speyer: “And even after five years it still has lots of good benefits and few side effects?”

Anton Langebrekke, MD: “Yes.”

Roberta Speyer: “Benefits that you’re finding through your research?”

Bjorn Busund, MD: “Yes, and it’s very easily removed.”

Roberta Speyer: “Always a good thing. Thank you very much.”