Monday, July 25, 2011

Mirena IUD for endometrial hyperplasia (TMI warning)

Ok,most of my facebook friends don't want to hear more about this, so I will write here, where I am more writing to myself.  I want to pull the whole story together, for reference 5 years down the road.

I used a diaphram for birth control my whole fertile life, so I experienced a natural menopause (quite different from the menopause experience of people taking birth control pills).  It is a long process.  During my last couple of years of perimenopause, I had very heavy periods.  Even the highest absorbancy protection lasted less than 2 hours at times.  My doctor suggested ablation, but I didn't want to do anything that dramatic--I figured it would end eventually.  With what I now know, I think I should have been on some kind of progesterone treatment then.

I had what I hoped might be a last period in the summer of 2008, then none for almost a year, then several a little under a year later in the summer of 2009.  Then I had nothing until the spring of 2011, when I had what seemed like a normal period.  I knew that since it was more than a year I needed to have it evaluated, so I went right in for an ultrasound.  That showed that the lining of my uterus was too thick, endometrial hyperplasia, so the next step was an endometrial biopsy.

The good news was that the biopsy did not show abnormal cells, but the thickening still needed to be treated before it did turn into abnormal cells.  Having avoided birth control pills all my life, I didn't want to start taking progesterone pills, so I like the idea of the Mirena IUD, which releases progesterone where it is needed.  My doctor agreed, so we started the process of ordering one.

The distributor for the Mirena is CVS Caremark, which tried to bill my insurance and was told that the Mirena isn't covered.  It turns out that it is covered, but under medical rather than under pharmacy.  My doctor wasn't willing to order it at their expense and then bill insurance, so I ordered it on a payment plan and then will file for insurance and pay when the insurance pays.  It finally showed up at my doctor's office last week, nearly two months after the biopsy.

I was told to take two Aleve before my appointment, and I arranged for my son to drive me.  The doctor had told me that some people find the biopsy easy and some people find it very painful.  I found it trivial so I was optimistic about the IUD insertation.  I think I talked the whole time about concerns about my kids--it did hurt some but I was trying to distract myself.  It was more like bad menstrual cramps than like labor, though with some sense of being painfully poked inside, particularly in the step that measures the depth of the uterus.  Once it was done I was just glad it was over, though I had cramps still.

My doctor said to me "You're a tough woman."  That was really the first time she had admitted that the procedure is pretty painful.  I said "I had a 10 lb 1 oz baby vaginally with an epidural that didn't work."  Yes, I'm tough, and proud of it.  I went home and rested a while then took my husband to his doctor's appointment.  I made dinner, but I was significantly uncomfortable with cramps.  About 6 hours after the procedure they suddenly got much better, so I'm hopeful they're over.

If all goes well I will have another ultrasound in 5 months to see if my uterine lining is back to normal.  But what my doctor doesn't know and I can't find discussion of is how it will get that way. Will it bleed off, in one giant period or gradually over a long time?  Or will it reabsorb without significant bleeding?  My doctor was hopeful that might be the case.

Update in early October:  I had light spotting for about two months, but now it seems to have stopped.  I had a lot of difficulty getting my insurance company to agreee to pay, but that has been because it falls between medical and pharmacy and each said the other would handle it.  Supposedly it is now worked out, but the check hasn't come.


Jolene Matthews said...

Has everything gone okay for you? Did the mirena aid in the regression of your hyperplasia?

Pem said...

I have been very happy with the results. The Mirena has given me no trouble and the hyperplasia issues went away immediately and completely. After 2 years I began to have dryness of the vulva. My gynecologist said that would happen anyway, but I wonder if it is a little worse because I have a little more progesterone relative to my diminishing estrogen. It is easily fixed with a phytoestrogen cream. I'm not convinced enough to have the Mirena removed, though the dryness probably means I no longer need it.

My daughter went from the pill to a Mirena and she had a bad month with her body adjusting to no longer getting the hormones in the pill. The mood swings bothered her most.

Unknown said...

I am in the process of waiting to have this procedure done with the Mirena as well. We are currently waiting for the insurance to get back on whether or not they'll cover. Glad to hear everything worked out.

Pem said...

I had it in four five years and had no bleeding. It was removed last fall and the problem has not returned.