Healthcast 644 - The Progesterone IUD is a new prevention for Post-Menopausal Bleeding.

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Often in medicine, doctors discover a new use for an old treatment or a treatment that is approved for one use and serendipitously doctors find a new use for a drug or medical device.

I have used a specific type of IUD in menopausal women on estradiol to prevent postmenopausal bleeding. The Mirena or Kyla IUD produces progesterone into the uterus to suppress the effects of estrogen on the endometrium, preventing post-menopausal bleeding and growth of fibroids.

In the May 2023 Journal of OBG Management the experts have discovered that these special IUDs can be used for more than just birth control.  They don’t contain any estrogen, but they deliver the progesterone (progestin) where it is needed to the lining of the uterus for 8 years!

The cost of one IUD/8 years vs that of daily progesterone reveals a great cost savings by using a Mirena or Lyetta or Kyla (for uteruses that have not been pregnant) and a time savings for patients who are having difficulty with post-menopausal bleeding while on estradiol pellets, or any form of estrogen after menopause.

The way these IUDs work is that the soft plastic material of the IUD has a packet of progestin attached to it that slowly dissolves over 8 years. In general, I don’t advise the use of Progestins orally as it increases risk of breast cancer and heart disease ONLY when it is taken orally.  The small dose that circulates locally in the uterus is only beneficial and is not circulated throughout the bloodstream.

The Mirena (I will use “Mirena” to represent all IUDs of the same genre because it was the first one FDA approved) is placed in the uterus in the GYN office, and a short string is left to stick out of the cervix to be palpable by the patient or the doctor to show that the IUD has not exited the uterus (which is rare in women not having periods, menopause).

Generally the patient is given a week of progesterone to cause her to evacuate the remaining lining of the uterus before the IUD is placed. This will decrease the spotting and bleeding after the procedure. If it is a difficult insertion of the IUD, the GYN will often do a post insertion Ultrasound of the uterus to make sure the IUD is in place. 

There are a few menopausal women who cannot have an IUD after menopause.  Those patients who have had an ablation of the lining of the uterus usually has scarring of the uterine lining so that an IUD would not be inserted easily or at all.  A patient with a uterine septum is not a cancidate for an IUD. Patients who have had a perforation of the uterus in the past are not a candidate for this treatment either. Patients with fibroids on the inside of the uterine cavity are not a candidate either, because the IUD may rub against the fibroid and cause it to bleed.

However if you have a uterus and are on estradiol or oral estrogen and take progesterone or progestin with it to protect your uterus, and have trouble remembering the progestin or progesterone dose every night or you continue to bleed even on progesterone/progestin, then a Mirena would be a good solution for you!

There is a novel treatment for those women who we have been unable to give estrogen to because of uterine bleeding, and the Mirena IUD or one of its sisters is the answer!