From the Guidelines
I would not recommend removing a Mirena IUD in a patient with severe hypertension without first stabilizing their blood pressure. This severely elevated blood pressure represents a medical emergency that requires immediate attention before any elective procedures. According to the 2009 ACCF/AHA focused update on perioperative beta blockade incorporated into the ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery 1, patients with stage 3 hypertension (systolic blood pressure greater than or equal to 180 mm Hg and diastolic blood pressure greater than or equal to 110 mm Hg) should have their blood pressure controlled before undergoing surgery.
The patient should be evaluated for hypertensive urgency or emergency and receive appropriate antihypertensive treatment to lower their blood pressure to safer levels. Removing an IUD is generally a minor procedure, but in the setting of severely elevated blood pressure, it could potentially increase the risk of complications such as vasovagal reactions or bleeding.
- Key considerations include:
- Evaluating the patient for associated metabolic or cardiovascular abnormalities
- Continuing antihypertensive medications during the perioperative period
- Avoiding withdrawal of beta blockers and clonidine due to potential heart rate or blood pressure rebound
- Using parenteral beta blockers and transdermal clonidine if the patient is unable to take oral medications
Once the patient's blood pressure is controlled to safer levels (ideally below 140/90 mmHg), the Mirena removal can be safely performed. The priority should be addressing the dangerous hypertension first through appropriate medication and monitoring, as uncontrolled hypertension poses significant risks for stroke, heart attack, and other cardiovascular complications that are more immediately life-threatening than delaying IUD removal.
From the Research
Removal of Mirena in Patients with Severe Hypertension
- There are no research papers to assist in answering this question, as the provided studies focus on the management and treatment of hypertension, rather than the removal of a Mirena (levonorgestrel-releasing intrauterine system) in patients with severe hypertension.
- The studies discuss various aspects of hypertension, including its management 2, 3, 4, 5, 6, but do not address the specific topic of Mirena removal in patients with severe hypertension.
- The provided evidence does not provide any information on the safety or feasibility of removing a Mirena in patients with severe hypertension, and therefore, it is not possible to provide a definitive answer to this question based on the available data.