From the Guidelines
To check for postmenopausal changes while using a Mirena IUD, blood tests measuring follicle-stimulating hormone (FSH) levels are recommended, with levels above 30 mIU/mL on two tests taken 6-8 weeks apart suggesting menopause. Since the Mirena IUD releases levonorgestrel locally, which often reduces or eliminates menstrual bleeding, the usual sign of menopause (cessation of periods) isn't reliable. Other menopausal symptoms like hot flashes, night sweats, mood changes, vaginal dryness, and sleep disturbances should also be monitored. The Mirena can safely remain in place during this transition and provides the progestin component of hormone therapy if estrogen is added later. Women approaching menopause (typically age 45-55) should discuss testing options with their healthcare provider, as individual circumstances may require personalized approaches to determining menopausal status while using hormonal IUDs.
Key Considerations
- The Mirena IUD's local release of levonorgestrel can mask typical menopausal symptoms, making FSH level testing a crucial diagnostic tool 1.
- Regular check-ups with a healthcare provider are essential to monitor for any changes in health status that may affect the continued safe and effective use of the IUD, as recommended by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013 1.
- The presence of the IUD strings should be checked during examinations, and weight changes should be assessed and addressed through counseling if necessary 1.
Diagnostic Approach
- FSH level testing is the primary method for determining menopausal status in women using a Mirena IUD.
- Other diagnostic tools, such as endometrial biopsy or vaginal ultrasound scan, may be used to investigate abnormal uterine bleeding or other symptoms, but are not directly relevant to determining menopausal status in this context 1.
Hormone Therapy Considerations
- If estrogen therapy is initiated, the Mirena IUD can provide the progestin component, eliminating the need for additional progestin therapy.
- The decision to continue or discontinue hormone therapy after the average age of spontaneous menopause (45-55 years) should be made on an individual basis, taking into account personal risks, family history, and menopausal symptoms 1.
From the Research
Checking for Postmenopausal Changes with a Mirena IUD
To check for postmenopausal changes in a woman with a Mirena (levonorgestrel-releasing) intrauterine device (IUD), the following steps can be considered:
- The diagnosis of menopause is typically a clinical diagnosis, made retrospectively, based on a 12-month period of consecutive amenorrhoea in a compatible age group (after 45 years of age) 2.
- In women using a Levonorgestrel-intrauterine device (LNG IUD), hormonal assays or pelvic ultrasound are neither recommended to make a diagnosis of menopause nor to decide to stop contraception 2.
- The proposed strategy is the discontinuation of the LNG-IUD and clinical follow-up (occurrence of amenorrhea) 2.
- If the woman experiences postmenopausal bleeding, a transvaginal ultrasonography can be used as an initial evaluation to exclude or diagnose endometrial carcinoma and endometrial intraepithelial neoplasia 3.
Considerations for Women with a Mirena IUD
Some considerations for women with a Mirena IUD include:
- Almost half of perimenopausal users of 52 mg levonorgestrel intrauterine devices (LNG-IUD) have concerns that LNG-IUD use could influence aspects after menopause 4.
- A retained IUD should be considered in the differential diagnosis for postmenopausal bleeding (PMB), and pelvic sonography can be used as the first-line diagnostic modality to aid in the diagnosis of retained IUD as well as other pathology 5.
Diagnostic Approaches
Diagnostic approaches for postmenopausal changes in women with a Mirena IUD may involve: