Mirena as an alternative to sterilization
Many women opt for sterilization because they consider it to be a highly effective and permanent form of contraception. However, there is considerable evidence to support the fact that Mirena is a good alternative to sterilization as it offers a similar level of contraceptive protection but without the need for surgery1. Furthermore, it is reversible, with a rapid return to fertility after removal, even after 5 years of continuous use.
The high rates of sterilization reversal seen in young women suggest a need for better counselling about alternative contraceptive strategies2. The younger the woman is at the moment of sterilization, the more likely she is to regret the procedure in later life3. Women under the age of 30 at the time of the procedure were twice as likely as women older than 30 to report regretting having the procedure performed (Figure 17)4.
Figure 17: Cumulative probability of expressing regret following tubal sterilization
Patients can be advised that a career change, a divorce, a second marriage or even a family tragedy can, in the future, result in regretting a decision to have sterilization performed.
The Royal College of Obstetricians and Gynaecologists in the UK recommend that women should be informed of the variety of long-term reversible methods of contraception now available before they decide on sterilization1.
An added advantage to Mirena being reversible in comparison to sterilization is that it also alleviates the pain and inconvenience of monthly periods. A study by Scholten showed that the strong and local progestational effect of Mirena on the endometrium can lead to a reduction in menstrual blood loss in women with both normal menstruation and with idiopathic menorrhagia5. In addition, women have been shown to benefit from significant relief from menstrual pain6. Studies in the treatment of menorrhagia also show that use of Mirena can lead to a reduced rate of hysterectomy7,8.