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 hysterectomy^7,8.