Contraceptives may be ingested, implanted, inserted, injected and even stuck on. The modern woman has such a large variety of contraception options that making an informed choice has become an imperative.

Each contraceptive has advantages and disadvantages and, even within a single category, there may be different indications for use. For example, within the category of oral medication, some tablets help with PMS (premenstrual tension), other tablets help women with high testosterone and still others assist women who are on epileptic treatments. Disadvantages common to all categories may include weight gain, risk of blood clot formation, migraines/headaches and excessive bleeding.

As I am myself spinal cord injured I looked with interest at the needs of mobility-impaired women and the different options available and believe that the Intra-Uterine System, Mirena, is probably the safest and most comfortable. Available worldwide for over twenty years it has only been available in South Africa since mid-1999.

The Mirena is no longer than a match, is T-shaped and contains a progestogen hormone, called levonorgestrel, which is similar to a hormone produced in the body. The hormone is released directly into the womb at a constant rate of 20 micrograms per day for five years before the device needs to be replaced. TheMirena© is as effective as a contraceptive that it is comparable to female sterilization but can be removed at any time if the woman wishes to fall pregnant. As the hormone is delivered directly to the womb the Mirena© can be reinserted soon after childbirth and will not interfere with breastfeeding.

In addition to being a highly effective contraceptive the Mirena makes menstrual periods shorter, lighter and less painful and is especially indicated for women with heavy menstrual bleeding. It is also useful for menopausal women to help with the balancing of hormones. It does not treat skin problems like acne but should not cause weight gain as it functions mainly inside the womb.

The small amount of hormone that is absorbed in the bloodstream does not suppress ovulation. Them Irena prevents pregnancy by increasing the viscosity of the normal mucus in the opening of the womb and by keeping the lining of the womb thin and inhibiting the normal sperm movement in the womb and tubes.

The Mirena is effective, does not interfere with intercourse, protects you for up to five years, can be removed at any time and - once removed - does not compromise fertility. It is cost effective, usually gets rid of period pains, will not interfere with the many drugs that you may be taking for other conditions and – especially appealing for women with spinal cord injuries and other mobility impairments - after a few months it should reduce the menstrual flow to little or nothing! If your menstrual period disappears completely it does not necessarily mean you are pregnant –it probably means that the Mirena is working well.

The Mirena is fitted by a doctor using a speculum with an antiseptic solution. It is introduced into the womb via a thin plastic tube, leaving 2-3 cm of thread hanging down in the vagina that can be used to check whether the device is properly in place. Women whose periods do not disappear completely should rather use sanitary pads instead of tampons.

Pain caused by the insertion is minimal and short lived and pain relief can be discussed with your doctor. I suggest returning to your doctor for a check-up four weeks after insertion and then once a year - unless your doctor advises otherwise.

Unfortunately the Mirena is not available at all government hospitals - even though it is so cost effective. Some hospitals may order them on a per patient basis but this is mainly when heavy menstrual bleeding has not responded to other treatments. I would think that, with the proper motivations, our hospitals could provide this system for ladies with mobility impairment.

The Mirena can be purchased from your pharmacy on presentation of a doctor’s prescription, just make sure that your pharmacy does stock it or is able to order it for you. Most medical aid companies provide some funds for a Mirena© but do check with yours. Contraception and treatment for heavy menstrual bleeding should always be discussed with your doctor.

The author has no conflict of interest and is not employed or funded by Mirena.

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