MIRENA – An Alternative To Hysterectomy In Heavy Menstrual Bleeding
Menstrual bleeding is a natural
biological function post-puberty until menopause, however, certain women suffer
from Heavy Menstrual Bleeding which can lead to a condition known as
Menorrhagia. Though not all Heavy Menstrual Bleeding conditions can be
diagnosed as Menorrhagia, they still can lead to severe health complications
and discomfort in general. One should consult the best gynecologist in Delhi
NCR for proper diagnosis.
Heavy bleeding during periods affects around 1 in 5 women in the age group of
30 to 40 years. Heavy menstrual bleeding is a common cause of morbidity among
women causing anemia, weakness, chronic fatigue reduced immunity, and weight
loss. A comprehensive check-up may be required at the best multispeciality
hospital in India.
Symptoms of Heavy Menstrual bleeding
Heavy menstrual bleeding can be easily identified by the excessive menstrual
fluid discharge during menstrual periods. Some of the other signs of Heavy
Menstrual Bleeding are:
• Need to use several sanitary pads every hour
• Requiring double sanitary protection to control your
• Menstrual discharges for more than a week
• Discharging blood clots
• Feeling tired and anemic
• Constant fatigue along with shortness of breath
In case of heavy menstrual bleeding one is advised to consult a Gynecologist
Obstetricians in Delhi immediately.
What is Menorrhagia?
Heavy menstrual bleeding for prolonged periods leading to anemia, severe pain,
reduction in hemoglobin due to Iron deficiency is diagnosed as Menorrhagia.
The common causes of heavy menstrual bleeding and Menorrhagia are:
Hormone imbalance. It causes excessive development of the endometrium (the
lining of the uterus which sheds during menstruation) eventually leading to
heavy menstrual bleeding. It can be caused by polycystic ovary syndrome
(PCOS), obesity, insulin resistance, and other problems such as thyroid
Ovulatory Dysfunction: Non-ovulation during a menstrual cycle leads to the
non-production of the hormone progesterone. This can lead to hormone imbalance
and resulting in Heavy Menstrual Bleeding.
Uterine fibroids. The uterus fibroids may appear during pregnancy. They may
lead to prolonged or heavy menstrual bleeding.
Uterine Polyps: Small growths on the uterus lining may lead to prolonged
or heavy menstrual bleeding.
Uterine Cancer and Cervical Cancer: It can also cause excessive menstrual
Menorrhagia or heavy menstrual bleeding can also be attributed to Adenomyosis,
Use of non-hormonal intrauterine devices, pregnancy complications, and other
medical conditions. Certain medications can also contribute to heavy or
prolonged menstrual bleeding. One should consult a online gynecologist to check
for all the possible reasons.
Sometimes the cause of heavy bleeding may remain unknown (idiopathic), in which
case a comprehensive diagnosis becomes necessary.
Menorrhagia or Heavy Menstrual Bleeding Diagnosis
Investigations of heavy menstrual bleeding should include Transvaginal Scan,
Dilatation & Curettage (D&C), and Endometrial Biopsy, besides the
routine Haemogram, Thyroid Function Test, Blood Sugar Check, etc. Heavy
menstrual bleeding ven for short periods should not be ignored as they may lead
to severe complications, one is advised to get in touch with the best
Prescribed Treatments for Menorrhagia or Heavy Menstrual Bleeding Diagnosis
Treatment of Heavy Menstrual Bleeding is individualized depending on the age of
the patient, need for contraception, desire to retain fertility, nature, and
severity of complaints, presence of pelvic pathology outcome of previous
treatment, cost of treatment.
Aim of treatment is to offer a healthy future and femininity perseverance.
The first-line treatment of Heavy Menstrual Bleeding is usually drug therapy.
Drug therapy includes NSAIDS, antifibrinolytic agents, oral contraceptives,
cyclical progesterone therapy, GnRH analogues. If the results from drug therapy
are not favorable then surgical methods are opted.
Surgical methods include endometrial ablation and hysterectomy. Endometrial
ablation is a procedure that surgically destroys or ablates the lining of the
uterus. Endometrial ablation is not suitable for a very large uterus.
The other surgical option for treatment of Heavy Menstrual Bleeding is
‘Hysterectomy’ It is considered as definitive treatment for heavy menstrual
bleeding by Gynecologists, but should be opted upon failure or all other
30% of women in the reproductive age group suffer from menorrhagia and 60% of
these women ultimately end up opting for Hysterectomy (surgical removal of the
Hysterectomy is the 2nd most frequent surgical procedure in women of
reproductive age group and 90% of these are for benign reasons (noncancerous
tumor growths). Hysterectomy is a major surgical procedure with a major
postoperative complication rate of 3.5% and morbidity rate of 0.38/1000 and it
has psychological effects also too. Gynecologists are of opinion that
alternative to hysterectomy should be considered.
Alternate Treatment for Menorrhagia or Heavy Menstrual Bleeding
MIRENA is the most recommended alternative to usual treatments offered for
Menorrhagia or Heavy Menstrual Bleeding.
It is a T shaped hormone-releasing intra-uterine device loaded with Levonorgestrel
(LNG), which is a very safe drug. It releases 20 micros of LNG daily and
prevents endometrial proliferation thus reducing bleeding.
The MIRENA insertion procedure is simple, painless, takes, and can be done on
an OPD basis with anesthesia in about 10-15 minutes. The cost of the MIRENA
insertion procedure is far less than hysterectomy and other oral hormone
therapy, which needs to be given for months together.
Post about 10-15 minutes there is an 80% reduction in blood loss in the first 6
months. Periods may become less frequent and the amount of bleeding also
The MIRENA has known to be effective in moderate-sized fibroids, endometriosis,
adenomyosis. It has the additional advantage of producing reversible
contraception, at the same time future childbearing ability is also
preserved. Life of MIRENA is about 5 years after which it may be changed
or removed depending on the condition of the patient.
Side effects of The MIRENA
The effects of the MIRENA on BP, cholesterol, liver function, bone density,
carbohydrates, metabolism, coagulation factor, lipid profile are much less than
oral hormone therapy as blood levels of the drug are 4 times lower than oral
Few problems that may happen sometimes with MIRENA include irregular bleeding
for the initial few months after insertion, as it may take 6 months for the
full effect of MIRENA to come and during that time additional hormonal
treatment may be required. Sometimes there is spontaneous expulsion of MIRENA
reinsertion that may be required. Sometimes patients become amenorrheic after
Mirena can replace the need for Hysterectomy in 50% of patients. We at the
Metro Hospitals have been successfully using MIRENA in our patients. We have
been able to prevent Hysterectomy in High-Risk patients such as very obese
patients, patients with previous 3 cesareans, multiple surgeries, patients with
coagulopathy, and patients on blood thinners. All these patients are doing well
post MIRENA procedure.
We at the metro group of hospitals are always committed to realizing the vision
of providing world-class healthcare at an affordable cost and to achieve
excellence in Healthcare services by offering exceptional care through
The Metro Group was established in the year 1997 by Padama Vibhusan, Padma
Bhusan and Dr. B C Roy National Awardee Dr. Purshotam Lal with the vision to
provide world-class healthcare amenities to his countrymen at an affordable
Metro Group of Hospitals are the leading healthcare centers in our country
boasting an ultra-modern infrastructure providing multispeciality care by an
exceptional team of healthcare professionals under the leadership of
world-renowned interventional cardiologist Dr. Purshotam Lal. We at Metro
hospitals provide multispecialty care for 35 Chief and Allied-specialities that
include Anaesthesiology, Cardiology & CTVS, Dentistry, Gastroenterology
& Gastro Surgery, Internal Medicine, Neurosciences, Obstetrics and
Gynaecology, Oncology & Onco Surgery, Orthopaedics, Joint Replacement &
Spine Surgery, Paediatrics & Neonatology, Physiotherapy Plastic, Cosmetic
& Reconstructive Surgery, Pulmonology & Sleep Medicine, Rheumatology,
Stem Cell Therapy, Bariatric & Metabolic Surgery, Blood Bank, Dermatology,
Endocrinology And Diabetes, ENT & Cochlear Implant, Haemotology, Holistic
Medicine, Homeopathy, Interventional Radiology Laboratory, Laparoscopic &
General Surgery, Nephrology & Renal Transplant, Nutrition & Health, Ophthalmology, Metro Eye Centre, Psychiatry, Psychology, Radiology, and Urology.
Dr. Purshotam Lal is an internationally acclaimed Interventional Cardiologist
who epitomizes the best in professional excellence and service to humanity,
especially the poor and the needy.
Dr. Lal was trained at world renowned medical institutions in the UK, Germany,
and the USA. He is fellow of American College of Cardiology, American College
of Medicine, Royal College of Physician (Canada), British Cardiovascular
Interventional Society, German Society of Cardiovascular Research, Fellow of
Society of Cardiac Angiography and Interventions, USA, etc. He has the unique
distinction of pioneering the largest number of procedures in the field of
Interventional Cardiology for the first time in the country such as Slow
Rotational Angioplasty, Atherectomy, Rotablator, Stenting, Heart hole closure,
He has developed techniques of Aortofemoral bypass support (partial artificial
heart), Opening of tight heart valves with echo without cath lab. He has
performed the first case of Non-surgical heart hole closure (ASD) with monodisc
device and the first case of Non-surgical aortic valve replacement with core
valve, both being the first time in the world. He is the first investigator of
Inoue Balloon Mitral Valvuloplasty in the Country and his name has been listed
in the ‘Limca Book of World Records’.
A crusader against unethical commercialization of medical services, he has
committed himself to provide to the middle class, poor and the needy the latest
cardio-vascular procedures at the most affordable cost. In pursuance of his
mission, he has established thirteen state-of-the-art Hospitals and three
satellite units. Such is Dr. Lal’s commitment to his mission that an
ever-increasing number of poor patients have been treated either free of cost
or at concessional rates and ‘No patient is ever turned back for want of
money’. He has been named as ‘Creator of Affordable Healthcare’ by ‘Express
Healthcare’, a leading health magazine and has been a trendsetter for NRIs to
return to India to serve the needy people.
Dr. Lal has been decorated with several prestigious awards:–
• 2nd Jawaharlal Nehru International Excellence Award (1990),
Rajiv Gandhi Award (1991), Dr.V.V.Shah Oration Gold Medal by Cardiological
Society of India (1992) for his pioneering contributions in Interventional
• Distinguished Achievement Award of Highest Order by the
National Forum of Indian Medical Association (2006-07) for performing the
largest number of angioplasties/stenting as a single operator in the country.
• ‘Life Time Achievement Award’ by Shri Arun Jaitley on
behalf of Delhi Medical Association and ‘Life Time Achievement Award’ by Dr.
Lilly Engineer, Professor of Harvard University on behalf of ‘Times of India’.
• Padma Bhushan (2003), prestigious Dr. B.C.Roy National
Award (2004) and Padma Vibhushan (2009) by the President of India.
He has contributed over one hundred research papers, articles, chapters and
authored a book “Cause and Prevention of Heart Diseases”. He has been a Member
at Central Council of Health and Family Welfare, Expert Committee for
medical devices, Ministry of Health, Govt. of India, Delhi Medical Council,
Standing Committee ESI Corporation – Ministry of Labour & Employment, Govt.
of India and Member Board of Governors, Medical Council of India from May 2011
to May 2013.