Rights issue, say doctors
LARC. The project provided nocost reversible contraception to 9256 women in the St Louis area for two to three years, with the goal of increasing the uptake of LARCs and decreasing unintended pregnancies.
Increasing the uptake of LARCs ‘‘can decrease unintended pregnancy and abortion rates, which may ultimately translate into better financial, economic, educational, and social situations for women and their families’’, the authors concluded.
Helen Paterson, a gynaecologist, has been campaigning for 15 years to have the Mirena fully funded in New Zealand, and is frustrated about the limited access.
‘‘If more women change from using a non-LARC to a LARC then there will be a reduction in unwanted pregnancies. There is clear data to show that,’’ says Paterson, who is also a senior lecturer at the Otago University Dunedin School of Medicine department of women’s and children’s health.
She says the widest possible range of contraception should be available and fully funded so that women can choose what is best for them. ‘‘What is happening at the moment is women are forced into making bad choices for themselves and that’s really not good.’’
Data from the Ministry of Health showed about 5000 women have a funded Mirena inserted each year. Neither the ministry nor the Mirena’s manufacturer, Bayer, could provide the number of selffunded Mirenas used in New Zealand.
Based on the Choice study, an application by the Royal Australian and New Zealand College of Gynaecologists and Obstetricians to Pharmac estimated more than 200,000 Kiwi women would use a Mirena if it was funded.
But not all women with a Mirena have a positive experience.
Christchurch gynaecologist Olivia Smart, from Oxford Women’s Health, says she would put in ‘‘several’’ Mirena every week and remove one to two out of 10 for various reasons, including bleeding, pain and changes to mood.
‘‘We have to counsel our patients around risk, benefits, known side-effects, and we also have to listen to our patients if they tell us they are experiencing side-effects and remove it if we think it’s causing problems.
‘‘But that’s one of the beauties of Mirena – you can take it out if you think it’s not working for you.’’
Paterson says the Mirena is designed so that the progesterone hormone will work mainly in the uterus, rather than being distributed throughout the body.
This did not mean that some of the hormone might be absorbed into a woman’s system.
However, several randomised controlled trials had shown no negative effect on mood.
A 10-year randomised controlled trial in Finland showed the Mirena made no significant difference to levels of anxiety at the 10-year follow-up.
Bayer’s drug sheet for the Mirena lists depression and low mood as commonly reported adverse events in its clinical trials.
But Paterson says this does not prove a cause and effect as participants in trials were required to record anything they experienced during the study period.
‘‘You have to ask is [anxiety and depression] common anyway? If it is common anyway then it is likely it will be reported.’’
Paterson says she and other professionals have to rely on high-quality trials to form professional views about sideeffects.
Regardless of this, if a patient believed the Mirena was having a bad effect and wanted it removed, then that was all that mattered.
‘‘It is the person who has the healthcare who has the right to choose what they want, there is no question about that.’’