Pharmac to the rescue for thousands
Ihave worked for a long time in primary care, where most of my patients have been women, at all ages and stages of life. Over the years, I have come to realise that when it comes to periods, sex lives and contraception there is a massive spectrum for women, and where we fall on that spectrum is completely random.
For some at the fortunate end, periods will be easy to manage, and contraception will work as it should, without side effects or complications.
For others it will be a very different picture, the month dominated by a week or more of heavy blood loss, pain, bloating and low mood, and contraceptive options all having drawbacks leading to a compromise that may not suit them.
I know that being at the less fortunate end of the spectrum is no fun at all. It can have a huge impact on quality of life, earning potential, relationships and wellbeing, and short of waiting until menopause, or considering a hysterectomy to remove the offending body part, historically there wasn’t much that could be done.
When the Mirena intra-uterine system first appeared on the scene in Europe in the 1990s, doctors breathed a sigh of relief.
Here at last it looked like we might have the solution for many women – something that could provide long-acting, reliable contraception, as well as solve the problem of heavy or painful periods for many women.
Since that time, more than 10 million women around the world have used a Mirena, most with huge success. Despite this massive uptake in use, until now its availability has been restricted in New Zealand. Women had to either self-fund it to a tune of $340 plus the cost of the insertion procedure, or access pretty narrow funding streams if they had bleeding heavy enough to cause anaemia or pain from endometriosis.
These restrictions have meant that thousands of New Zealand women have missed out on what could be the right option for them. But the exciting news is that in the next week or two, we should receive confirmation from Pharmac that its proposal to enable all women to get a free Mirena (or similar device known as a Jaydess) has been confirmed, meaning equitable access for all.
So what do you need to know about Mirena and Jaydess, and what should you do if this sounds like something you’d like to consider?
Mirena and Jaydess are types of levonorgestrel intra-uterine systems, known as LIUS. They work by sitting in the womb, exactly like a copper IUD does, and releasing a tiny amount of a progesterone-type hormone. This hormone thins the lining of the womb and thickens the mucous around the entrance to the womb, making fertilisation of an egg, and then implantation virtually impossible.
They are one of the most effective contraceptives available, and in fact they are so good that their failure rate is lower than that of female sterilisation. This is partly because of their mode of action, but also the fact that there is no ‘‘user variability’’ compared with, for example, the possibility of forgetting to take a pill, or using a condom incorrectly.
The Mirena works for up to five years, and the Jaydess for three, however removing these devices and getting your cycle back again if you are hoping to conceive is super simple and can happen at any time.
There are very few reasons why someone can’t have a Mirena or Jaydess – women at all ages and
stages find them beneficial, though fitting them in someone who hasn’t had a genital examination before (for example, a smear test or sexual health check-up) or hasn’t started having sex yet can be a little more complicated. This doesn’t mean that it can’t be done though, so talk to your doctor if you’re in this situation and would like to discuss it further.
Inserting a LIUS takes experience and training, so make sure you talk to someone who does plenty of this work. Family Planning services are a great place to start, but your GP may also be an experienced inserter, or someone at the Youth Service or Sexual Health service near you could be an option as well. The insertion is likely to be a bit painful, but knowing what to expect, taking pain relief before the procedure, and getting it fitted at the end of a period can all make it easier.
As it releases a higher dose of hormone, Mirena is more potent than Jaydess. This means that it can also be used to treat painful or heavy periods effectively, as well as being a fantastic contraception. In my experience with patients, Mirena can be an absolute godsend, particularly for those with troublesome bleeding that hasn’t responded to anything else.
For many women it will completely remove their periods, so that after a few weeks or months, they don’t have any bleeding at all (which is completely safe) and, for those who still get bleeding, it is usually lighter and less often than before. It is also an effective treatment for endometriosis as it is thought to ‘‘dampen down’’ the condition, meaning that not only does the pain reduce substantially but the disease should progress less while the Mirena is in place.
Of course, as with any medical treatment, LIUSs won’t be the answer for everyone, by any means. They have pros and cons. Some women will get side-effects – troublesome bleeding, pain, or mood changes – but in my experience, the majority by far are happy with their choice.
I, for one, am thrilled at the likelihood of improved access for women, and am waiting with bated breath for Pharmac to confirm its decision later this month. If it’s something you’re considering, talk to your doctor or family planning clinic.
For more information, visit familyplanning.org.nz, familydoctor.co.nz, healthnavigator.org.nz