IUD & Warfarin

[ManiSham]

hi, Just wanted to check whether it is safe to get an IUD ( intrauterine device) while on warfarin. I know I need to check with my doctor but does any one of you ladies have any experience with this?

 

[pellicle]

gosh I love the diversity of questions here. Of course I have no experience in this (being a male) but I would suggest it depends on if you use a hormonal or metal (say copper) one. I would not expect them to be causing any substantial tissue damage normally and so if you are not experiencing bleeding from using it pre-warfarin then you should be fine post.

I'll be interested to read any experiences or more informed views.

Best Wishes

 

[mina]

My doctors told me that an IUD was the best type of birth control to use with a mechanical valve and warfarin, as there is a risk of clots with oral and other types of birth control. (The risk is inherent in the drugs themselves and not related to the use of warfarin.)

 

[ottagal]

My doctors told me that an IUD was the best type of birth control to use with a mechanical valve and warfarin, as there is a risk of clots with oral and other types of birth control. (The risk is inherent in the drugs themselves and not related to the use of warfarin.)

What type of IUD is he recommending? There is the Mirena IUD which contains progesterone and is supposed to be relatively safe for us female 'valvers'. However, one doctor told me that the risk of endocarditis is there (although low) and he definitely recommended antibiotic prophylaxis prior to this IUD being placed.

Pellicle, I am impressed with your knowledge base.

 

[ManiSham]

What type of IUD is he recommending? There is the Mirena IUD which contains progesterone and is "supposed" to be relatively safe for us female 'valvers'. However, one doctor told me that the risk of endocarditis is
there (although low) and he definitely recommends antibiotic prophylaxis prior to an IUD being placed.

Pellicle, I am impressed with your knowledge base.

I read somewhere that the Mirena IUD causes lot of bleeding but I must talk to a doctor I suppose.
I never heard anything about a risk of getting endocarditis that makes me nervous since I had it once and NEVER want to get it again

 

[ManiSham]

gosh I love the diversity of questions here. Of course I have no experience in this (being a male) but I would suggest it depends on if you use a hormonal or metal (say copper) one. I would not expect them to be causing any substantial tissue damage normally and so if you are not experiencing bleeding from using it pre-warfarin then you should be fine post.

I'll be interested to read any experiences or more informed views.

Best Wishes

I will share my experience once I get it done. Thank you for the info, its very impressive to see a gentlemen who is well informed on these topics

 

[dornole]

Already got told "NO MORE BABIES!" myself, so got the permanent solution . . . still, will be curious what they say.

 

[pellicle]

Hi

I will share my experience once I get it done.

that would be great. Its my observation that there are many who simply google, find answers and never even register or make themselves known. So while you may not know it I'm sure that your contribution will be of assistance to someone.

 

[pellicle]

Pellicle, I am impressed with your knowledge base.

:redface2:

well I guess it all started because as a 5YO I was taken out of all sports (liked them, especially nippers) and banned from sports at School because I had a <hammerHorrorMusic>Heart Condition</hammerHorrorMusic>. So sports days were confined to library days till after I was about 13 and everyone was happy with the (nowadays called) remodeling of my heart.

By then it was too late ... I had already developed a mild case of "Shedlon Syndrome".

There is no cure for this disease

 

[Halya]

In the interest of sharing information, perhaps too much information for some...

I'm still some years away from getting my valve replaced, so I don't have anything to say about anticoagulation, however, I did have the Mirena IUD implanted a little over a month ago.

Minimal bleeding for about a day just after the procedure. Moderately unpleasant levels of pain during the procedure but it was over in less than 10 minutes. Next cycle, which came at normal time, had initially lower volumes of blood than usual. However, it lasted much longer - close to 20 days. So, overall probably the same amount of blood loss as usual. Just a bit of spotting since then. This is apparently the expected course and overall bleeding should decrease over the next few months.

There are some impressive numbers like 80% reduction at 3 months and 90% at 6 months. That would be nice! See http://labeling.bayerhealthcare.com/html/products/pi/Mirena_Pl.pdf for the full information. Heart valve problems and clotting issues are mentioned as information that must be discussed with physician, but neither is a contraindication. My gynaecologist had no concerns whatsoever. He just wants me to come in for a follow-up in July.

Halya

 

[ottagal]

I read somewhere that the Mirena IUD causes lot of bleeding but I must talk to a doctor I suppose.
I never heard anything about a risk of getting endocarditis that makes me nervous since I had it once and NEVER want to get it again

Here is the link to one Mirena Website:
http://hcp.m.mirena-us.com/index.php
This following information is copied from the above Website. Of course, it is important to discuss this with your physician to determine what is best for you. As mentioned, it says use with caution, but it is not a contraindication. The website lists all the conditions that would be a contraindication for Mirena use.
Good luck!
Use with caution in Patients
with Certain conditions

"In patients with certain types of valvular or congenital heart disease and surgically constructed systemic-pulmonary shunts, Mirena increases risk of infective endocarditis and may be a source of septic emboli. Give appropriate antibiotics at insertion and removal to patients with known congenital heart disease who may have higher risk. Monitor for infections any patient on chronic corticosteroid therapy or insulin for diabetes.

Use Mirena with caution in patients with coagulopathy or taking anticoagulants; migraine, focal migraine with asymmetrical visual loss or other symptoms indicating transient cerebral ischemia; exceptionally severe headache; marked increase of blood pressure; or severe arterial disease such as stroke or myocardial infarction."

 

[ottagal]

:redface2:

well I guess it all started because as a 5YO I was taken out of all sports (liked them, especially nippers) and banned from sports at School because I had a <hammerHorrorMusic>Heart Condition</hammerHorrorMusic>. So sports days were confined to library days till after I was about 13 and everyone was happy with the (nowadays called) remodeling of my heart.

By then it was too late ... I had already developed a mild case of "Shedlon Syndrome".

There is no cure for this disease

Ah yes...Sheldon in the Big Bang Theory. Well, this is one disease that it is OK not having a cure for!

 

[dreamy885]

I'm gonna bump an old thread because with my surgery being 15 days out, I need to find a permanent birth control option. Doc wanted me to get my tubes tied but I'm wanting to control my already heavy periods (which I'm told will become even heavier on warfarin.) and a tubal wont help which that. I heavily considered an endometrial ablation but the further under age 45 you are (I'm 31), the higher chance you have of needing a hysterectomy down the road following the ablation. And with possible double valve replacements (mechanical), any future surgery will be very risky. So now I'm thinking of getting the Mirena which should help with heavy periods and of course prevent pregnancy. I wondered if any of the females with mechanical valves have an IUD and what their experience has been? I'm normally very anti-hormonal birth control, but I'm left with not much choice.
-Heather

 

[dornole]

Well, it's not like they can force you to have a hysterectomy later. You'd only do later at your choice to control the symptoms. From a paper:

Endometrial ablation is a minimally invasive procedure for menorrhagia. High success rates are documented with >90% of patients experiencing satisfaction. However, adequate relief after endometrial ablation is not obtained in a cohort of patients. The purpose of this study is to identify the characteristics of patients for whom endometrial ablation fails due to persistent symptoms, causing them to choose hysterectomy for definitive treatment.

So even if you are "more likely" for it not to work due to your age, that still might not be a big risk with a 90% success rate. This was not even mentioned to me when I had an ablation at about age 40. Note, ablation IS NOT a guaranteed birth control technique (at least that's what they told me). So your flow and your fertility are separate issues.

I'm also guessing your cardiologist may not be a fan of hormonal control as it increases your clotting risk - at least pills do, I am not sure about Mirena.

Are your docs telling you that "any future surgery will likely be very risky"? Is this a special double valve replacement issue? Many people on here with mechanical valves and on warfarin have had significant surgery. Tubal ligation is a small surgery and ablation even easier. . . . Or what about a tubal implant for your birth control, that goes in via the route nature provided, no cutting that way either.

You're right you need to check with your doc, but might also need to check with them about some assumptions you are making to make sure they're accurate for you specifically.
.

In our case the way it went down was - I had requested ligation to be done post-delivery in the hospital as we were done having kids, but that pregnancy went to heck due to the sudden onset of heart symptoms. The perinatologist called in to do the emergency delivery said "ain't got time for that" and literally whipped his finger around to my husband and said "YOU take care of that - get a vasectomy." He tried but the urologist told him he was a bad candidate! So after I recovered I did get a tubal which is probably for the best as they recommended I never get pregnant again by any person, and it's my womb. I had to go off the aspirin for several days which carried some risk of stroke but not a lot. Obviously warfarin is a bigger deal but judging from others' comments, it's workable and your doc may still consider a tubal ligation the best solution for you. They can also can advise whether ablation, hormonal control of bleeding, or putting up with it is your best option for the heavy bleeding.

Hoping others can chime in their experiences with IUD, but I wanted you to get "some" response . . . you're right to examine the options carefully. ​

 

[dornole]

It sure would be great if you could somehow get this taken care of before surgery . . . tubals of any kind take about 6 weeks to be guaranteed effective (not sure about IUDs?), and I don't imagine you'll want an active sex life right after OHS either, so those time periods could overlap reducing the need to use a backup birth control method. Not to mention dodging the warfarin issue (assuming it's not already too late to physically recover). You might be able to get priority based on your circumstances? Your cardiologist might be able to make a call for you.

Good luck!!

 

[pellicle]

I'm normally very anti-hormonal birth control, but I'm left with not much choice.
-Heather

My wife had good results with a thing called a nuva-ring

https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring

 

[dreamy885]

My wife had good results with a thing called a nuva-ring

https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring

Nuva-ring in not a good option for me for a couple reasons: it is estrogen based which increases your risk of blood clots (whereas progestin based BC does not), also if you are prone to migraines you should not be on an estrogen BC, and finally, it doesn't lighten your period which is a concern when on warfarin.

 

[dreamy885]

Well, it's not like they can force you to have a hysterectomy later. You'd only do later at your choice to control the symptoms. From a paper:

Endometrial ablation is a minimally invasive procedure for menorrhagia. High success rates are documented with >90% of patients experiencing satisfaction. However, adequate relief after endometrial ablation is not obtained in a cohort of patients. The purpose of this study is to identify the characteristics of patients for whom endometrial ablation fails due to persistent symptoms, causing them to choose hysterectomy for definitive treatment.

So even if you are "more likely" for it not to work due to your age, that still might not be a big risk with a 90% success rate. This was not even mentioned to me when I had an ablation at about age 40. Note, ablation IS NOT a guaranteed birth control technique (at least that's what they told me). So your flow and your fertility are separate issues.

I'm also guessing your cardiologist may not be a fan of hormonal control as it increases your clotting risk - at least pills do, I am not sure about Mirena.

Are your docs telling you that "any future surgery will likely be very risky"? Is this a special double valve replacement issue? Many people on here with mechanical valves and on warfarin have had significant surgery. Tubal ligation is a small surgery and ablation even easier. . . . Or what about a tubal implant for your birth control, that goes in via the route nature provided, no cutting that way either.

You're right you need to check with your doc, but might also need to check with them about some assumptions you are making to make sure they're accurate for you specifically.
.

In our case the way it went down was - I had requested ligation to be done post-delivery in the hospital as we were done having kids, but that pregnancy went to heck due to the sudden onset of heart symptoms. The perinatologist called in to do the emergency delivery said "ain't got time for that" and literally whipped his finger around to my husband and said "YOU take care of that - get a vasectomy." He tried but the urologist told him he was a bad candidate! So after I recovered I did get a tubal which is probably for the best as they recommended I never get pregnant again by any person, and it's my womb. I had to go off the aspirin for several days which carried some risk of stroke but not a lot. Obviously warfarin is a bigger deal but judging from others' comments, it's workable and your doc may still consider a tubal ligation the best solution for you. They can also can advise whether ablation, hormonal control of bleeding, or putting up with it is your best option for the heavy bleeding.

Hoping others can chime in their experiences with IUD, but I wanted you to get "some" response . . . you're right to examine the options carefully. ​

This was the study that I found about increased risk of hysterectomy at a younger age http://www.medscape.com/viewarticle/585863

My cardiologist said that if I ever needed to have surgery after the valves are replaced that I would be switched to a different blood thinner for it. So I suppose he didn't use those words, but he did say that we could push my surgery back in order to get this done first (if I do it.) I just assumed that if I'm still on a blood thinner during surgery, albeit a different one, that it makes surgery more risky.

Estrogen based birth control does put you at a higher risk of clots, but the Mirena is progestin based luckily. Tubal implant wont help with my heavy period and from the tiny search I did, it turned up with over a handful of pages about class action lawsuits against it and the FDA warnings, so I stopped research! I'm less worried about getting pregnant and more worried about heavy periods anyway. If need be, I can just have my SO get a vasectomy.