Mirena – is this the droid you were looking for?

I had a fabulous time in Armenia. Despite giardia, and a twisted ankle, and all the hassle of trying to return right in the middle of the hurricane – it was wonderful beyond whooping to see my family and friends again; it was delightful to be back, and so it was. I ate many many persimmons (it being the season), I had a lovely time, I saw people I loved and it was  good.

And so it was.

Then I returned – just after Sandy, once the airports re-opened – and TSA rifled through my bag and broke all my mouraba (Armenian preserves – and very tasty they would have been, too), and that was Friday, and Monday I went in to have the Mirena placed, hoping it would be the droid I was looking for.

The jury’s still out on that, but here’s my experience so far, for whatever it’s worth. I didn’t have much choice in choosing the Mirena – as long as I’m on estrogen replacement and have an intact uterus, I’ll need to have some form of progesterone to keep my endometrial tissue from building up (and potentially causing Very Bad Things). The original plan was to cycle oral progesterone every three to four months, but:

a) I don’t tolerate oral progesterone well, as we found out – severe ‘side’ effects. It took me just over a month to recover from the last cycled dose.

b) I would need to cycle far more frequently than originally planned, as my endometrial tissue is very healthy and responds strongly to estrogen. Myself, I tend to think this is connected with going through chemopause, rather than natural menopause – but I’d need to be on oral progesterone pretty much every month. NOT an option.

c) Because I’m a breast cancer patient, I should limit my exposure to progesterone as much as possible as the current thinking is that progesterone increases the risks of recurrence.

So, since oral progesterone isn’t a viable option for me, the Mirena IUD is the next choice – it’s a progesterone bearing IUD, delivering progesterone directly to the tissues that need it, while limiting systemic exposure. At least that’s the theory – and for many women, it works perfectly well.

Insertion – really fucking painful while it lasted. Bear in mind, I’ve not had children, and since I don’t have periods anymore I couldn’t go ‘during my cycle’ as is often advised (the os tends to be more relaxed and open during the bleeding part of the cycle). It was a strange and nasty pain, both during the sounding of the uterus and during the actual insertion and there was enough swearing so that I sounded like someone with Tourette’s. Once it was over, though, it was pretty much over – still, I’d recommend a local (which can be used) or a drug to dilate the cervix. Between the tenaculum (the clamp used to hold the cervix – ouch!), and the speculum opened a bit wider than usual, and the actual Stuff Going Where No Man Has Gone Before – not a fun experience.

Still, that part was over relatively quickly and, once done, was done.

The first few days afterwards I was immensely tired, and I almost immediately developed what my friend Ron calls ‘man-zits’ – nice big juicy pimples coming up fast out of nowhere. Perversely enough, I also experienced dry eye, dry mouth, and dry skin – and I felt pretty much as though I’d been kicked hard in the crotch. I also bled fairly constantly – which is expected and is still ongoing, two weeks later. Eventually, that should stop altogether – most fertile women find that their cycles stop once their bodies adjust to the Mirena and, being that I’m decidedly infertile, I’d expect that sooner than later.

The thing I’m most worried about, however, is the emotional and physical effects from the systemic uptake of progesterone – it is supposed to be relatively slight, but it’s definitely there. The last few days I’ve been experiencing more hormonal effects, which I had thought were dying down, once I got through the first few days of incredible fatigue and acne – the muscles in my legs ache, my joints are stiffer, and I’m verging on depression again – though it’s a different depression than before. Before, I was hopeless – now I’m constantly angry, impatient, resentful, and pissed off. I want to hit things. Hard. Still not a lot of joy in things, which I truly miss, and my creativity index has dropped; my will to do things is missing. All of which pisses me off further, of course.

The good thing is that I have a clear ‘compare and contrast’ from my recent trip to Armenia, where I picked up giardia, sprained my ankle, and generally had a splendid time. Came home bursting with energy and inspired with projects, and got the Mirena put in… and everything went out the window again. Dammit.

I had just gotten over the oral progesterone dose (before I left) and now this? It seems a bit rough – much of the past year has been spent in varying states of artificially induced insanity: from chemopause and its complications, to finding the right estrogen dose and playing with patch placement, to the oral progesterone havoc, and now *this*? Could it stop already?

I did call the doctor’s office yesterday, just to check in, and the feeling is to give it another four weeks or so – it normally can take up to six months to settle and adjust.

I’m hoping this works for me, and that everything evens out in time (sooner would better, btw), since the only other option I can see is having a hysterectomy – which, while not the end of the world, is something to be avoided if possible. You’d think it would be easy-peasy, take the cause of the problem out and not worry about progesterone anymore, and I could be me again  – but since the uterus isn’t just free floating in the abdomen but has a lot of stuff attached to it (such as the bladder), a hysterectomy is something I’d rather avoid, if possible. Not to mention the fact that it’s still a major medical procedure, involving general anesthesia and abdominal incisions and potential months of recovery and it all sounds like way too much fun for me. Still, I’m looking at it as a possible option, if the Mirena doesn’t pan out for me. How much quality of life do I need to sacrifice, and where?

And I am so sick of the medical world. I want this part of my life over.

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