High doses of progestins increase the risk for blood clots. However, Progestins can also be taken without a break. Because continuous progestins can cause breakthrough bleeding and spotting (from atrophy=thinning of the endometrium), it can be considered to discontinue them every 3-4 months, to let the woman have a period progestins can then be restarted. Some women will develop breakthrough bleeding and spotting and will, therefore, not find this a suitable option.
Further information on the Mirena® IUD can also be found at Ĭontinuous progestins (for example Aygestin® 2.5 mg per day to start off with may have to be increased to 10-15 mg per day) sometimes work with heavy menstrual bleeding, but this is a trial-and-error approach. They have been found to be effective in deceasing menstrual bleeds on warfarin. IUDs releasing progestins have been found to be safe from a clotting point of view – they do not increase the risk for blood clots. Only little of the released progestins is absorbed into the blood stream therefore, Mirena® does not lead to an increased risk for blood clots and appears to be a good choice to control bleeding or to use as a birth control method in women with (a) thrombophilia (such as factor V Leiden), (b) a history of blood clots (deep vein thrombosis or pulmonary embolism), and (c) the woman on “blood thinners”, such as warfarin (coumadin®, Jantoven®). This leads to a suppression of build-up of the layering of the uterus (endometrium) and, thus, to a decrease and, eventually, disappearance of bleeding. The Mirena® IUD is a device that continuously releases very low doses of progestins in the uterus. However, in the person on warfarin and other “blood thinners” this may not be a clinically relevant risk. However, the woman needs to be aware that these may increase the risk for thrombosis. If these methods fail, oral progestin medications or continuous estrogens could be considered. For the woman who still wants to be able to have children, the Mirena® intrauterine device (IUD) is a good first choice. If a woman does not plan to have more children, the ablation procedures are, generally, a very good option to prevent or decrease the bleeding. They are either (a) hormone treatment, (b) so called ablation procedures during which the superficial layer of the uterus is destroyed, or (c) hysterectomy.
If no bleeding disorder is present and the bleeding is significant enough to require intervention, there are several treatment options that can be discussed with the Ob-Gyn and hematologist. If a bleeding disorder is present, then consideration of treatment for the disorder is appropriate (for example use of the medication DDAVPor Lysteda® in women with von Willebrand’s disease).
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