Tranexamic acid or mirena coil? Heavy periods plus anaemia.

[CreatingHavoc]

I'm anaemic (ferritin is 8) and have heavy periods. I need to take something to control my periods. I had terrible acne with the mini pill but a gp said the mirena has a smaller concentration of progestogen and so may not have the same effect? She also said the implant isn't as reliable as the mirena for stopping periods so they wouldn't recommend that.

I have some anxiety about Tranexamic acid as I don't like the idea of taking something that encourages clotting. I have health anxiety issues, particularly when it comes to blood clots and even taking the mini pill made me terrified of getting one.

That said, I'm anxious about all my options. I'm really not keen on having the coil fitted at all. I know someone who had their coil 'disappear' and I've known people get pregnant whilst using it and then there's the increased risk of complications that comes with that. Also just seen another thread where someone couldn't have it fitted due to scar tissue from c section, of which I've had two. So yeah, none of this is helping my anxiety levels.

I feel I'm stuck between a rock and hard place and don't know what to do.

In the meantime, GP has referred me for an ultrasound to check there's no underlying cause for heavy periods and I'm waiting for her to get back to me about iron supplements as the ones I've tried previously have ruined my digestive system. I feel very much 'that awkward patient' at the moment!

All i'll say is that the mirena made my heavy bleeding worse not better and once you've got it they'll tell you it "might settle down" for months while it makes your life hell. Thankfully mine bled itself out but I vowed never to use anything I couldn't stop taking myself ever again.

Just an aside and may not apply to you but my periods got v heavy and I was very anaemic due to another condition preventing iron absorption, and needed an iron infusion. V low ferritin can cause periods to become v heavy so the low iron gets even worse - once I got the iron infusion my periods returned to normal heaviness after a few years of me considering tranamexic acid / coil and what the heck was going on. Worth considering if you’ve not always had heavy periods. The iron infusion has been wonderful for me, two infusions a week apart and HB and ferritin levels have stayed normal for a year now with iron supplements.

If it helps allay your fears at all, I've had 3 sections and a uterine rupture and had a Mirena coil fitted today after nurse recommended it at my smear test. Friends have recommended it too. It wasn't as painful as expected, a little spotting but the cramps have eased up already.

@JAC76 what condition was it that was preventing absorbtion? I've always struggled with low iron since having my 2 dc but the heavy periods have got gradually worse over the last 6 - 12 months to the point that they are now difficult to manage.

I have been wondering for a long time if there's an underlying cause but no gp seems to want to consider it. I've had so many appointments recently and I've only just been referred for an ultrasound today.

I took tranexamic acid as the first step in dealing with heavy periods - my GP said it was the first in a range of treatments, working up to hysterectomy, and we'd work through until we got to one that worked. Mirena would have been step 2, but the acid was enough for me. I have high blood pressure which is medicated, but that isn't contraindicated, and I haven't had any issues.

I had very bad morning sickness with both my DC and developed a hiatus hernia so have to take PPIs daily which affect iron absorption.

@JAC76 interesting. I also have a hiatus hernia but I don't take ppi's anymore, just gaviscon advance when needed. I wonder if that would have the same effect 🤔

Did tranxemic for years....not sure whh coil not suggested...but had it 2 yrs now....life changing .... not anemic, less tired , less anxious about going anywhere and flooding... give it try it can always been taken out! Effective within 3weeks but 6ish to completely settle

I was you two years ago. Got the mirena and my ferritin is much much better, and the mirena is great!

I was anaemic due to heavy periods caused by adenomyosis and took tranexamic acid. I had a mirena fitted about a year ago. My periods have got much lighter and I have no period pains now. My ferritin levels are now normal. No regrets having the mirena.

I took the Trans’ acid which worked well. No issues.
Then a change of lifestyle meant I needed the coil for contraception & heavy periods so the Mirena was fitted. I had it for six years. Bit of cramping in the early days but it was wonderful. No issues & periods completely stopped. Result!

Tranexamic acid never worked for me however I had fibroids that needing removing. Mirena coil after removal & a course of iron tablets seems to have worked perfectly

I think it does yes unless you take them apart. I now take my iron AM, no coffee until mid morning to let it get a chance to absorb and then PPI at bedtime. I might give Gaviscon a go as interested in cutting PPIs out as there’re not great long term.

might be worthwhile asking GP if they’d consider an iron transfusion before you make your mind up about other treatments. My Haemoglobin was 70 though which was why I got the infusion, what’s your Hb?

I'm in the same boat op, have Tranexamic acid ready to be picked up but also I've been offered to try coil or progesterone only pill to try and control the bleeding. Not sure what to do as I'm 99% sure I don't want the coil.

I guess the tranexamic acid is probably the lowest risk. Maybe I'll try that first. The thought of having a coil inserted really bothers me. And then once it's in there's still the possibility of side effects and you can't just take it out.

Hey.

Just wanted to give you my experience with heavy periods and the marina!
I've always struggled with heavy periods, I am a bleeder after all - I'm a red head! Which in turn has lead to anaemia being up and down over the years.
The pill was a no go for me from late teens. I loved the depo injection, it was a god send.. but my Dr didn't want me on that longer than a year.
I've had 3 kids, 2 of which were c sections. I haemorraghed with every one of them leading to blood transfusions and oral stuff for anaemia for months after each birth. After my 2rd 2.5 years ago, my periods became so heavy again, I couldn't handle them and in turn became anaemic again. They recommended to me the marina coil, which I've always said point blank no to. The implant has always been 100% no go to me too. After having a chat with the GP she reassured me, though I have heard awful things about the coil, I decided to try it at least.
For the first 6 months it was HELLLL, my bleeding was all over the place and unpredictable, my mood swings were here there and everywhere and quite frankly I was tempted to yank it out myself a few times. The GP assured me that after 6 months things would calm down, and that my body needs to get used to it, so i gave it the benefit of the doubt.. she was right. Once 6 months or so had passed, everything settled. I've not experienced weight gain, I don't get as spotty as I used to, but have the usual flare around the time I'd be due on a period, I don't bleed at all which in turn means anaemia has long gone and is now all good.
The 6 months were hard but ultimately it's the best thing I've ever done.
I know every person is different but I wanted to shed a bit of a positive note on the coil as there is not many positive stories about. X

@CreatingHavoc I can add a bit from my experience. The mirena fitting for me was not nearly as bad as I know some women suffer. I’ve had 4 vaginal births so maybe that helps. It was a bit crampy but not awful. Like early labour. But I’d left it too late to try, my periods were too heavy - I bled it out the first time I had a big bleed.

Tranexamic acid works like magic for me, like turning off a tap. Flooding to stopped within an hour. But it treats the symptom not the cause. You can only take it for three or four days and for me the flooding just starts again after.

I’ve tried the mini pill too and a double dose of it on GP advice. I’m now waiting for a hysterectomy after scans showed large fibroids.

My feeling (I have no evidence) is that some of these things might have worked for me if I had tried them sooner, but a combination of reluctance and then Covid meant I left it until surgery is my only option.

Not sure what I’m really offering here except to say I think you have to play the system. Gynae are incredibly backed up and won’t even accept a GP referral unless you’ve tried their list of things and they’ve failed, so I would just go with whatever the GP suggests in whatever order and hope one works. I’d personally go coil over TXA as it does at least address part of the issue rather than just deal with symptoms.

i hope you get sorted soon x

Thanks for the info @Lula74 and @Adeleex . I've got some prescription strength liquid ferrous fumerate to try and see if my digestive system can cope with it. Also picked up tranexamic acid but I'm very, very hesitant to take it. I might end up trying the coil after all... 😬

Good luck!
I over thought having the coil so much and the negatives really played on my mind, but like I said, in the long run it's the best thing I've done contraception wise. ☺️ let us know how you get on xx

I had horrendous periods and anaemia. Tried the coil and various meds over the years. Nothing worked for me (had to have surgery in the end). It’s trial and error I think op. If you really don’t want a coil (I had no problems with it, it just didn’t actually solve the issue), then start with meds. I hope something sorts it for you.

I’m on my fifth Mirena coil now, it’s been amazing. I had my first one after my child was born 19 years ago. I really wish I had done it sooner. I’ve had no trouble from it only a very small amount of spotting for a couple of months or so with my first one then no periods since then. I’ve met a few nurses a couple of doctors who have had it themselves and say how brilliant it is . It’s so rare to get pregnant as you would usually know if it’s come out. It’s easy to check the strings yourself. I’ve been told it is as effective against pregnancy as sterilisation. It was quite painful being inserted but it takes seconds and I would advise pain meds like ibuprofen plus paracetamol after as you can get some cramping like period pain. The pain has been worth it though for years of no painful or heavy periods!

Forgot to say I’ve also had a C section, I’ve never heard that being an issue with the Mirena only that if you haven’t had a vaginal delivery it may be a little more painful to insert

@CreatingHavoc i’d definitely give the coil a go. Although it didn’t work for me, the insertion wasn’t painful, it’s just like a smear and almost all of my friends also use it as the adjunct for oestrogen therapy in their mid forties and have no issues at all.
(I didn’t have any major issues, it just makes me bleed constantly - but not so heavily, but in a way that I still couldn’t wear anything except dark jeans going out anywhere).

I didn’t have any major issues, it just makes me bleed constantly - but not so heavily, but in a way that I still couldn’t wear anything except dark jeans going out anywhere

You don't consider that a major issue? It would be a total dealbreaker for me

Try iron bisglycinate, my gp recommended as easier on the digestive system and better absorbed than ferritin. You buy over the counter and I take 50mg daily and 100mg during my period. Life changing - am full of energy now!

I also take tranexamic acid for 3 days a period. It helps reduce my periods by about 50% - no longer flooding. I don’t do well with the pill and friends have put me off the mirena with months of bleeding. But clearly for many people it works well.