If your GP doesn't fit Mirena and sexual health clinic only fits for contraception...

[WhereAreWeNow]

What do you do when you're past an age when you're likely to need it for contraception?
I got mine fitted at 45 and I love it. I'd like another one when this one needs replacing.
Where I live GPs don't do it. You have to go to sexual health clinic. The clinic is only commissioned to fit Mirenas for contraception. So where do post-menopausal women go to get a Mirena? Are they only available on NHS for contraception?

No, you can get them for HRT on the NHS, my GP fits them.

However I needed an emergency fitting when my mirena came out recently, so I paid £200 for a private GP to fit one (I was not prepared to wait for NHS GP to put me on the 2 month waiting list and have to use utrogestan for that time).

My NHS GP gave me the prescription to collect the actual mirena and I took it to private GP who fitted it the next day.

why do you want one and how old are you ?

If you don't have periods and are post meno, they are available on the NHS as the progestogen part of HRT alongside a form of estrogen.

If you don't use HRT and you're not having periods any more, you don't need one.

My GP will only fit for contraception, not for menopause. You have to go to the sexual health clinic for the latter. I was told it's due to funding because they receive money for contraception.

@JinglingSpringbells I'm now 48 and I'm using it for HRT (with estrogen patches).

@Droolylabradors I didn't realise the GP could prescribe the device. Do you pick it up from a chemist like a normal prescription?!

@Rumpoleoftheballet Sounds like you're in the same boat. I think it varies between NHS trusts. Some only fund Mirena coils for contraception and some seem to also fund for contraception. It seems like a bit of a gap in provision. A postcode lottery.

I didn't realise you were using it for hrt.

Have you written to the GP practice and asked in a formal way if they can provide it? I'm wondering if they are being honest.

I'd query this because I've never ever heard of anyone not being able to get it as part of HRT on the NHS and from their GP.

Hi OP, yes I've had to pick up my last two from the chemist and take it with me on fitting day.

So you get a regular prescription, collect from the chemist and then take to the doctor. It has the coil and the fitting instruments in.

Mine runs out soon, I'm probably now past menopause but not sure as I don't get periods with my mirena. I will definitely make sure I start the getting a replacement process early! I'm North Bristol for health, does anyone know their policy?

Some PCTs are stopping prescribing the mirena for HRT use (Buckinghamshire being one of them), so best to check. We have a local private doctor who will do it at a price (obviously).

Mine was fitted in a gynae clinic, run out of the same place as the sexual health clinic.

OP what do you like about the coil as I am considering it. I didn’t get one when I enquired at my GP as it seemed to difficult. They said to lie to the sexual health clinic and pretend it was for contraception! I couldn’t easily even get through to the sexual health clinic which is at the hospital.

You can still get it on the NHS but you are referred by your GP to the sexual health clinic to have it put in.

@JinglingSpringbells I haven't written but I've been told by the GP that they don't do it and I've heard from other women at other GP practices in the area that GPs don't do it here. They're not funded to do it.

@LoreleiG I like it because I had really difficult periods which were just getting worse with perimenopause and the Mirena has stopped my periods altogether. I'm also on estrogen patch. The GP recommended the Mirena and estrogen as a good option for HRT and it's working well for me. The only problem is the hassle of getting it fitted (both in terms of discomfort and having to lie about why you're getting it at the sexual health clinic!).

It varies on area and availability of doctors and nurses trained in fitting.In our area most GP practices have a doctor who fits them and if they don't have a reciprocal arrangement with another practice so it might be worth asking your practice manager. The sexual health clinics will fit for contraception only. You can ask a private practitioner to do it of course and your GP might do the prescription for you. There are a lot of pressures on the system at the moment and around here it is mainly time. GPs are horrendously busy and if they take an hour out of their day to fit two coils that is 6 other patients not seen . Training is expensive and young doctors have many other demands on their time and money. The old systems of training pathways have also broken down outside big centres.

The GP recommended the Mirena and estrogen as a good option for HRT and it's working well for me

So they have an obligation surely to replace it.

AS PP says it's probably they don't have anyone trained to do it rather than a financial constraint.

@Droolylabradors I've just looked at private clinics near me and they're all around £500!

You'd think so but they won't do it. The GP recommended it but explained I would have to go to the sexual health clinic and say it was for contraception rather than HRT.

This wasn't a private clinic, it was a private GP. It would have been £350 without the coil provided by me, or £200 if I brought the device with me.

It wasn't a clinic as such, just a private GP surgery.

I'm in the southeast and there are loads of private GPs around.

Our local private hospital is £350 which can be booked direct without GP referral. (Circle Group). Think Nuffield was similar.

Another pathway worth pursuing would be to ask the sexual health clinic whether they are allowed to fit it if you bring a the mirena with you , prescribed by a GP. If you are perimenopausal and thus in need of contraception the SH clinic should have no problem in fitting in any case.In the past women could be referred to gynaecology if there were no other options, again they sometimes provided the mirena depending on local funding, but with the waiting list situation and the fact that there is no urgency as such you could be waiting an awfully long time. If you have debilitating periods without the mirena then gynaecologist would definitely be an option.

In many surgeries there is no coil fitter. Would have to refer to gynae clinic in my area unfortunately.

@WhereAreWeNow I had the same issue. My GP had to refer me to hospital gynaecology where the consultant rolled her eyes and sighed (not at me, at the situation) and replaced it. To be fair, she was amazing and for once I got adequate pain relief. But it was lucky I spoke to my GP 6 months before I needed a replacement.

That's understandable if no one is qualified but originally it sounded as if it was a policy or financial issue, rather than expertise.

My GP fit my first Mirena coil, however stopped doing this over the pandemic. Services to offer this very between area and also GP surgery and where it’s funded as part of HRT. I was able to at least get my coil removed at a sexual health clinic. However, this was done in the ‘emergency contraception’ clinic and the nurse was unable to install a new one. To get this done would have involved a referral from the GP to the gynae/menopause clinic in the same place which meant a wait.
I asked my GP for Utrogestan instead

I mean, this doesn't strictly answer your question, but I was advised (& online NHS advice is the same) that you should have contraception up to age 55 - which at least gives you 10 years in which hopefully things might get sorted out a bit. (I checked this out recently, as 54 & still have a copper coil fitted for contraceptive purposes, advice is not to have it removed quite yet.)