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Gynacology and Health


Yogi Berra Was Right

By Dr. W. Gifford Jones

August 25, 2003

Yogi Berra, the self-proclaimed philosopher king of the New York Yankee baseball team, had a knack of saying it the way it was. He remarked, "If you don't know where you're going you're bound to end up someplace else." Every year I see female patients who end up somewhere they would prefer not to be. The ones who face abortion. Or are told they have a sexually transmitted disease (STD). Or wish they could have had more time between pregnancies. All because they took the wrong contraceptive, or none at all.

There is no ideal method of birth control for every woman. I often tell young unmarried women to make love like porcupines, very, very carefully. Especially those who are using only oral contraceptives and should also be insisting on condoms to protect against STD.

It's not just young girls who play Russian roulette with pregnancy. I see older women who have a young child but push their luck by becoming absent-minded about the Pill and who then become mothers when they'd prefer to be grandmothers.

Dr. Louise Lapensee, gynecologist at the University de Montreal, says, " Priorities change for couples after having a baby. Many women stop taking the Pill because they don't like the fact that they need to remember to take it everyday and many are concerned about the permanence of sterilization and the need for surgery."

Now, a new unique device, "Mirena" removes Russian roulette from the bedroom for five years, enables women to toss away pills, vaginal contraceptive creams and space their pregnancies. This provides a great insurance policy to protect against unexpected motherhood.

Mirena is a sophisticated intrauterine system of the same design as older intrauterine devices. But there's one big difference. The T-shaped frame is surrounded by a narrow cylindrical reservoir that contains levonorgestrel. This hormone, commonly used in birth control pills, is similar to progesterone, a sex hormone produced by the body. Two fine plastic threads are attached to the device which are needed for removal and to confirm its presence after being placed in the uterus.

Mirena slowly releases tiny amounts (20 micrograms of levonorgestrel) per day, directly into the lining of the uterus for up to five years. It prevents pregnancy by increasing the thickness of the cervical mucus (opening into the uterus), decreases motility of sperm and prevents growth and development of the uterine lining.

Studies show that Mirena is highly effective and as reliable as sterilization. And even more effective than oral contraceptives since missing a pill is such a common happening.

A trained doctor is needed to insert Mirena within seven days of the onset of menstruation. It can also be inserted immediately after termination of a pregnancy up to 12 weeks or six weeks after childbirth. Following removal normal fertility quickly returns and normal menstrual bleeding usually occurs within one month.

Mirena offers an big additional benefit to women suffering heavy and painful periods. By gradually thinning the uterine lining during the first few months of use it decreases the amount of menstrual bleeding and pain. This may offer an alternative to hysterectomy for women suffering from heavy periods.

During the first year of use one in five women of reproductive age will stop having periods, a ratio which increases to four in five for those near menopause. Most women welcome this change when they are assured it's not unhealthy for them.

Some women notice irregular bleeding or spotting in the early months of use. Or breast tenderness, vaginal discharge and lower abdominal pain. These are resolved after a few months.

Mirena isn't for all women. It's not advisable for those who have had pelvic infection, a heart attack or stroke, a history of blood clots or an ectopic pregnancy.

But it is ideal for women who have had a child and want to space their family every three to five years.

Mirena costs about $350.00, but the cost is covered by most health plans or private insurance companies. It's an inexpensive way to prevent pregnancy as the cost is less than $6.00 a month over five years.

The message is to think ahead and ask your doctor about Mirena or other means of birth control. Knowing where you're going ensures that you don't end up someplace else!

W. Gifford-Jones M.D Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is:
Dr. Walker can be reached at

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