Women's Health Community

Dear An: Let's start with time to conception first. There are two types of IUDs in North American use currently—the older Paragard Copper T and the newer synthetic progesterone releasing Mirena.

So are there any differences in the return to fertility between the two types of IUDs? Generally there is no statistical difference in pregnancy rates after the removal of either type of IUD. One particularly good study randomly assigned women to one of the two types of IUD, then followed the time to pregnancy after the IUDs were removed. In this study, time to conception after Copper T removal was 3 months and 4 months for the Mirena (Belhadj, 1986). It is important to note that the women in these studies had had prior pregnancies thus known fertility--like you.

In another study of 2269 women (Hassan, 2004), 82 women used a non-hormonal IUD and 13 used the Mirena. Compared to women using condoms, the time to pregnancy in non-hormonal IUD users was twice as long. The Mirena users had the same time to pregnancy (about 4 months) as condom users.

My best GUESS about your bleed on 8/4 was that it was a hormone withdrawal bleed due to the Mirena being removed. Typically, an ovulatory bleed is accompanied by typical PMS symptoms and cramps. Time to conception is an indirect way to gauge the return of regular ovulations. You may have an ovulatory cycle this month or next. If you are really trying to pinpoint ovulation you may need either an ovulation predictor kit (measures LH surge) or basal body temperature charting (temperature rise reflects elevated progesterone levels that follow an egg being released.

If you have a history of regular cycles, hopefully these will return soon. If you have no flow for three months, or more erratic bleeding, contact your GYN.

Yours,
Jane

I got my mirena dec 2008 at my 6 week checkup, after my 1st child. I had it removed aug 19, 2012. Had just finished my period, got my next one Sept 15 and then again Oct 8. They were not my normal 28 day cycle but nov 4th my period should have come again! Tested nov 5!!! Baby #2 will arrive July 2013! Happy baby making and good luck!

Dear ComingJuly2013: Congrats and thanks for adding your encouraging personal experience!

Yours,
Jane

I actually never really got a period after the "bleed out" but I am pregnant due may 19, 2013- however I have a sub chorionic hematoma and have been in the ER twice for hemorrhage's from them. Both times the baby has been fine. They say its normal in 20% of pregnancy to have these but most people their body reabsorbs them. I think it's from the mirena. Congratulations to you! Hopefully your pregnancy is less eventful than mine!

Dear An_247581: Thanks for the important follow up. MULTIPLE literature searches at the National Library of Medicine site did not yield any data suggesting Mirena (or any IUD) use with the development of a subchorionic hematoma. Another lit search was done to find citations about causes of this condition. Here is one of the most recent:

J Obstet Gynaecol Res. 2012 Jan;38(1):180-4. doi: 10.1111/j.1447-0756.2011.01665.x. Epub 2011 Oct 14.
Characteristics of patients with subchorionic hematomas in the second trimester.
Yamada T, Atsuki Y, Wakasaya A, Kobayashi M, Hirano Y, Ohwada M.
Source

Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Nasushiobara, Japan. yamada88@iuhw.ac.jp
Abstract
AIM:

The aim of this study was to investigate the etiological characteristics of patients diagnosed with subchorionic hematoma.
METHODS:

A case-controlled study was performed to compare characteristics of patients and controls. Via ultrasound examination, 47 pregnant patients were found to have subchorionic hematomas and 1075 had no evidence of subchorionic hematomas (controls). In the second trimester, patients were compared with regard to endocervical Chlamydia trachomatis and other vaginal microorganisms.
RESULTS:

The overall incidence of subchorionic hematomas in this pregnant population was 4.2%. Maternal clinical characteristics did not differ between cases and controls. Evaluation of the vaginal flora revealed that the positive rates of coagulase-negative staphylococci (cases: 12.8%; controls: 4.1%; P<0.01) and Gardnerella vaginalis (cases: 12.8%; controls: 2.5%; P<0.001) in the cases were significantly higher than those of the controls. The negative rate of Lactobacillus in the cases was significantly higher than that of the controls (cases: 42.6%; controls: 27.6%; P<0.05).
CONCLUSION:

Pregnant women with subchorionic hematoma in the first trimester showed changes in vaginal flora in the second trimester, which suggests a possible association with subchorionic hematoma and vaginal flora change.

An_247581, we all will be hoping that your pregnancy results in a healthy baby and after a smooth delivery.

Yours,
Jane