GPC | Helpful information and advice
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Should I choose a Mirena or a Kyleena?
Dr Malini Kanagalingam, Consultant Gynaecologist

Many women choose to have an Intrauterine System as they are highly effective (more than 99%), long lasting and reversible. How do you decide between a Mirena and a Kyleena?

These are both hormonal coils that release a Progestogen Levonorgestrel (LNG) into the uterus. They work by thinning the lining of the uterus and thickening the cervical mucus. The Mirena also partially suppresses ovulation, the Kyleena generally does not change ovulatory function.

The decision on which one to choose depends on several factors- your age, whether you need contraception only or also endometrial protection- as part of HRT or to treat endometrial hyerplasia, how heavy or painful your periods are, and if you have conditions such as endometriosis.

The Mirena has a higher dose of LNG- 52 mg and can be used for 6 years for contraception, and 5 years for endometrial protection. If it is inserted over the age of 45, it can be used until the age of 55 for contraception. It has the benefit of reducing heavy bleeding, period cramps and pain from endometriosis. It can also be used as the Progesterone part of your HRT. About 20% of women with a Mirena will have no periods after a year of using it.

The Kyleena has a much lower dose of the hormone LNG- 19.5 mg and can be used for 5 years for contraception. It has a slightly smaller frame compared to the Mirena and the inserter has a smaller diameter ( 3.8 mm vs 4.4 mm) so can be less painful to insert. This IUS is ideal for women who are worried that their periods might get heavier with a copper coil but would prefer a lower dose of hormones. Only about 12% of women will have no periods after a year of using this IUS.

Speak to your doctor for more information and to help you make your decision.

Menopause and Weight gain
Dr Malini Kanagalingam, Consultant Gynaecologist

Most women have heard of the common perimenopausal symptoms caused by falling Oestrogen levels but for some, weight gain is unexpected when there have not been any changes to their diet and lifestyle.

On average, women gain 1.5 Kg every year during the perimenopause transition, leading to around 10 Kg of extra weight over those years.

This is caused by a combination of changes in the way your body stores fat, the slowing of your metabolic rate and declining muscle mass.

We know that being overweight can worsen flushes, and increase your risk of heart disease, diabetes, breast and endometrial cancer so it is important to try maintain a normal weight.

There is good evidence that in order to sustain long term weight loss, you need a combination of a calorie reducing diet and exercise. What you can do:

• Look at reducing your portion sizes, avoid unstructured meals, grazing and unconscious snacking. Eat more slowly.

• There is good evidence for time restricted eating- this is where you eat all your meals within a 10 hour window and avoid eating after 7 pm.

• Balance your food groups- more fruit, vegetables, seeds, nuts, pulses, whole grains, and less fat, sugar, salt and highly processed foods.

• Reduce your alcohol intake- set weekly drinking limits.

• Add gut microbiome friendly foods- fermented foods like Kimchi, Kombucha and sauerkraut, live yoghurt- Keffir, garlic, onions, leeks, asparagus, dark chocolate as well a a variety of colourful plant foods, seeds, nuts, pulses and whole grains.

• Exercise- High intensity interval training with weight resistance exercises will increase your metabolic rate and increase for muscle mass. Progression is important for continued results. Regular exercise has also been shown to reduce flushes and sweats.

A common question is “Does HRT cause weight gain?” There is no evidence that HRT cause weight gain- some women do get fluid retention which usually settles after a few weeks.

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