When treating perimenopausal women who smoke (Item 101-6), I have had wonderful results with the Mirena intrauterine contraceptive (IUC). It provides contraception (if needed) while treating dysfunctional uterine bleeding (DUB). The device can be placed after blood work and pelvic ultrasound have ruled out organic causes of DUB. Patients are advised that they may experience irregular menses for three to six months post insertion. By the one-year mark, approximately 90% have lighter periods than prior to IUC placement, and ≤25% experience amenorrhea. The device is good for up to five years and releases a progestational agent that minimizes any systemic side effects and is not contraindicated in smokers.
—Stacey Tanay, RN, MSN, WHNP, Okemos, Mich.

Progestin-only therapy is often useful in these transitional women who have DUB. The only variables for decision-making would involve cost and convenience. While the Mirena IUC is more expensive initially, it is quickly more convenient and cost-effective over time than other forms of progestin (including medroxyprogesterone [Depo-Provera] injections). For patients with extreme financial constraints, oral progestin would still be the least expensive option, but it would require significant diligence to a daily medication.
—Sherril Sego, MSN, FNP (104-16)