Expert: Norman Solberg - 5/8/2009

Question
About a year ago I was hospitalized for blood clots in my lungs and leg. I
have Factor V Leiden and was placed on coumadin. I also have endometriosis.
ovarian cysts and heavy periods. Today I went to a gyno and he wanted to put
me on progesterin but I asked my hematologist who said no, it will form
more clots. I have the copper, hormone-free IUD but that does nothing for
cramps and bleeding. What are my options here?

Answer
Hi Beth,
It's a difficult question, and there's not good agreement on the answer.  I think the progesterone IUD Mirena would be a valid option.  It does contain progesterone, but with the effect primarily inside the uterus.  The amount of progesterone in your system would be minimal.  I don't know of studies that would show that it has no increased risk of blood clotting in your situation, but I think there would be none.  However, I wouldn't go against your hematologist.  Perhaps you could ask him/her about this particular progestin device.  Most women with the Mirena have much lighter periods, and some have no periods.  Other progestin only birth control (depo Provera and the minipill) come with warning that they shouldn't be used by women who have had blood clots.  Good luck.