Mar 27, 2009

forced to keep mirena?

Why do some health care providers feel that they are entitled to force their patients to keep unwanted Mirena IUDs?

I recently came across a blog post from a NP where she vents her annoyance about removing a recently inserted Mirena from a patient who was concerned about the side effects. The majority of the comments she received are almost more disturbing than the original post itself.

Tales like this are repeated frequently across the web - women told that they must keep IUDs that are causing them discomfort. Adding to this concern is the reluctance of other health care providers to remove an IUD that they themselves didn't insert.

I can't for the life of me understand why a provider would be reluctant to remove an unwanted IUD. It is a simple and quick procedure. Do they not believe patient's reports of side effects?

Am I alone in thinking that this kind of behavior is offensive?


  1. Wow. I just read that post and the only decent comment was the last one, by the PhD nursing student. I have never used an IUD and never plan to, but you're right - if they want it out, take it out, for crying out loud. I have no idea why this would be a problem for a health care professional; it is all about the patient after all.

  2. That post was shocking, as were the comments. I left a comment at the end but if anyone follows the link they'll just assume I'm nuts anyway.

  3. I was speechless. I don't know how NPs are trained, but I can't imagine that this kind of attitude is promoted.

    I've even found instructions online teaching women how to take out their own IUDs. A recipe for disaster, I think.

    Like I said, I just don't get it. Is there some sort of cash incentive for health care providers who manage to keep IUDs in their patients longer?

  4. I have to say that the patient in question had a shaky understanding of statistics -- AT BEST. Sure, she should be able to have the IUD removed if she wants, but if she wants to avoid a tubal pregnancy, her odds of doing so are much higher *with* an IUD than without. This had to have been frustrating to the staff at the clinic, especially given the patient's questionable ability to use contraception in the past, combined with her desire to avoid future pregnancies.

    I didn't actually disagree with their suggestion to "see how it goes" for a few months before going through with the removal. People change their minds all the time, and the patient might have just as easily felt better about it a few weeks later.

    The real problem with the post was the scorn for the patient expressed by the author, rather than with what seems to have actually happened in the clinic. I don't really know what to say about that. All health professionals get frustrated with some patients, and no patient wants to be seen in a negative light. Though I will add, sometimes the way the patient acts influences how they are perceived. It is a two way street.

    The author should have employed a different tone in this post. It would have been better writing and far more effective. Try not to get too bent out of shape about it. It has nothing to do with you.

  5. I don't know much about this, but just reading the article, I too was very shocked! Unbelievable!

  6. Old MD girl, I realize that it has nothing to do with me - but a lot of issues that concern me don't effect me personally or directly.

    I do have empathy for NewNP, it sounds like she is dealing with a difficult client. I think what shocked me most is how frequently I have heard women say that they had problems with Mirena and were unable to get it removed.

    Having gone through the same thing myself (the weekend things started to go wrong, I could not find one clinic willing to remove it) I have a great deal of empathy for them.

    If a client is going to sit in your waiting room day after day, I think it is safe to assume that she really wants it out.

    I would like to understand the thinking behind those medical professionals who refuse to remove them. Not "wait and see", but "no".

    JBR - thanks for reading and posting.

  7. You've actually made me feel vindicated in my opinion. Thank you.

  8. OMDG,
    I want to apologize for the antagonist tone of my earlier response.

    I'm not sure why this issue provoked so much frustration from within me in the first place. As you said, it really doesn't have anything to do with me (and I realize that you meant that with kindness).

    I think my over-identification with these women is likely a product of how completely crummy and powerless I feel in my current health situation.

  9. :-O (jaw on floor)

    Wow! I wasn't expecting an apology.

    It's completely understandable that you feel powerless and frustrated by your lack of improvement. It's obvious why you identify with this situation, but yeah, you're not this patient (for reasons that I hope are obvious aside from the lack of 8 unintended babies). Perseverating on it is probably not going to make you feel any better, though the temptation can be hard to resist.

  10. Thanks for being so gracious in accepting my apology. I always appreciate your thoughtful comments.

  11. I too read the post. I was shocked at how unprofessional it was. I know if it was me the post was referring to I would be mortified. I too have 7 children and a Mirena fitted. I too am considering having it removed due to depression. I was googling to read articles on the Mirena to gain more information about it and depression if it could be a trigger and came across your blog.
    Most of my children have been unplanned, just like the woman referred to in the post. That doesn't say I don't care for them, provide for them or love them or that I am not a good mother.

    How does the author know these ladies children aren't loved and cared for?
    There is a move here in Australia to have nurse practioners and the blog you linked to doesn't portray NP's in a good way.
    I certainly wouldn't be comfortable to see a NP after reading that blog and the comments left by other NP's.