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Cervical staining with Mirena

20 June, 2019

Question:

I had the mirena IUD placed almost 8 months ago. After the initial 3 month adjustment period I had no bleeding or staining for close to 3 months. (I am breastfeeding full time) About 2 months ago, following a regular period, I started staining, quite heavily at times. I went to see my gyn last month. She did a thorough exam & confirmed that the bleeding was all cervical due to many scratches on the surface of the cervix. She cauterized the cervix and the staining stopped within a few days. I did not get to the mikva because my next period came shortly thereafter.

My last period ended a week ago but the bleeding & staining came back full force. I understand I can see a bodekes to confirm the bleeding is cervical but do I have to do this every month? (My rav did pasken that due to the sensitivity of my cervix I should not do the moch, only the hefsek bedika) Is it possible/common that the iud strings can cause the scratches on the cervix? I have never had this type of straining before.

Any advice would be helpful as this is causing me terrible anxiety. It is more than 2 months since I’ve been to the mikva last…


Answer:

We are sorry to hear of your difficulties getting to mikveh.

We do recommend an examination to confirm that the staining is from a cervical wound and not due to uterine bleeding. This is because irregular hormonal staining is not uncommon on the Mirena, and it is important to clarify that you are not experiencing uterine and cervical bleeding simultaneously. For halachic purposes, it is sufficient to go to a bodeket. However, medically, you should return to your OB/GYN to see if further treatment is possible so you do not need to do this monthly.

In the meantime, you should soak in a warm bath to remove any old blood prior to performing a hefsek taharah. You should go gently and slowly, and try to avoid touching the cervix during your bedikah. You may also reduce the number of bedikot to one each on days 1, 7, and one of the intermediate clean days. If the doctor or bodeket confirms that you still have a cervical wound and are not experiencing any other bleeding, you may disregard any stains found on the bedikot. However, you still must have an acceptable bedikah on day 1 and day 7, so if your first attempt has a stain, you should repeat the bedikah (leaving time between attempts and being very careful to avoid the cervix) until you have an acceptable bedikah.

We have also received anecdotal reports of women using alfalfa, vitamin C, and bioflavonoids (1000 mg 3x/day) to help reduce staining.

Finally, if this situation continues over the next few months after the cervical sensitivity has resolved, it may be worthwhile speaking to your doctor to discuss alternate forms of birth control.

Please feel free to get back to us with any further questions.

B’Hatzlacha!


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