Mirena can cause mid-cycle bleeding and unpredictability, sometimes for several months after insertion. It is impossible to know in advance how an individual woman will adjust to Mirena. However, following the adjustment period, many women have no bleeding at all on Mirena for years.

Given your age and the associated decline in fertility, you may wish to consult your physician about whether spermicide on its own, or with a diaphragm, would be sufficient as a contraceptive. Neither spermicide nor the diaphragm are associated with irregular bleeding. On the other hand, they also will not lead to a cessation of menstrual bleeding, as is possible with the Mirena after the adjustment period. Some women find this to be an advantage of the Mirena, as perimenopause can itself be associated with some menstrual irregularity.

This is an individual choice. More information about different contraceptive methods is available on this site under "Family Planning." If and when you choose a method, we are happy to advise you about any concerns or difficulties that arise.