Nishmat's Women’s Health and HalachaIn memory of Chaya Mirel bat R' Avraham

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Mirena or ablation for spotting?

13 September, 2004


Thank you for this website and chance to ask for help.

I have six children and have already had a "tubal". I can't take oral hormones because of painful side effects in my legs. I am having mid cycle spotting/bleeding every couple of months, which drives me as crazy as the other posts here.

My doctor mentioned endometrial ablation therapy and Mirena IUD. He wants to use the IUD which he says will help the spotting. But I am afraid it will cause more problems than I already have. (If I want to live with staining, all I have to do is nothing). He says the ablation is more invasive than the IUD.

My husband is a doctor and he says the best decisions are made keeping medical and halachic issues separate. If it were not for halachic problems with midcycle spotting, I would do nothing. But the matzav now is a constant distraction.

I wear red underwear and mark my pantyliners with magic marker . As you can see I have asked numerous shealot before.

I think your site is fantastic.

Thank you and Shana Tova Umetuka to everyone.


Quality of life is certainly a consideration in medical decision making. For the niddah observant woman, being niddah most of the time is certainly a quality of life issue. Therefore, medical and halachic issues are not really separate in this case.

Both of the options your physician suggested are reasonable ones. While some women do have a lot of spotting with the Mirena, others get very light periods or none at all. Unfortunately, there is no way to know how it will affect a particular woman without trying. This intervention is reversible (you just have it taken out), thus you might want to consider devoting a certain number of months to trying it. If it works, great. If not, then endometrial ablation is still an option – discuss with your doctor all the techniques available for this as there are quite a few.

It is important to realize that the Mirena does contain the hormone progesterone. While its effect is mostly local, some is absorbed. Thus discuss with your physician if he feel that your side effects are from the combined hormones (estrogen in particular), rather than progesterone. This may also be a factor in your decision making.

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