RCOG World Congress 2023

Accessing Mirena IUS for endometrial protection - are current policies affecting our patients?

Doctors menopause cafe (DMC) is a Facebook group of 5200 female doctors

Current practices in the use of the Mirena IUS for menopausal women in GP practices throughout the UK.

introduction

•Utrogestan (UG) is the primary progesterone for endometrial protection (EP)

•Alternatives are higher breast risk and often less well tolerated by progesterone sensitive women than the IUS.

•The BMS suggests the Mirena IUS as an option to help women who are suffering from bleeding on HRT, obesity and progesterone sensitivity. It is the only IUS licensed for EP.

•Mirena availability is a common theme in the DMC group with many members struggling to access this for their patients.

methods

A survey was disseminated in November 2022-January 2023 to DMC members. The survey was trialled prior to use. Responses were anonymised and consent was gained for survey responses to be used for research purposes.

192 members responded covering all regions of the United Kingdom. The most common source of accessing the Mirena for endometrial protection are GP practices and then Gynaecology clinics.

There are multiple barriers for women to access the Mirena insertion for EP.

•Lack of services for Mirena insertion aimed at endometrial protection

•Primary care and Gynae waiting lists are under extreme pressure due to this

•Women face additional breast and VTE risk using oral synthetic progestogens while awaiting Mirena.

•There is lack of funding and commissioning for GPs and SRH to do this procedure.

Changes to commissioning for Mirena insertion for EP in primary care and in sexual health would reduce gynaecology clinic wait times and improve patient pathways and safety. Larger sample size would be needed to conclude if any regional differences exist.

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