Reducing the effectiveness of Mirena

I am not pregnant! I have a Marina inserted!

The photo: an escort trainee from another casino, who had Mirena, Levonorgestrel releasing, IUD inserted 2 years ago finds she is pregnant at her recent weekly hCG test at my clinic after being away on Christmas vacation for 4 weeks. Worse, it’s an ectopic pregnancy. Up to half of pregnancies that occur with Mirena in place are ectopic and she is going to need surgery to terminate the pregnancy and may lose her tube.

This photo of a lovely Scandinavian escort, Birgit, encased in transparent and pink latex shows why my casino does not hire or train escorts of either sex who have tats as the ink detracts from the natural line of the body and this is particularly true for women who are prized for our smooth unblemished skin. She would look out of place in a strapless gown, but right at home in a tee, jeans and Doc Martens in a biker bar. I have nothing against bikers, but they aren’t the market we are targeting with ballerina quality escorts.

Contraceptive sabotage: We did blood tests to try to determine why her Mirena failed. She hadn’t been on an antibiotic, a common cause of hormonal birth control failure,  and her Mirena was properly positioned. However, when we checked the meds and supplements she is taking we found that the pills in a nutritional supplement bottle had been switched. The correct pills - to be taken once a week - had been switched with the emergency contraceptive pill, ella (or ellaOne in Europe), a 30mg ulipristal acetate tablet, that looks very similar to the one it replaced.

She thinks a boyfriend who is a pharmacist in Gothenburg switched her pills with the EC pills as she began getting headaches at the start of the 4 weeks she stayed at his place before breaking up with him because he wanted her to move back to Sweden and have his babies. The ella prescribing information (below) says there can be an interaction between hormonal contraceptives and ella leading to the decrease in effectiveness of hormonal contraceptives. The prescribing information says:

FERTILITY FOLLOWING USE: A rapid return of fertility is likely following treatment with ella for emergency contraception; therefore, routine contraception should be continued or initiated as soon as possible following use of ella to ensure ongoing prevention of pregnancy. While there are no data about use of ella with regular hormonal contraceptives, due to its high affinity binding to the progesterone receptor, use of ella may reduce the contraceptive action of regular hormonal methods. Therefore, after use of ella, a reliable barrier method of contraception should be used with subsequent acts of intercourse that occur in that same menstrual cycle.

The most common adverse reactions to ella (≥ 5%) in the clinical trials were headache (18%), abdominal pain (12%), nausea (12%), dysmenorrhea –menstrual pain (9%), fatigue (6%) and dizziness (5%).  Thinking back, the only noticeable side effect she experienced was headaches and so she has probably been taking ella for the last 5 weeks. Her surgery will be tomorrow.