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E-stim with Mirena in situ

What is the general consensus on using vaginal e-stim with a Mirena in situ? A copper IUD is contra-indicated , Mirena is plastic but there is concern from some that there is a small amount of a metal oxide in the strings. Here in Australia the view is no evidence either way so don't use but many women who could benefit don't get to try stim as a treatment option due to their Mirena. Is there any evidence for/against? It is the most common question I get asked as the major retailer of e-stim machines to physios here in Australia . If the cervix is sitting high ( not prolapsed ) and a reasonable work/rest ratio used there should not be risk of current concentration / heating effect. Any clarification on this please as the manufacturers won't . I have used in my own practice with informed consent but am wary of advising others without concrete evidence. thanks

Fiona Rogers

2 months ago

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L.Laakso335
L.Laakso335

Hi again, Fiona. Pleased to see that a Tim has responded. I’m happy to take this conversation off-line. I can be found on LinkedIn where we can do so. Cheers, Liisa

Fiona Rogers
Fiona Rogers

Hi Tim, Thank you for your response. I tend to be of the same opinion re the Mirena but have struggled to find any evidence. It is also the most common question I get asked and here in Australia everyone seems to be much more cautious with this. My thought process is even if there were a heating effect , using it on a work/rest ratio of say 5/10 would allow dissipation anyway, and if the cervix with the Mirena in situ is sitting high then it is unlikely to be in the field. I will try the companies again, and the manufacturer of the Mirena and if i hear anything new will report back. Thanks again for taking the time to respond. kind regards Fiona

Prof Tim Watson
Prof Tim Watson

Fiona. Sorry for the delay in joining in with this conversation. This is a question that I get asked with remarkable regularity - and there is no simpleanswer so far as I can tell. There is certainly nothing that I have seen in the evidence which suggests that there would be an adverse outcome. There is a 'historical' contraindication listed in several publications which suggests that E Stim - especially with a vaginal electrode - should not be utilised if the patient has such an implant BUT if the implant is a plastic structure, the current will have no effect on it, and indeed, the plastic will have no significant effect on the current (pathway through the tissues) being used. Even if the device was metal based, there is no strong argument for it constituting a contraindication - though I am sure that some might disagree with this opinion (I tend to take a more liberal view than some when it comes to contraindications!). In essence, my response when therapists ask me is that the Mirena device does not constitute a contraindication to the use of E Stim - whether with an internal (vaginal) or external electrode placement.

Fiona Rogers
Fiona Rogers

Thank you for responding Liisa, really appreciate it. From my research over the time, there is no evidence one way or the other which is the frustrating thing . I had hoped someone may have seen some that I had missed! and this seems to be where the cautionary approach comes from here in Aus. In the UK and Canada there seems to be no restrictions but i have had no joy from manufacturers on the topic. Do you know what is currently taught here? Would you have concerns re just the plastic component of the Mirena as well? If you are happy to pursue this topic offline via email I'd be very grateful . Whilst i run the website pelvicfloorexercise where we sell the machines I also still work clinically and am regularly asked about this so am quite keen to find a resolution one way or the other. regards Fiona Rogers

L.Laakso335
L.Laakso335

Hi Fiona. I have been observing to see if you’ve had a response and as there appears to be no-one willing to venture specific advice, I would suggest that there is no evidence (one way or the other). I would start by contacting the manufacturer to determine if, what, and how much ‘metal oxide’ exists in the device. Some manufacturers will have specific advice on how their device is used, and any potential precautions or contra-indications which may have resulted from adverse incident reports. All best, Liisa Laakso

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