Contraceptive Use of Levonorgestrel Intrauterine System: Case Series
Aim: Levonorgestrel intrauterine system (LNG-RIS) is a highly effective, safe and reversible contraceptive method. It suppresses endometrial cell proliferation, thickens cervical mucus, disrupts tubal motility by creating a high levonorgestrel concentration in the endometrium and tubal mucosa. In our country, LNG-RIS is mostly used in Gynecology and Obstetrics clinics in the treatment of pathologies such as adenomyosis, endometriosis, hyperplasia and their symptoms such as menorrhagia, dysmenorrhea, pelvic pain, and is prescribed at the hospitals due to a medication report. It has a high level of protection (99.9%), and its contraceptive effect is considered to last five years, and fertility returns rapidly after removal. In this study it was aimed to evaluate retrospectively the continuation rate, the presence of unwanted effects and the patient satisfaction after insertion of LNG-RIS.
Method: This is a retrospective, descriptive study of women who had been inserted LNG-IUS with contraceptive purpose in the family planning unit of the Marmara University Pendik Training and Research Hospital, between 2013-2019; the data of a total 38 patients were retrospectively analyzed.
Results: The average age of the participants was 36±5 years. No pregnancy is detected during the use of the method. Five-year usage rate was 21% among users. A total of nine patients discontinued the method; one because being diagnosed with a glial tumor, two because of excessive bleeding, one other patient because having hysterectomy due to myoma uteri, two patients because the threads were not visible, two others because they have been told that their LNG-IUS had slipped down and one patient because of her pregnancy plan. The satisfaction rate was 52.6%. There was a decrease in both the duration and the amount of bleeding of menstruation but this decrease was not statistically significant.
Conclusion: LNG-RIS is an effective, reliable contraception method with low side effect. It is still limited in primary care and it will be more appropriate to spread its use.
References
- Costescu J. Levonorgestrel-releasing intrauterine systems for long-acting contraception: current perspectives, safety, and patient counseling. International Journal of Women’s Health 2016:8;589–98.
- Speroff L, Darney P. A Clinical Guide for Contraception. In “Intrauterine contraception”. (ed) Wolters Kluwer. Fifth edition, Philadelphia PA, Lippincott Williams & Wilkins. 2011:239-81.
- Inki P. Long-term use of the levonorgestrel-releasing intrauterine system. Contraception 2007;75(6 Suppl):161-6.
- Perino A, Quartararo P, Catinella E, Genova G, Cittadini E. et al. Treatment of endometrial hyperplasia with levonorgestrel releasing intrauterine devices. Acta Eur Fertil 1987;18(2):137-40.
- Mirena Wayne NJ: Bayer Healthcare Pharmaceuticals INC; c2013.(cited 2013 Feb 15).
- Gemzell-Danielsson K, Schellschmidt I, Apter D. Randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril 2012;97(3):616-22.
- Nelson A, Apter D, Hauck B, Schmelter T, Rybowski S, Rosen K, et al. Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial. Obstet Gynecol 2013;122(6):1205-13.
- Black A, Guilbert E, Costescu D, Dunn S, Fisher W, Kives S et al. Canadian Contraception Consensus (Part 3 of 4): Chapter 7–Intrauterine Contraception. J Obstet Gynaecol Can 2016;38(2):182-222.
- Gupta J, Kai J, Middleton L, Pattison H, Gray R, Daniels J et al. Levonorgestrel intrauterine system versus medical therapy for menorrhagia. N Engl J Med 2013; 368:128-37.
- Heikinheimo O, Gemzell-Danielsson K. Emerging indications for the levonorgestrel-releasing intrauterine system (LNG-IUS). Acta Obstet Gynecol Scand 2012;91(1):3-9.
- Yap C, Furness S, Farquhar C. Pre and post operative medical therapy for endometriosis surgery. Cochrane Database Syst Rev 2004;(3):CD003678.
- Abou-Setta A, MHouston B, Al-Inany HG, Farquhar C. Levonorgestrel-releasing intrauterine device (LNG-IUD) for symptomatic endometriosis following surgery. Cochrane Database Syst Rev 2013 Jan 31;(1):CD005072.
- Lee TS, Seong SJ, Kim JW, Ryu HS, Seop Song ES, Byung Ho Nam BH. Management of endometrial hyperplasia with a levonorgestrel-releasing intrauterine system: single arm, prospective multicenter study: Korean gynecologic oncology group study (KGOG2006). Jpn J Clin Oncol 2011;41(6):817-9.
- Intrauterine Levonorgestrel. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-.
- Rowe P, Farley T, Peregoudov A, Piaggio G, Boccard S, Landoulsi S. Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A. Contraception 2016;93(6):498-506.
- Heinemann K. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception 2015;91(4):280-3.
- French R, Van Vliet H, Cowan F, Mansour D, Morris S, Hughes D, et al. Hormonally impregnated intrauterine systems (IUSs) versus other forms of reversible contraceptives as effective methods of preventing pregnancy. Cochrane Database Syst Rev 2004;(3):2.
- Backman T. Benefit-risk assessment of the levonorgestrel intrauterine system in contraception. Drug Saf 2004;27(15):1185-204.
- US Medical Eligibility Criteria (US MEC) for Contraceptive Use, 2016 CDC Contraceptive Guidance for Health Care Providers. https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/summary.html adresinden 27.05.2020 tarihinde erişilmiştir.
- Bosco-Lévy P, Gouverneur A, Langlade C, Miremont G, Pariente A. Safety of levonorgestrel 52 mg intrauterine system compared to copper intrauterine device: A Population-based cohort study. Contraception 2019;99(6):345-9.
- Bednarek PH, Jensen JT. Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS. Int J Womens Health 2010;1:45-58.
- Nascimento R, Bahamondes L, Hidalgo M, Perrotti M , Espejo-Arce X, Carlos, Petta A. Users’ Perspectives on bleeding patterns after two years of levonorgestrel-releasing intrauterine system use. Drugs RD 2002;3(6):387-91.
- Diaz J, Bahamondes L, Monteiro I, Petta C, Hildalgo MM, Arce XE. Acceptability and performance of the levonorgestrel-eleasing intrauterine system (Mirena) in Campinas, Brazil. Contraception 2000;62(2):59-61.
- Nascimento RI, Bahamondes L, Hidalgo M, Perrotti M, Espejo-Arce X, Petta CA. Users’perspectives on bleeding patterns after two years of levonorgestrel-releasing intrauterine system use. Drugs RD 2002;3(6):387-91.
- Lyus R, Lohr P, Prager S. Use of the Mirena LNG-IUS and Paragard CuT380A intrauterine devices in nulliparous women. Contraception 2010;81(5):367-71.
- Bachofner M, Blickenstorfer K, Hutmacher J, Leeners B, Merki-Feld G. Intrauterine device continuation rates and reasons for discontinuation in a Central European Clinic with a high standard of care and ultrasound follow-up: A retrospective cohort study. Eur J Contracept Reprod Health Care 2018 Dec;23(6):407-14.
- Wildemeersch D, Goldstuck ND, Jackers G. Results of a 5-year contraceptive trial in parous and nulliparous women with a new LNG-IUS. Gynecol Endocrinol 2017;33(3):223-6.
- Glasier AF, Smith KB, van der Spuy ZM, Ho PC, Cheng L, Dada K, Wellings K, Baird DT. Amenorrhea associated with contraception-an international study on acceptability. Contraception 2003;67(1):1-8.
- Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: A 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis. Contraception 2009;79(3):189-93.
- Jones RL, Critchley HO. Morphological and functional changes in human endometrium following intrauterine levonorgestrel deli-very. Hum Reprod 2000;15 Suppl 3:162-72.
- Fedele L, Bianchi S, Zanconato G, Portuese A, Raffaelli R. Use of a levonorgestrel-releasing intrauterine device in the treatment of rectovaginal endometriosis. Fertil Steril 2001;75(3):485-8.
- Lockhat FB, Emembolu JO, Konje JC. The Efficacy, side-effects and continuation rates in women with symptomatic endometriosis undergoing treatment with an intra-uterine administered progestogen (Levonorgestrel): A 3 year follow-up. Hum Reprod 2005;20(3):789-93.
