Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience

Wildemeersch, Dirk; Andrade, Arnaldo F.B.; Goldstuck, Norman D; Hasskamp, Thomas; Jackers, Geert

doi:10.2147/ijwh.s122579

Cited by 11 publications

(8 citation statements)

References 34 publications

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“…2 Notably, the implantation and fixation method can effectively address both issues. 11 Intrauterine LNG delivery with a frameless fiber system was studied by Wildemeersch et al 12 in a review including 304 contraceptive patients. Achieve satisfactory results, there were three cases of expulsion, three cases of downward movement, and two cases of uterine perforation (attributed to novice and rough placement).…”

Section: Discussionmentioning

confidence: 99%

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Hong¹,

Wang²,

Fu³

et al. 2021

J of Obstet and Gynaecol

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Aim: The levonorgestrel-releasing intrauterine (LNG-IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system-allowing affixion to the myometrium-and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding. Methods: This study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG-IUS (experimental group, n = 47); and the original system after gonadotropin-releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016. Results: In the experimental group, two device expulsions occurred 12-18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60-month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5-year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm 3 ), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups). Conclusions: Use of the modified LNG-IUS is a safe, cost-effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding.

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Section: Discussionmentioning

confidence: 99%

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Hong¹,

Wang²,

Fu³

et al. 2021

J of Obstet and Gynaecol

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“…A very thorough examination of the medical history supplied the missing piece of information that was necessary to elucidate the cause. To the best of our knowledge, medical literature has not previously reported any case of retinal vasculitis related to Jaydess ® 13.5 mg levonorgestrel intrauterine contraceptive device ( 21 ). However, some studies in literature indicate the occurrence of vasculitis related to oral contraceptive administration, but with mild vascular involvement ( 16 , 18 , 22 , 23 ).…”

Section: Discussionmentioning

confidence: 99%

Vasculitis associated with the use of an intrauterine device: A case report

et al. 2021

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Retinal vasculitis is a complication associated with a local condition or it can be a retinal expression of a systemic inflammatory disorder, which initially may go unnoticed. Drug-associated vasculitis is frequently difficult to identify, because many patients follow treatments with more than one drug and the route of administration varies. A 35-year-old female patient presented with sudden hearing loss, headache and blurred vision that had started two weeks earlier and had become progressively worse. Ophthalmological examination revealed anterior uveitis, bilateral optic disc swelling and retinal vasculitis. The orbito-cerebral MRI, the CT scan and the serological tests were within normal limits. Unable to identify the cause of the retinal vasculitis, the patient's medical history was reviewed. The patient had recently had a gynecological procedure, where a 13.5 mg levonorgestrel intrauterine contraceptive device was implanted. After the device was removed and methylprednisolone treatment started, the patient presented a visible remission of the symptoms and signs. To the best of our knowledge, there is no case of retinal disease and optic disc edema associated with auditory problems caused by an intrauterine device. A proper examination, correlated with a very thorough medical history, could identify rare diseases and associations, in order to provide adequate medical care.

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“…While oral progestin has historically been used for EH medical management, other delivery mechanisms are available. The 52 mg levonorgestrel (LNG) intrauterine device (IUD), which delivers 10 mcg to 20 mcg LNG daily for 5 years (52 mg-IUD/10–20 mcg-LNG-14t), the 60 mg LNG IUD, which delivers 14 mcg LNG daily for 5 years (60 mg-IUD/14 mcg-LNG), the 60 mg low-dose frameless LNG intrauterine system, which delivers 14 mcg daily for 3-years (60 mg-LD-frameless-IUD/14 mcg-LNG), and the 60 mcg high-dose frameless LNG intrauterine system, which delivers 20 mcg LNG daily (60 mg-HD-frameless-IUD/20 mcg-LNG), have the obvious advantage of long term patient adherence and proximity to the needed site of action [ 14 , 15 , 16 ]. In contrast to the 60 mg-IUD/14 mcg-LNG with a diffusion rate controlling ethylene vinyl acetate membrane [ 16 ], the 52 mg-IUD/10–20 mcg LNG-14t uses polydimethysiloxane in the drug reservoir, which may account for the difference in daily delivered dose.…”

Section: Introductionmentioning

confidence: 99%

Progestin Intrauterine Devices and Metformin: Endometrial Hyperplasia and Early Stage Endometrial Cancer Medical Management

Nwanodi¹

2017

Healthcare

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Globally, endometrial cancer is the sixth leading cause of female cancer-related deaths. Non-atypical endometrial hyperplasia (EH), has a lifetime progression rate to endometrial cancer ranging from less than 5%, if simple without atypia, to 40%, if complex with atypia. Site specific, long-acting intrauterine devices (IUDs) provide fertility sparing, progestin-based EH medical management. It is unclear which IUD is most beneficial, or if progesterone sensitizing metformin offers improved outcomes. For resolution, PubMed searches for “Mirena” or “Metformin,” “treatment,” “endometrial hyperplasia,” or “stage 1 endometrial cancer,” were performed, yielding 33 articles. Of these, 19 articles were included. The 60 mg high-dose frameless IUD/20 mcg levonorgestrel has achieved sustained regression of Grade 3 endometrial intraepithelial neoplasia for 14 years. Case series on early stage endometrial cancer (EC) treatment with IUDs have 75% or greater regression rates. For simple through complex EH with atypia, the 52 mg-IUD/10–20 mcg-LNG-14t has achieved 100% complete regression in 6-months. Clearly, IUDs have an outcome advantage over oral progestins. However, studies on metformin for EH, and of progestins or metformin for early stage EC management are underpowered, with inadequate dose ranges to achieve significant differences in, or optimal outcomes for, the treatment modalities. Therefore, outcomes from the feMMe trial for the 52 mg-IUD/10–20 mcg-LNG-14t and metformin will fill a gap in the literature.

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Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience

Cited by 11 publications

References 34 publications

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Vasculitis associated with the use of an intrauterine device: A case report

Progestin Intrauterine Devices and Metformin: Endometrial Hyperplasia and Early Stage Endometrial Cancer Medical Management

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