Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability

Lewis, Reuben R.; Taylor, D.; Natavio, Melissa; Melamed, Alexander; Felix, Juan C.; Mishell, Daniel R.

doi:10.1016/j.contraception.2010.06.006

Cited by 67 publications

(46 citation statements)

References 9 publications

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“…The absence of these uterine reactions in cases of perforating Cu-IUDs increases the risk of unplanned pregnancy. In contrast, the mechanism of action of the LNG-IUS is suppression of the endometrium and thickening of the cervical mucus (Luukkainen et al, 2001;Lewis et al, 2010). With the LNG-IUS in utero, plasma levels of LNG are low (Nilsson et al, 1986) and changes in ovarian function are minimal (Luukkainen et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Uterine perforation caused by intrauterine devices: clinical course and treatment

Kaislasuo

Suhonen²,

Gissler

et al. 2013

Human Reproduction

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summary answer: Symptoms are mostly mild and 30% of women are asymptomatic. Surgical findings are mainly minimal; no visceral complications were found in this study. However, adhesions as well as pregnancies seem to be more common among women using Cu-IUDs. what is known already: Prior studies and case reports have suggested that uterine perforation by modern IUDs/IUSs is rarely serious. main results and the role of chance: The majority of patients (n ¼ 53; 71%) had mild symptoms of abnormal bleeding or abdominal pain or both, in combination with missing IUD/IUS threads. Asymptomatic patients (n ¼ 22; 29%) were examined because of missing threads or pregnancy. Failure to remove the IUD/IUS by pulling visible threads was the reason for referral in seven women (9%) requesting removal of the device. Eleven women (15%) were pregnant. Misplaced IUDs/IUSs were localized by a combination of vaginal ultrasonography (US) and X-ray, hysteroscopy or curettage. Only after this were patients treated by means of laparoscopy. The majority (n ¼ 44; 65%) of the 68 intra-abdominal devices were located in the omentum, the remaining 24 (35%) around the uterus. Partial perforation or myometrial embedding was diagnosed in all seven cases (9%) with visible threads, but unsuccessful removal by pulling. During laparoscopy, filmy adhesions were found in 21 patients (30%). Pregnancy (33 versus 7%, P ¼ 0.009) and intra-abdominal adhesions (58 versus 20%, P ¼ 0.002) were significantly more common in the Cu-IUD group. Infections were rare; one non-specific acute abdominal infection, later found to be unrelated to the IUD, led to laparoscopy and in four cases the IUD was surrounded by pus, but there were no symptoms of infection.limitations, reasons for caution: The study setting revealed only surgically treated symptomatic patients and asymptomatic women attending regular follow-up. Women not treated, but only followed or not attending follow-up, were not identified, excluding the possibility to analyse missed undiagnosed perforations, or conservative follow-up as a treatment option.wider implications of the findings: As surgical findings are minimal, asymptomatic women may need no treatment at all.An alternative form of contraception is, however, important as pregnancies do occur. If a woman plans a pregnancy, a misplaced LNG-IUS should be removed, as it may act as a contraceptive. study funding/competing interest(s): Helsinki University Central Hospital research funds. O.H. has lectured and designed educational events with Bayer AG and MSD, and serves occasionally on scientific advisory boards for these companies. S.S. has

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Section: Discussionmentioning

confidence: 99%

Uterine perforation caused by intrauterine devices: clinical course and treatment

Kaislasuo

Suhonen²,

Gissler

et al. 2013

Human Reproduction

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“…Early studies showed inhibition of ovulation through the first year of use; [15,16] however, long-term users had normal ovarian follicular development, [17] and ovarian cysts or persistent ovarian follicles were also reported. [18,19] In addition to the described mechanism of action upon the endometrium level and in ovarian follicular development, it was also described changes in the CM and spermatozoa-CM interactions, [14,20,21] although they remain controversial. [15,17] When characteristics of CM and its interactions with spermatozoa were assessed, a significantly higher CM score was found among non-users as compared to users of the LNG-IUS; good sperm penetration was observed only among non-users of the Mirena-IUS.…”

Section: Introductionmentioning

confidence: 98%

Assessment of the quality of cervical mucus among users of the levonorgestrel-releasing intrauterine system at different times of use

Moraes

Marchi

Pitoli

et al. 2016

The European Journal of Contraception & Reproductive Health

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“…Moreover, the change of the uterine environment brings efficient contraception. For one thing, an altered cervical mucus from LNG that acts as a barrier to sperm migration, plus the endometrial atrophy that prevents sperm-egg binding were the main mechanism of contraception [3]. For another, the down-regulation of ER and PR in glands and stroma of the endometrium can inhibit cellular proliferation, and embryo implantation can thus be interrupted [4].…”

Section: Introductionmentioning

confidence: 99%

Morphological and Ultrastructural Changes in Human Endometrium Following Low-Dose Levonorgestrel Contraceptive Intrauterine Systems (LNG-IUS-12) 13.5 mg

Chai

Dong

2014

J Obstet Gynecol India

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Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability

Cited by 67 publications

References 9 publications

Uterine perforation caused by intrauterine devices: clinical course and treatment

Uterine perforation caused by intrauterine devices: clinical course and treatment

Assessment of the quality of cervical mucus among users of the levonorgestrel-releasing intrauterine system at different times of use

Morphological and Ultrastructural Changes in Human Endometrium Following Low-Dose Levonorgestrel Contraceptive Intrauterine Systems (LNG-IUS-12) 13.5 mg

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