Levonorgestrel‐releasing (20 μg/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives

Abstract

Objective To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel-releasing (20 pg per day) intrauterine system (LNG-20) compared with reversible contraceptive methods in women of reproductive age.Design A systematic review and meta-analysis of randomised controlled trials. Identification Studies were identified through seven databases, and by contacting investigators andMain outcome measures Unplanned pregnancy and continuation of contraceptive method.Results Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta-analyses; four were comparisons of the LNG-20 intrauterine system with nonhonnonal intrauterine devices. LNG-20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380A intrauterine devices) and those I 250 mm3 (Nova-T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG-20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices I 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG-20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm'. LNG-20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG-20 intrauterine system was compared with Norplant-2, the LNG-20 users were significantly more likely to experience oligo-amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting. ConclusionsThe effectiveness of the LNG-20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG-20 intrauterine system, usually unnecessarily, since this end-organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre-contraceptive counselling and that absent bleeding may be viewed as a positive outcome.organisations working in the contraceptive field.

Mise au point sur la contraception intra-utérine en 15 questions-réponses

“…La surface en cuivre né cessaire pour une efficacité satisfaisante doit être supé rieure ou é gale à 250 mm 2 [4]. Ce dosage minimal est respecté pour tous les DIU disponibles en France actuellement.…”

Treatment of heavy menstrual bleeding associated with uterine leiomyoma with the levonorgestrel-releasing intrauterine system

“…In addition it should be acknowledged that levonorgestrel has androgenic and anti-estrogenic activities on the endometrium that result mainly from downregulation of estrogenic receptors [32]. French et al [33] and Zalel et al [31] stated that the amenorrhea in LNG-IUS users is benign, end-organ suppression of bleeding, and associated with normal estrogen levels…”

Dispositif intra-utérin au lévonorgestrel (Mirena®) et cancer du sein: que nous apporte la littérature pour la pratique quotidienne?

“…L'efficacité contraceptive est remarquable, avec un taux cumulé de grossesse sur cinq ans de 0,5 à 1,1 % et un taux de grossesse extra-utérine de 0,02 % années-femmes (Vidal ® 2006). Ce DIU LNG est par ailleurs très efficace dans la correction des ménorragies [2][3][4][5][6][7][8][9][10][11][12][13].…”