The non-contraceptive effects of the levonorgestrel-releasing intrauterine device

Abstract

Clinical trials have consistently shown that the IUD that releases 20 micrograms levonorgestrel daily (LNG-IUD-20) has a contraceptive efficacy comparable to, if not surpassing, the Copper T380 and the Multiload Copper-375 IUDs. The focus of this review is the device's non-contraceptive effects--the beneficial ones, such as reduction of menorrhagia, a therapeutic effect on dysmenorrhea, and prevention of ectopic pregnancy, as well as the deleterious ones, such as amenorrhea, spotting and irregular bleeding, hormonal side-effects, and functional ovarian cysts. Also discussed are the possibility of a preventive effect on pelvic inflammatory disease, the effects of the IUD on postpartum/lactating women, fertility return after removal and other safety issues. In general, the LNG-IUD-20's non-contraceptive benefits are substantive, carry important medical and public health implications, and far outweigh the device's deleterious effects, which are either medically mild or transient in nature, and can usually be managed satisfactorily by counseling. A better understanding of these effects, both beneficial and deleterious, of this hormone-releasing IUD should lead to more effective patient counseling, which, in turn, should improve user quality of life, minimize unnecessary removals, and maximize continuation of use.

Management of menorrhagia with the levonorgestrel intrauterine system versus endometrial resection

“…Although both methods seem to be equally effective in reducing MBL, ER is an invasive procedure requiring operative equipment and an operation theatre, while the placement of the LNG-IUS can be carried out in the outpatient department. This is in line with other studies that found that 64% of 28 women scheduled for hysterectomy due to bleeding problems could cancel their decision to undergo hysterectomy, compared with 14% in the control group [19]. Another aspect is the reversibility of the treatment and potential return of fertility associated with the LNG-IUS.…”

Prevalence of extrauterine pelvic lesions on transvaginal ultrasound in asymptomatic 20–39‐year‐old women

“…Moreover, we included unilocular cysts with anechoic cyst contents only if their mean diameter was > 35 mm. Despite this, our results confirm that functional cysts are less common among users of the COC pill and more common among women using a gestagen IUD than among women with spontaneous menstrual cycles. The higher rate of persisting ovarian masses in our study than in the other two is difficult to explain.…”

Microwave endometrial ablation: development, clinical trials and outcomes at three years

“…The levonorgestrol‐releasing intrauterine contraceptive device has added a new dimension to the medical treatment of menorrhagia 45 .…”