Three years' experience with levonorgestrel-releasing intrauterine device and Norplant-2 implants: a randomized comparative study

Abstract

A randomized comparative study of levonorgestrel-releasing intrauterine device (LNG-IUD) and Norplant-2 implants was carried out in 200 women for 36 months. Three thousand one hundred woman-months of use were observed with each device. Only one pregnancy occurred in users of LNG-IUD at the 12th month of use. The change in bleeding pattern was the most frequent reason for discontinuation. The discontinuation rate for irregular bleeding with Norplant-2 was 17.3 and 26.8 at 24 and 36 months, respectively, as compared to 3.3 with LNG-IUD at both 24 and 36 months. The differences were statistically significant. Removal for amenorrhea and pain only occurred in acceptors of LNG-IUD. About 20-40% of women using Norplant-2 had prolonged bleeding through 36 months. The percentage of amenorrhea in LNG-IUD was the highest (29.3%) at the end of two years of use. More than 97% of subjects reported satisfaction with the methods used by themselves.

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

“…Three studies 20,34,35 compared the levonorgestrel‐20 intrauterine system with intrauterine devices > 250 mm 3 and three 15,27,34 compared the levonorgestrel‐20 intrauterine system with intrauterine devices > 250 mm 3 . The two remaining comparisons were the levonorgestrel‐20 intrauterine system versus Norplant rods 31 and the levonorgestrel‐20 intrauterine system versus the levonorgestrel‐intracervical device 12 . Five studies reported that all participants had proven fertility 12,20,27,31,34 .…”

“…The two remaining comparisons were the levonorgestrel‐20 intrauterine system versus Norplant rods 31 and the levonorgestrel‐20 intrauterine system versus the levonorgestrel‐intracervical device 12 . Five studies reported that all participants had proven fertility 12,20,27,31,34 . The study by Sivin et al 20 was the longest, with seven years follow up.…”

“…Information was also collected on additional factors, which could potentially affect the results. Two of the seven randomised controlled trials reported that women had received contraceptive counselling 14,31 . Five studies provided information on timing of insertion during the menstrual cycle 14,20,27,31,34 , all within appropriate time frames.…”

“…Two of the seven randomised controlled trials reported that women had received contraceptive counselling 14,31 . Five studies provided information on timing of insertion during the menstrual cycle 14,20,27,31,34 , all within appropriate time frames. In one study 20 physicians found insertion of the levonorgestrel‐20 intrauterine system more difficult than insertion of the CuT 380 Ag intrauterine device and more women reported moderate to severe pain at the insertion of the levonorgestrel‐20 intrauterine system.…”

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

“…Some early studies (including the Finland/Brazil Study) included the LNG-IUDs that released 30/zg of levonorgestrel daily (the LNG-IUD-30) for comparison. A few other clinical trials with smaller study populations have been reported from China comparing the IUD that releases 2/zg of levonorgestrel daily (LNG-IUD-02) with IUDs made in China [17,18], or the LNG-IUD-20 with Norplant implants [19,20]. Other aspects of the LNG-IUD-20, like return of fertility [15,[21][22][23], use by postpartum and/or lactating women [24,25], or using the LNG-IUD-20 as a treatment for menorrhagia or dysmenorrhea [13,[26][27][28][29], have been reported sporadically, mostly by Scandinavian or British investigators.…”