Use of levonorgestrel-releasing intrauterine system safe and effective after five years

(1 January 2010: VIDYYA MEDICAL NEWS SERVICE) -- Women who have a popular levonorgestrel-releasing intrauterine device removed after several years can immediately have another one inserted if they wish, according to a report from Finland.

"Removal and replacement of the levonorgestrel intrauterine system (LNG-IUS) following approximately 5 years of use was well tolerated by the woman and regarded as easy by the physician in the majority of the cases," the researchers said.

Furthermore, senior author Dr. Oskari Heikinheimo told Reuters Health by email, "Bleeding and spotting is even further reduced during repeat use, with up to one-third of subjects not having any bleeding or spotting at all, and this is associated with high patient satisfaction."

In a December 1st advance online article in Human Reproduction, Dr. Heikinheimo, from Helsinki University Central Hospital, and colleagues note that the LNG-IUS, which has been marketed in Europe since the mid-1990s and in the US since 2001, is used not only for birth control but also for menorrhagia, as well as for endometrial protection during hormone replacement therapy.

Each device can be used for up to 5 years, and women often opt to have a second one inserted - although data on bleeding patterns and the safety of consecutive use have been scarce, the researchers note.

Now, in their study of 155 women who used the LNG-IUS for contraception and 49 who used it for menorrhagia, the investigators found that 88% of patients overall reported only mild or no pain during removal, and 61.7% had mild or no pain on reinsertion.

In the year after re-insertion, the median number of bleeding/spotting episodes was 2.0 in the first 90 days, 2.0 in the second 90 days, 2.0 in the third 90 days, and 1.0 in the fourth 90 days.

The median length of bleeding/spotting episodes was 4.0 for episodes in the first quarter of the year, 3.5 days for second-quarter episodes, and 3.0 in the third and fourth quarters.

The percentage of women with amenorrhea increased from 29.8% to 33.3% during the first year after replacement of the device, and the percentage with spotting-only increased from 22.2 to 30.6%. The proportion of women with any bleeding or more than 9 spotting-only days decreased from 48.0% with the first device to 36% with the second.

The most frequently reported adverse events were headache (9.3%), sinusitis (5.9%), influenza (4.9%), and upper abdominal pain (4.9%). All other adverse events were reported in fewer than 10 women.

"The removal of the first IUS and the insertion of the second one is a straightforward procedure, and can easily be performed at the same visit," Dr. Heikinheimo said.

Also, he noted, "As the levonorgestrel-releasing intrauterine system does not contain any estrogens, advancing age does not incur any precautions for use."

"In conclusion," the investigators write, "transition from the first to the second LNG-IUS was uneventful and predictable."

The study was funded by Bayer Schering Pharma AG, which developed and markets the LNG-IUS.

Return to Vidyya Medical News Service for 1 January 2010

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