Progestin-Releasing Intrauterine Systems

Tapani Luukkainen; Päivi Pakarinen; Juhani Toivonen

doi:10.1055/s-2001-18643

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Semin Reprod Med 2001; 19(4): 355-364
DOI: 10.1055/s-2001-18643

Progestin-Releasing Intrauterine Systems

Tapani Luukkainen¹ , Päivi Pakarinen^1,2 , Juhani Toivonen^1,3

¹Steroid Research Laboratory, Institute of Biomedicine, University of Helsinki, Helsinki, Finland
²Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland
³Department of Obstetrics and Gynecology, Jorvi Hospital, Helsinki University Central Hospital, Espoo, Finland

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Publication History

Publication Date:
29 November 2001 (online)

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ABSTRACT

The levonorgestrel-releasing intrauterine system (LNG IUS) is an effective method for contraception. It has a strong antiproliferative action on the endometrium. The endometrium is transformed under the influence of local levonorgestrel and becomes unresponsive to ovarian estrogens. This process is associated with progressive reduction of menstrual blood loss and menstrual duration. Scanty and irregular bleeding and/or spotting is usual during the first 3 to 4 months. The reduction of menstrual blood loss continues and after the first 9 months many women have no bleeding at all. However, they have normal ovarian function. The absence of bleeding is a result of the local antiproliferative action of the LNG IUS on the endometrium, which is also responsible for many health benefits during the use of this method. As with oral contraceptives, the risk of pelvic inflammatory disease is reduced, because of reduced menstrual blood loss, endometrial suppression, and thickening of the cervical mucus. There are some steroidal side effects: mood changes, oily skin, and acne. Weight increase is similar to that associated with copper intrauterine devices: 500 g per year over 5 years. Users should be told that the LNG IUS does not prevent sexually transmitted infection, and therefore women at risk should also use condoms for their protection.

KEYWORD

Contraception - intrauterine release - levonorgestrel - IUD - PID

REFERENCES

1 Söderström R M. Progestasert® intrauterine progesterone contraceptive system. In: Bardin CW, Mishell DR Jr, eds. Proceedings from Fourth International Conference on IUDs Newton, MA: Butterworth-Heinemann 1994: 319-327

Search in Google Scholar
2 Luukkainen T. Progestin releasing intrauterine contraceptive device. In: Bardin CW, Mishell DR Jr, eds. Proceedings from Fourth International Conference on IUDs Newton, MA: Butterworth-Heinemann 1994: 32-41

Search in Google Scholar
3 Toivonen J, Luukkainen T. Progestin-releasing intrauterine devices. In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism St. Louis, MO: Mosby 1997: 281-285

Search in Google Scholar
4 Luukkainen T, Toivonen J. Levonorgestrel-releasing IUD as method of contraception with therapeutic properties. Contraception . 1995; 52 269-276

Crossref PubMed Search in Google Scholar
5 Luukkainen T. Progestin-releasing intrauterine devices. In: Sitruk-Ware R, Mishell DR Jr, eds. Progestins and Antiprogestins in Clinical Practice New York: Marcel Dekker, Inc.; 2000: 229-243

Search in Google Scholar
6 Newton J, Szontagh F, Lebech P, Rowe P. A collaborative study of progesterone intrauterine device (Progestasert). Fertil Steril . 1979; 19 575-589

PubMed Search in Google Scholar
7 Zador G, Nilsson B A, Nilsson B. Clinical experience with the uterine progesterone system (Progestasert). Contraception . 1976; 13 559-569

Crossref PubMed Search in Google Scholar
8 Rantakylä P, Ylöstalo P, Järvinen P A, Vierjoki A. Ectopic pregnancies and the use of intrauterine device and low progestogen contraception. Acta Obstet Gynecol Scand . 1977; 56 61-62

PubMed Search in Google Scholar
9 Snowden R. The progestasert and ectopic pregnancy. Br Med J . 1977; 2 1600-1601

PubMed Search in Google Scholar
10 Shoupe D, Meme D, Merzrow G, Lobo R A. Prevention of endometrial hyperplasia in postmenopausal women with intrauterine progesterone. N Engl J Med . 1991; 325 811-812

PubMed Search in Google Scholar
11 Archer D F, Viniegra-Sibal A, Hsiu J-G. Endometrial histology, uterine bleeding and metabolic changes in postmenopausal women using a progesterone-releasing intrauterine device and oral conjugated estrogens for hormone replacement therapy. Menopause . 1994; 1 109-116

PubMed Search in Google Scholar
12 Nilsson C G, Haukkamaa M, Vierola H, Luukkainen T. Tissue concentrations of levonorgestrel in women using a levonorgestrel-releasing IUD. Contraception . 1982; 17 529-536

PubMed Search in Google Scholar
13 Silverberg S G, Haukkamaa M, Arko H, Nilsson C G, Luukkainen T. Endometrial morphology during long-term use of levonorgestrel-releasing intrauterine devices. Int J Gynecol Pathol . 1986; 5 235-241

PubMed Search in Google Scholar
14 Heikkilä M, Haukkamaa M, Luukkainen T. Levonorgestrel in milk and plasma of breast-feeding women with a levonorgestrel-releasing IUD. Contraception . 1982; 25 41-49

Crossref PubMed Search in Google Scholar
15 Heikkilä M. Puerperal insertion of a copper-releasing and a levonorgestrel-releasing intrauterine device. Contraception . 1982; 25 561-572

Crossref PubMed Search in Google Scholar
16 Luukkainen T, Nielsen N-C, Nygren K-G, Pyörälä T. Nulliparous women, IUD and pelvic infection. Ann Clin Res . 1979; 11 121-124

PubMed Search in Google Scholar
17 Toivonen J, Luukkainen T, Allonen H. Protective effect of intrauterine release of levonorgestrel on pelvic infection: three year's comparative experience of levonorgestrel- and copper-releasing intrauterine devices. Obstet Gynecol . 1991; 77 261-264

PubMed Search in Google Scholar
18 Andersson K, Odling V, Rybo G. Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception . 1994; 49 56-72

Crossref PubMed Search in Google Scholar
19 Mishell Jr D R. Intrauterine devices. In: Bardin CW, ed. Current Therapy in Endocrinology and Metabolism St. Louis: Mosby 1997: 285-292

Search in Google Scholar
20 Indian Council of Medical Research Task Force on IUD. Randomized trial with intrauterine devices (levonorgestrel intrauterine device (LNG), CuT 380 Ag, CuT 220C and CuT 200B): a 36-month study. Contraception . 1989; 39 37-52

Crossref PubMed Search in Google Scholar
21 Scholten P C. The Levonorgestrel IUD: Clinical Performance and Impact on Menstruation [dissertation]. Utrecht, The Netherlands: University Hospital of Utrecht 1989: 71-84

Search in Google Scholar
22 Luukkainen T, Allonen H, Haukkamaa M, Lähteenmäki P, Nilsson C G, Toivonen J. Five years' experience with levonorgestrel-releasing IUDs. Contraception . 1986; 33 139-148

Crossref PubMed Search in Google Scholar
23 Sivin I, El-Mahgoub S, McCarthy T. Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380Ag intrauterine devices: a five-year randomized study. Contraception . 1990; 42 361-378

Crossref PubMed Search in Google Scholar
24 Xiao B, Zeng T, Wu S, Sun H, Xiao N. Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual pattern after long-term use. Contraception . 1995; 51 359-365

Crossref PubMed Search in Google Scholar
25 Diaz J, Faundes A, Diaz M, Marchi N. Evaluation of the clinical performance of a levonorgestrel-releasing IUD, up to seven years of use, in Campinas, Brazil. Contraception . 1993; 47 169-175

Crossref PubMed Search in Google Scholar
26 Sivin I, Stern J, Coutinho E. Prolonged intrauterine contraception: a seven year randomized study of levonorgestrel 20 mcg/day (LNG 20) and copper Tcu 380Ag IUDs. Contraception . 1991; 44 473-480

Crossref PubMed Search in Google Scholar
27 Thiery M, Van der Pas H, Delberge W, Van Kets H. Das Levonorgestrel-Intrauterinpessar. Geburtsh Frauenheilk . 1989; 49 186-188

PubMed Search in Google Scholar
28 Cox M, Blacksell S. Clinical performance of levonorgestrel intrauterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 12 month report. Br J Fam Planning . 2000; 26 143-147

PubMed Search in Google Scholar
29 Sivin I. Dose- and age-dependent ectopic pregnancy risks with intrauterine contraception. Obstet Gynecol . 1991; 78 291-298

PubMed Search in Google Scholar
30 Croxatto H B, Ortiz M E, Valdez E. IUD Mechanisms of action. In: Bardin CW, Mishell DR Jr, eds. Proceedings from Fourth International Conference on IUDs Newton, MA: Butterworth-Heinemann 1994: 44-62

Search in Google Scholar
31 Rutanen E-M. Insulin-like growth factors and insulin-like growth factor binding proteins in the endometrium: effect of intrauterine levonorgestrel delivery. Hum Reprod . 2000 (suppl 3); 15 (173-181)

PubMed Search in Google Scholar
32 Mandelin E, Koistinen H, Koistinen R, Affandi B, Seppälä M. Levonorgestrel-releasing intrauterine device-wearing women express contraceptive glycodelin A in endometrium during midcycle: another contraceptive mechanism. Hum Reprod . 1997; 12 2671-2675

Crossref PubMed Search in Google Scholar
33 Pakarinen P, Luukkainen T, Laine H, Lähteenmäki P. The effect of local intrauterine levonorgestrel administration on endometrial thickness and uterine blood circulation. Hum Reprod . 1995; 10 2390-2394

PubMed Search in Google Scholar
34 Nilsson C G. Comparative quantitation of menstrual blood loss with a d-norgestrel-releasing IUD and a Nova-T-copper device. Contraception . 1977; 15 379-387

Crossref PubMed Search in Google Scholar
35 Scholten P C. The Levonorgestrel IUD: Clinical Performance and Impact on Menstruation [dissertation]. Utrecht, The Netherlands: University Hospital of Utrecht 1989: 35-46

Search in Google Scholar
36 Nilsson C G, Luukkainen T, Diaz J, Allonen H. Intrauterine contraception with levonorgestrel: a comparative randomized clinical performance study. Lancet . 1981; 1 577-580

PubMed Search in Google Scholar
37 Pakarinen P, Luukkainen T, Elomaa K. A 12-month comparative clinical investigation of a levonorgestrel-releasing intracervical device situated in the uterine cavity or cervical canal. Contraception . 1996; 54 187-192

Crossref PubMed Search in Google Scholar
38 Faundes A, Alvarez F, Diaz J. A Latin American experience with levonorgestrel IUD. Ann Med . 1993; 25 149-153

PubMed Search in Google Scholar
39 Irvine G A, Campbell Brown B M, Lumsden M A, Heikkilä A, Walker J J, Cameron I T. Randomized comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol . 1998; 105 592-598

PubMed Search in Google Scholar
40 Critchley H OD, Wang H, Jones R L. Morphological and functional features of endometrial decidualization following long-term intrauterine levonorgestrel delivery. Hum Reprod . 1998; 13 1218-1224

Crossref PubMed Search in Google Scholar
41 Jones R L, Critchley H OD. Morphological and functional changes in human endometrium following intrauterine levonorgestrel delivery. Hum Reprod . 2000; 15 162-172

PubMed Search in Google Scholar
42 Charnock-Jones D S, Macpherson A M, Archer D F. The effect of progestins on vascular endothelial growth factor, oestrogen receptor and progesterone receptor immunoreactivity and endothelial cell density in human endometrium. Hum Reprod . 2000; 15 85-95

PubMed Search in Google Scholar
43 Hurskainen R, Salmi A, Paavonen J, Rutanen E-M. Expression of sex steroid receptors and Ki-67 in the endometria of menoarrhagic women: effects of intrauterine levonorgestrel. Mol Hum Reprod . 2000; 6 1013-1018

Crossref PubMed Search in Google Scholar
44 Luukkainen T, Allonen H, Haukkamaa M. Effective contraception with levonorgestrel-releasing intrauterine device: 12 month report of an European multicenter study. Contraception . 1987; 36 169-179

Crossref PubMed Search in Google Scholar
45 Nilsson C, Allonen H, Diaz J. Two years' experience with two levonorgestrel-releasing intrauterine devices and one copper-releasing intrauterine device: a randomized comparative performance study. Fertil Steril . 1983; 39 187-192

PubMed Search in Google Scholar
46 Rönnerdag M, Odling V. Health effects of long-term use of the intrauterine levonorgestrel-releasing system. Acta Obstet Gynecol Scand . 1999; 78 716-721

Crossref PubMed Search in Google Scholar
47 Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception . 1992; 46 575-584

Crossref PubMed Search in Google Scholar
48 Luukkainen T, Allonen H, Nielsen N-C. Five year's experience of intrauterine contraception with Nova-T and Copper-T-200. Am J Obst Gynecol . 1983; 147 885-892

PubMed Search in Google Scholar
49 Senanayake P, Kramer D. Contraception and the etiology of pelvic inflammatory disease: new perspectives. Amer J Obstet Gynecol . 1980; 138 852-860

PubMed Search in Google Scholar
50 Shaaban M M, Segal S, Salem H T, Ghaneimah S A, Khalifa E A, Ahmed A G. Sonographic assessment of ovarian and endometrial changes during long-term Norplant use and their correlation with hormonal levels. Fertil Steril . 1993; 59 998-1002

PubMed Search in Google Scholar
51 Robinson G E, Bounds W, Kubba A A, Adams J, Guillebaud J. Functional ovarian cysts associated with the levonorgestrel releasing intrauterine device. R J Fam Plann . 1989; 14 131-132

PubMed Search in Google Scholar
52 Järvelä I, Tekay A, Jouppila P. The effect of a levonorgestrel-releasing intrauterine system on uterine artery blood flow, hormone concentrations and ovarian cyst formation in fertile women. Hum Reprod . 1998; 13 3379-3383

Crossref PubMed Search in Google Scholar
53 Pakarinen P I, Suvisaari J, Luukkainen T, Lähteenmäki P. Intracervical and fundal administration of levonorgestrel for contraception: endometrial thickness, patterns of bleeding, and persisting ovarian follicles. Fertil Steril . 1997; 68 59-64

Crossref PubMed Search in Google Scholar
54 Sivin I, Alvarez F, Diaz J. Intrauterine contraception with copper and with levonorgestrel: a randomized study of the Tcu380Ag and levonorgestrel 20 μg/D devices. Contraception . 1984; 30 443-456

Crossref PubMed Search in Google Scholar
55 Suhonen S, Holmström T, Lähteenmäki P. Three-year follow-up of the use of a levonorgestrel releasing intrauterine system in hormone replacement therapy. Acta Obstet Gynecol Scand . 1997; 76 145-50

PubMed Search in Google Scholar
56 Palinkas L A, Barrett-Connor E. Estrogen use and depressive symptoms in postmenopausal women. Obstet Gynecol . 1992; 80 30-36

PubMed Search in Google Scholar
57 Meirik O, Farley T MM, Sivin I. Safety and efficacy of levonorgestrel implant intrauterine device and sterilization. Obstet Gynecol . 2001; 97 539-547

Crossref PubMed Search in Google Scholar
58 Vercellini P, Aimi G, Panazza S, De Giorgi O, Pesole A, Crosignani P G. A levonorgestrel-releasing intrauterine system for the treatment of dysmenorrhea associated with endometriosis: a pilot study. Fertil Steril . 1999; 72 505-508

Crossref PubMed Search in Google Scholar
59 Sivin I, Stern J. Health during prolonged use of levonorgestrel 20 mug/D and the copper TCu 380Ag intrauterine contraceptive devices. Fertil Steril . 1994; 61 70-77

PubMed Search in Google Scholar