Insertion Of LNG-IUS Research Articles

Does Timing of Levonorgestrel Insertion in Women with Abnormal Uterine Bleeding Affect its Expulsion and Bleeding Pattern? A Follow-Up Study.

Levonorgestrel Intra Uterine System insertion for contraception is preferred in the follicular phase. However, the ideal time of insertion for Abnormal Uterine Bleeding is not stated clearly. The aim of our study is to find out the effect of timing of insertion on expulsion and irregular bleeding pattern post insertion. A follow-up study of patients with LNG-IUS for AUB was conducted. They were grouped into four based on the day of insertion from Last Menstrual Period (LMP). The pattern of irregular bleeding post insertion was compared with odds ratio and the expulsion rate was compared with log rank test. The most common indication for the 76 patients was ovulatory dysfunction (39.4%) followed by Adenomyosis (36.84%). Those who had LNG-IUS insertion from day 22-30 had quicker expulsions of 25% of patients by 3 months. By 6 months and later expulsion rate was much higher in the luteal phase than the follicular phase (p < 0.03). The least risk of moderate or heavy bleeding was for the 8-15day group when compared to the 22-30day group, the odds ratio being 0.03 [95% CI: (0.01-0.2)]. Based on expulsion rate alone, insertion of LNG-IUS at any time in the follicular phase is ideal. Considering both expulsion rate and pattern of bleeding the ideal time would be late follicular phase, that is 8-15th day.

Postplacental Insertion of Levonorgestrel Intrauterine System Versus Copper Intrauterine Device: A Prospective Study.

To compare between postplacental insertion of levonorgestrel intrauterine system versus copper intrauterine device regarding expulsion rates, patient satisfaction, complications, and continuation rates. This prospective observational study was conducted on 1100 participants divided in to two groups: group (1) CU-IUD group and group (2) LNG-IUS group where women were assigned for postplacental insertion of either CU-IUD or LNG-IUS, respectively. Follow-up at 6weeks, 3 and 6months postpartum and data were collected and analyzed to evaluate outcomes. No statistical difference between both groups regarding patients' characteristics, the overall expulsion rate was higher in LNS-IUS group than CU-IUD group; 77 patients (14%) and 50 patients (9%), respectively, (P value < 0.05), odds ratio: 1.63 at CI: (1.12-2.37). No significant difference between the two groups regarding pain intensity, perforation, abnormal uterine bleeding, and clinical endometritis (P > 0.05). Overall satisfaction rate at six months was 478(87%) in the CU-IUD group and 472(85.8%) in the LNS-IUS group (P value > 0.05), odds ratio: 1.1 at CI: (0.78-1.55). Continuation rate at s6 months was comparable between the two groups 485 (88.2%) and 480 (87.3%) in CU-IUD group and LNS-IUS group respectively, (P value < 0.05), odds ratio: 1.09 at CI: (0.76-1.56). The rate of expulsion of LNG-IUS is higher than copper IUD when inserted postplacental, yet the continuation and acceptability rates were comparable between the two groups.

Twelve-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg and subdermal etonogestrel implant in women aged 18–44: A retrospective claims database analysis

ObjectiveTo investigate the 12-month discontinuation rates of levonorgestrel intrauterine system 13.5 mg (LNG-IUS 13.5) and subdermal etonogestrel (ENG) implant in the US. Study DesignWe identified women aged 18–44 who had an insertion of LNG-IUS 13.5 or ENG implant from the MarketScan Commercial claims database (7/1/2013–9/30/2014). Women were required to have 12 months of continuous insurance coverage prior to the insertion (baseline) and at least 12-months after (follow-up). Discontinuation was defined as presence of an insurance claim for pregnancy-related services, hysterectomy, female sterilization, a claim for another contraceptive method, or removal of the index contraceptive without re-insertion within 30 days. Using Cox regression we examined the potential impact of ENG implant vs. LNG-IUS 13.5 on the likelihood for discontinuation after controlling for patient characteristics. ResultsA total of 3680 (mean age: 25.4 years) LNG-IUS 13.5 and 23,770 (mean age: 24.6 years) ENG implant users met the selection criteria. Prior to insertion, 56.6% of LNG-IUS 13.5 and 42.1% of ENG implant users had used contraceptives, with oral contraceptives being most common (LNG-IUS 13.5: 42.1%; ENG implant: 28.5%). Among users of LNG-IUS 13.5 and ENG implant, rates of discontinuation were similar during the 12-month follow-up (LNG-IUS 13.5: 24.9%; ENG implant: 24.0%). Regression results showed that women using LNG-IUS 13.5 vs. ENG implant had similar likelihood for discontinuation (hazard ratio: 0.97, 95% confidence interval: 0.90–1.05, p=.41). ConclusionIn the real-world US setting, women aged 18–44 using LNG-IUS 13.5 and ENG implant have similar discontinuation rates after 12 months. ImplicationsIn the United States, women aged 18–44 using levonorgestrel intrauterine system (13.5 mg) and subdermal etonogestrel implant have similar discontinuation rates after 12 months.

The Effect of Levonorgestrel-releasing Intrauterine System (Mirena®) on the Mammographic Density and Breast Ultrasonographic Findings in Korean Premenopausal Women

Objectives: The aim of the present study was to investigate the influence of levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) on the mammographic density, mammographic findings and breast ultrasonographic findings in Korean premenopausal women. Methods: We reviewed medical records of 639 premenopausal women, who inserted LNG-IUS in our department from 20002011. Among these, 46 women, who underwent regular mammography (MMG) or breast ultrasonography (USG) examination in radiology department before and after insertion of the LNG-IUS after establishment of picture archiving and communication system (PACS) system in our hospital were finally included in this analysis. We compared the findings of MMG and breast USG between preand post-insertion of LNG-IUS. We also checked the pathologic results of any breast biopsy performed in these study participants. The Cochran-Armitage trend test was used to investigate the changes preand postinsertion of LNG-IUS. Results: The mean age of participants was 42.3 ± 4.9 years and the mean interval period for MMG and US follow-up (FU) was 25.5 ± 10.8 months and 25.2 ± 11.5 months, respectively. The density of MMG before insertion of LNG-IUS correlated well with the FU MMG density. The findings of MMG and US also correlated well before and after insertion of LNG-IUS. There was no case of breast cancer among women who were supposed to undergo breast biopsy because of abnormal findings in MMG and US. Conclusion: The use of LNG-IUS did not cause any changes in MMG density, findings of MMG, and findings of breast USG in healthy premenopausal Korean women. (J Korean Soc Menopause 2012;18:187-192)

OP17.04: Accuracy of transvaginal sonography in the diagnosis of deep posterior endometriosis

adenomyosis were enrolled into the study. All the patients underwent before and at least three months after insertion of the LNG-IUS, a detailed transvaginal sonography which evaluates: uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, asymmetric myometrium, presence of myometrial hyperechoich striation, vascularization of the myometrial lesions and accurate mapping of the localisation of the myometrial alterations. A comparison between dimensions and presence of these different signs of adenomyosis before and after insertion of LNG-IUS was performed. Results: Seven patients (58.3%) become amenorrhoic and the other patients referred a significantly reduction in menstrual bleeding. Dysmenorrhea was completely relieved or significantly alleviated in all patients. We observed a significant decrease in uterine volume (716.9 ± 213.8 ml vs. 520.6 ± 148.3 mL). However sonographic signs of adenomyosis such as myometrial cystic areas, asymmetric myometrium, or presence of myometrial hyperechoich striation does not disappear, some decrease in size but not significantly. Conclusion: After insertion of the LNG-IUS in patients with adenomyosis, uterine volume decrease and symptoms relieved or were significantly alleviated. However sonographic sign of adenomyosis seems not to disappear completely. A long term followup during and after treatment could be useful to understand the therapeutic role on adenomyosis of LNG-IUS.

Continuous combined parenteral estrogen substitution and intrauterine progestogen delivery: the ideal HST combination?

Objective: To evaluate ease of insertion, acceptability and endometrial safety of a novel, miniature intrauterine, T-shaped, levonorgestrel (LNG)-releasing intrauterine system (IUS), Femilis™ Slim LNG-IUS (Contrel Research, Belgium), combined with parenteral estrogen substitution therapy (EST) in postmenopausal women. Design: A prospective, non-comparative, study in postmenopausal women. A 3.0 cm long and 2.0 mm wide coaxial fibrous delivery system, delivering approximately 20 μg/day of levonorgestrel (LNG) was used. The drug compartment is provided with crossarms fixed to the upper part of the drug delivery rod. The calculated duration of release of the system is at least 5 years. The majority of women received percutaneous 17β estradiol (Oestrogel ®, Besins Int., Belgium), 1.5 mg daily on a continuous basis, which provides sufficient blood levels of estrogen in most women to suppress climacteric symptoms and protection against bone loss. Primary outcome measures: ease of insertion, retention and side effects of the T-LNG Slim IUS. Secondary outcome measures: endometrial safety assessed by transvaginal ultrasound examination and by endometrial biopsy in a subset of women. Results: One hundred and seventy insertions were performed in postmenopausal women with median age of age 56.6 (range 43.5–80.3). Insertion was easy in 161 (94.2%) and difficult in 9 (5.3%) women. Pain at insertion was rated as none in 57 women (33.5%), mild in 105 (61.7%), moderate in 7 (4.1%) and severe in 1 (0.5%) woman. The system was well retained in the uterus as no expulsions occurred. At the time of study analysis, the total number of women-months was 1797.5. Ninety-five women had the T-LNG-IUS in place for periods in excess of 1 year. The study was well followed-up with lost-to-follow-up rate (defined as no follow-up during 12 months) of zero at the time of study analysis. The number of women continuing the method was 160 (94.1%) including four women which were released from follow-up for various non-medical related reasons. The histological examinations conducted in 105 women showed predominantly inactive endometrium characterized by a pseudo-decidual reaction of the endometrial stroma with endometrial atrophy. The mean thickness (double-layer) of the endometrium was 3.3 mm (range 2–5 mm) which correlated well with the histology results. Conclusions: The results suggest that the small T-LNG-IUS is easy to insert in most postmenopausal women without anaesthesia and dilatation of the cervix. It is well tolerated, well accepted and effective in suppressing the endometrium during EST. The lack of expulsions of the device in this study is attributed to the optimal design characteristics of the IUS, the absence of uterine bleeding and absent or reduced contractility of the uterus. The study confirms earlier studies conducted with other LNG-releasing systems used for endometrial suppression during EST. The ease of insertion of the small LNG-IUS could be an important incentive to expand the use of the continuous combined regimen with local delivery of the progestogen. It could be a method of choice for endometrial suppression in women using EST with fundamental advantages to systemically applied progestogens which have been the subject of considerable debate as reported in the recent literature.

A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy

Objective: To investigate endometrial histology, bleeding, and the effects of replacing the levonorgestrel intrauterine system (LNG IUS, Mirena/Levonova, Leiras Oy, Turku, Finland) after 5 years of combined use with estrogen. Design: Prospective cohort study. Setting: Private outpatient clinic. Patient(s): Forty postmenopausal women started hormone replacement therapy with LNG IUS and either a patch (50 μg/24 h) or oral (2 mg) estradiol valerate protocol. Thirty-nine completed 12 months of treatment. Twenty-nine of them had used LNG IUS with continuous estradiol replacement therapy for 5 years. Seven of them volunteered to a 3-month treatment-free period before reinsertion; 22 opted for immediate reinsertion. Intervention(s): Endometrial sampling for histology, endometrial thickness, and location of the LNG IUS by ultrasound at removal and after washout. The women completed bleeding diaries from 3 months prior to removal to 3 months after reinsertion. Main Outcome Measure(s): Endometrial histology was evaluated and estrogen and progestin effects were also investigated. Endometrial thickness was measured. Bleeding was examined based on bleeding diaries. The investigator and the women evaluated the insertion, removal, and reinsertion of the LNG IUS. Result(s): At 6 and 12 months endometrial histology was nonproliferative. At removal, all endometria were suppressed and a strong progestin effect was seen. The thickest endometrium was 3.6 mm. After washout, all seven endometria were atrophic. Before the IUS was replaced, 26 women were amenorrheic, whereas three had minor spotting. After replacement 5 women had no bleeding and an additional 10 women had only spotting. The bleeding or spotting discontinued within 18 days. The insertion of LNG IUS was characterized as easy by the investigator and it was well tolerated by the women. Cervical dilatation and/or paracervical blockade was used in 10 insertions. Conclusion(s): Intrauterine levonorgestrel effectively protects against endometrial hyperplasia. In most women it induces amenorrhea, which is only temporarily affected by replacement of the LNG IUS.