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  • Title: Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual pattern after long-term use.
    Author: Xiao B, Zeng T, Wu S, Sun H, Xiao N.
    Journal: Contraception; 1995 Jun; 51(6):359-65. PubMed ID: 7554977.
    Abstract:
    In the present study 14 women after 6 years' use of levonorgestrel-releasing IUD were investigated for the changes of LH, progesterone (P), estradiol (E2), prolactin (PRL) and serum binding globulin (SHBG) in relation to the levonorgestrel levels throughout a segment of 26-40 days with the aim of comparing the hormonal profiles with those during the first year of use of Lng-IUD. Ultrasound scanning was used to follow the development of follicles along with the RIA measurement of hormones. The results of serum LH, P and E2 showed ovulation in 11 cases with either normal menstrual cycles (5 cases), prolonged or irregular cycles (4 cases) or with amenorrhea for 2-3 years (2 cases). One case showed insufficiency of luteal function and 2 cases showed anovulation but with follicular hyperactivity. Higher percentages of ovulatory cycles (78.5%) were found after 6 years of use. No case of complete suppression of ovulation was found. Anovulatory cycles only constituted 14.3%. Clinically, the development of follicles followed by ultrasound scanning further confirmed the hormonal findings. The persistent enlargement of follicles coincided with high levels of E2. After 6 years of use, the serum levels of levonorgestrel were still maintained at mean levels of 314.26 pmol/L and 470.63 pmol/L in the ovulatory and anovulatory groups, respectively. It is concluded that over two-thirds of the cases have ovulatory cycles after long-term use of Lng-IUD; the contraceptive effect is mainly due to its local action on the endometrium, with much less effect on the ovarian function. In 1993 in China, 14 women who had used a levonorgestrel [LNG]-releasing (20 mcg/day) IUD since 1987 underwent a medical check-up so that the National Research Institute for Family Planning in Beijing could study their hormonal profile along with their menstrual pattern and their follicular cyclic changes. Health workers drew blood samples three times/week, beginning with the fifth day of the menstrual cycle or, in cases of amenorrhea, after recruitment. They were followed for 26-40 days. Ultrasound recorded cyclic changes of ovarian follicles. The women recorded days of vaginal bleeding or spotting on a menstrual diary card. The serum levels of luteinizing hormone (LH), estradiol (E2), and progesterone (P) of 11 women were normal, indicating that they had ovulatory cycles. Three women (14.3%) did not ovulate. One anovulatory woman exhibited an insufficiency in luteal function. LH and P were suppressed and E2 levels were very high in the other two women, indicating follicular hyperactivity. Ultrasound confirmed the development of follicles as indicated by hormone levels. High levels of E2 were associated with persistent enlargement of follicles. Serum levels of LNG were still at a stable level after six years of use, with anovulatory women having higher levels than ovulatory women (470.63 vs. 314.26 pmol/L; p 0.001). These stable levels after six years' use suggest that the LNG-IUD could be effectively used for another 2-3 years. These findings suggest that the LNG-IUD has a minimal effect on ovarian function since 78.5% of users have ovulatory cycles after six years' use. Local action on the endometrium is largely responsible for its contraceptive effect.
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