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  • Title: Hormonal intrauterine devices.
    Author: Rybo G, Andersson K, Odlind V.
    Journal: Ann Med; 1993 Apr; 25(2):143-7. PubMed ID: 8489751.
    Abstract:
    Intrauterine administration of progestogens from an IUD was introduced more than 15 years ago in order to improve the contraceptive efficacy and to reduce side-effects. A device releasing 20 micrograms levonorgestrel daily (Levonova) with a life span of at least 5 years is now available and has been subjected to an extensive study including 1821 women followed during 5 years. The safety and efficacy were evaluated in comparison to Cu-T IUDs. The pregnancy rate (Pearl index) was 0.09. During the first two cycles after insertion intermenstrual bleeding was common, otherwise the frequency of side-effects was low. The results seem to justify the conclusion that intrauterine administration of progestogens represents a further development of IUDs and hormonal contraception. Furthermore, these devices have proven to be effective in treatment of heavy menstrual blood losses. In many menorrhagic women, use of these IUDs can replace more invasive surgical methods such as hysterectomy or endometrial resection. Intrauterine administration of progestogens is also effective in opposing the proliferative effect of oestrogen on the endometrium in women on hormonal replacement therapy. The levonorgestrel (LNg) IUD releases 20 mcg LNg/day and protects against pregnancy for 5 years (Pearl index = 0.1/100 women years of use). Its mode of action is reduced amount of cervical mucus and suppression of the endometrium. A multicenter study in Denmark, Finland, Hungary, and Sweden comparing the LNg IUD and the Nova T IUD found the 5-year continuation rate of the LNg IUD to be 46.9% (44.5% for Nova T). The leading reasons for LNg IUD removal at 5 years were planning pregnancy (15.2%), bleeding (13.7%), and hormonal reasons (11.9%). Bleeding disturbances occurred significantly less often in the LNg IUD users than in the Nova T users (13.7% vs. 20.7%; p = .002). Since LNg has a strong effect on endometrium suppression, LNg IUD users were more likely to quit using the IUD due to amenorrhea than Nova T users (6% vs. 0; p = .0001). The cumulative gross expulsion rate after 5 years was 5.8. Termination for genital infections was more likely in Nova T users than LNg IUD users, especially when the infections were pelvic inflammatory disease (2.2% vs. 0.8%; p .01) and endometritis (4% vs. 1.5%; p .01). Hormonal side effects were acne, hirsutism, weight changes, mood changes, breast tenderness, nausea, and headache. Women in the LNg IUD group experienced return to fertility at a higher rate than those in the Nova T group (79.1% at 12 months and 86.6% at 24 months vs. 71.2% and 79.7%, respectively), but the differences were not significant. Progestin-releasing IUDs can be used to treat menorrhagia, thereby making them an alternative to hysterectomy or endometrial resection. The LNg IUD reduced menstrual blood loss by 86% at 3 months and by 97% at 12 months in women with menorrhagia, resulting in an increase in hemoglobin and serum ferritin. This IUD also effectively opposes the proliferative effect of estrogen on the endometrium in women on hormonal replacement therapy.
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