A US multicenter open-label trial with the levonorgestrel-releasing intrauterine system — clinical and device-related experience

Costales, Antonio C.; Jensen, Jeffrey T.; Nelson, Alice; Korner, P.; Uddin, MM

doi:10.1016/j.contraception.2006.05.003

Cited by 2 publications

(3 citation statements)

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“…33 Thorough counseling about expected changes in bleeding patterns before IUD insertion correlates with satisfaction and continuation rates after 1 year of use. 39 A Finnish survey of over 16,000 women using the LNG-IUS found high continuation rates at 1 to 5 years: 93%, 87%, 81%, 75% and 65%, respectively. Rates were lowest for the 18-to 32-year age group and highest for the 39-to 48-year age group.…”

Section: Return To Fertilitymentioning

confidence: 99%

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Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS

Bednarek

Jensen²

2009

IJWH

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Intrauterine devices (IUDs) provide highly effective, long-term, safe, reversible contraception, and are the most widely used reversible contraceptive method worldwide. The levonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped IUD with a steroid reservoir containing 52 mg of levonorgestrel that is released at an initial rate of 20 µg daily. It is highly effective, with a typical-use first year pregnancy rate of 0.1%-similar to surgical tubal occlusion. It is approved for 5 years of contraceptive use, and there is evidence that it can be effective for up to 7 years of continuous use. After removal, there is rapid return to fertility, with 1-year life-table pregnancy rates of 89 per 100 for women less than 30 years of age. Most users experience a dramatic reduction in menstrual bleeding, and about 15% to 20% of women become amenorrheic 1 year after insertion. The device's strong local effects on the endometrium benefit women with various benign gynecological conditions such as menorrhagia, dysmenorrhea, leiomyomata, adenomyosis, and endometriosis. There is also evidence to support its role in endometrial protection during postmenopausal estrogen replacement therapy, and in the treatment of endometrial hyperplasia.

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Section: Return To Fertilitymentioning

confidence: 99%

“… 33 Thorough counseling about expected changes in bleeding patterns before IUD insertion correlates with satisfaction and continuation rates after 1 year of use. 39 …”

Section: Acceptabilitymentioning

confidence: 99%

Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS

Bednarek

Jensen²

2009

IJWH

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“…The expulsion rate associated with interval insertion of T-shaped IUDs is approximately 1–4.5% in the first year. 8–10 Postplacental insertion has an expulsion rate ranging from 6% to 20% for T-shaped IUDs over 1 year. 11–14 The expulsion rate is lower for immediate postplacental compared with early (11 minutes to 72 hours) postpartum insertion and is also lower when skilled health care providers insert the IUD.…”

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confidence: 99%

Postplacental or Delayed Insertion of the Levonorgestrel Intrauterine Device After Vaginal Delivery

Chen

Reeves

Hayes

et al. 2010

Obstetrics & Gynecology

168

115

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OBJECTIVE To estimate whether 6-month use of the levonorgestrel-releasing intrauterine device (IUD) would be higher when insertion occurred within 10 minutes of placental delivery compared with 6–8 weeks postpartum. METHODS We enrolled pregnant women planning vaginal deliveries and desiring a postpartum levonorgestrel-releasing IUD. Patients were randomly assigned when admitted in labor to postplacental or delayed IUD insertion. The women followed up in person at 6–8 weeks and 6 months and were contacted by telephone at 3 months. Women were ineligible for a study IUD postenrollment for intrapartum events including infection, hemorrhage, and cesarean delivery; these women were contacted by phone at 3 and 6 months. Expelled IUDs were replaced per patient preference. RESULTS Successful IUD placement occurred in 50 of 51 participants (98.0%) and 46 of 51 participants (90.2%) in the postplacental and delayed groups, respectively (P=.2). Expulsion within 6 months occurred in 12 of 50 (24.0%; 95% confidence interval [CI], 13.1–38.2) and two of 46 (4.4%; 95% CI 0.5–14.8) participants, respectively (P=.008). Intrauterine device use at 6 months was 43 of 51 (84.3%; 95% CI 71.4–93.0) and 39 of 51 (76.5%; 95% CI 62.5–87.2), respectively (P=.32). For ineligible patients, only 11 of 41 (26.8%) women were using IUDs at 6 months and two (4.9%) had become pregnant. CONCLUSION Intrauterine device use 6 months after delivery is similar in women who have postpartum or scheduled delayed IUD placement through a study after replacement of expelled IUDs. Expulsions are significantly higher with postplacental compared with delayed IUD placement. Women asked to follow up with their own health care providers for delayed insertion are significantly less likely to receive an IUD. CLINICALTRIALREGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT00476021. LEVEL OF EVIDENCE I

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A US multicenter open-label trial with the levonorgestrel-releasing intrauterine system — clinical and device-related experience

Cited by 2 publications

References 0 publications

Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS

Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS

Postplacental or Delayed Insertion of the Levonorgestrel Intrauterine Device After Vaginal Delivery

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