Levonorgestrel-Releasing Intrauterine System as a Contraceptive Method in Nulliparous Women: A Systematic Review

Abstract

<jats:p>The aim of this review was to summarize the available evidence about the use of levonorgestrel-releasing intrauterine system (LNG-IUS) as a contraceptive method in nulliparous women. For this purpose, studies evaluating the efficacy, safety, bleeding pattern, satisfaction and discontinuation of the levonorgestrel-releasing intrauterine system in nulliparous women were analyzed. Only original research articles published in English between 1990–27th March 2020 were considered eligible. Reviews, book chapters, case studies, conference papers, opinions, editorials and letters were excluded. The systematic literature search of PubMed/MEDLINE, Scopus, Embase and Cochrane Library databases identified 816 articles, 23 of which were analyzed. The available evidence indicates that LNG-IUS is an effective and safe contraceptive method for nulliparous women that achieves high levels of satisfaction among patients. Moreover, nulliparous women seem to experience fewer expulsions than parous ones. Bleeding pattern is acceptable for the majority of patients, and bleeding disorders mainly occur in the first months after the insertion. More in-depth, long-term prospective studies are needed in this patient group to determine risk factors for the occurrence of side effects and associated discontinuations, which should not, however, delay the wider use of the method in this group, given the number of advantages.</jats:p>

Expulsion and continuation rates of the levonorgestrel 52 mg intrauterine system was similar among nulligravid and parous users

“…19 However, this systematic review included older studies and several types of cooper IUDs, which differs from our study which only included LNG-IUSs. More recent articles included in two systematic reviews 10,13 also showed conflicting results, with equivalent or lower rates of IUD expulsion in nulliparous women compared to parous participants.…”

“…The most common reasons for discontinuation were expulsion, bleeding, pain and planning to pregnancy. 10 In one study with 253 parous and nulliparous users aged between 21 and 40 years old, the continuation rates of LNG-IUS were 90% and 81% for parous and 73% and 68% for nulliparous users by the first and second years of the use. 14 In other study with two low-dose of LNG-IUS, the continuation rate was significantly higher in parous participants in the first year of follow up, but there were no differences according to the parity after 3 years.…”

Intrauterine device use is safe among nulligravidas and adolescent girls

“…The contraceptive failure rate of the LNG‐IUS (independent of the difference in brands and in the quantities of LNG released) was 0.1‐0.3/100 W‐Ys and was not associated with age and parity (adolescents vs adults and parous vs nulliparous status) 17‐19,23 . A systematic review reported a Pearl Index of 0.1/100 W‐Ys in nulliparas 24 …”

“…The rates for the LNG-IUS, is 0.1-0.2/100 W-Ys and not related to women being parous or nulliparous; 23 A systematic review reported rates in LNG-IUS nulliparous women of 0.1/100 W-Ys. 24 Expulsion Rate was 2.0% in nulliparous and 5.6% in parous women (p < .0001); 43 With the LNG-IUS 8 and LNG-IUS 13 the rate was higher in parous than in nulliparous women (p = .000) with a crude rate of 4.2% up to 3 y; 18 Data with Cu-IUD and the LNG-IUS, the rates were similar among nulliparous and parous women 14-19 y old (18.7/100 vs 18.9, respectively; p = .47); 39,55 Less expulsions among nulligravidas (2.1%) when compared to parous (6.0%) women (p < .001); 42 No differences between parous and nulliparous women. 18 Bleeding/pain Removals among nulligravidas was 1.5; SE 1.0 W-Ys and among parous women was 2.1; SE 0.7 W-Ys; 23…”

Empowering women through expanded contraceptive access in Nigeria and Zambia

“…2 In highincome countries, satisfaction with the hormonal intrauterine device is high; it is viewed as having both contraceptive and non-contraceptive benefits, including lighter menstrual periods and less menstrual pain. 3 However, research on long-acting reversible contraceptives in LMICs remains scarce, and hence the study by Aurélie Brunie and colleagues 4…”