Levonogestrel-releasing intrauterine devices: clinical experience and
acceptability
M. Díaz-Vega, S. Repolles, L. Ornat, J.V. Gonzalez-Navarro
Department of Obstetrics and Gynaecology, University Clinic of Zaragoza,
Spain
Introduction: New contraceptive methods usually raise expectation and
queries to the contraception specialist. The levonogestrel- releasing
intrauterine device, despite being widely known, generates uncertainties with
respect to its handling and acceptability because the introductor is different
and the device involves a drug (levonogestrel).
Methods: We have analysed insertion problems and indications,
acceptability and adverse side effects of the levonogestrelreleasing device (LNG-IUD).
Five hundred women received LNG-IUD between 2001 and 2003 in our family planning
center. The troubles getting insertion was stratified in three groups: ‘easy’,
‘moderate’ and ‘difficult’. ‘Easy’ was reported when the
intrauterine device was inserted on the first or second attempts; ‘difficult’,
when the insertion was not possible or dilation of the cervical hole was
necessary; and ‘moderate’ difficulty when the insertion was between the two
other situations. The insertion indications were contraception, menorrhagia, and
perimenopausal women carrying IUD or with myoma or endometrium hyperplasia.
Benefits and troubles of LNG-IUD were explained to every woman and an ultrasound
examination was performed after the first menstruation. We investigated the
long-term acceptability of LNG-IUD in 180 women after six months of use and
asked them about pain, spotting, menstruation, satisfaction, and improvement.
Results: The women’s mean age for insertion of the LNG-IUD was 36.0
(17–49) years old. Insertion was ‘easy’ in 477 (95.4%) women and of ‘moderate’
difficulty or ‘difficult’ in 17 cases (4.6%). Only in 4 cases was the
insertion of LNG-IUD found to be impossible. In 307 cases (85.2%), the most
frequent indication was contraception, being in the 23.8% of the cases in
menorrhagia of IUD carriers. In 28 cases (5.6%) insertion was prescribed as a
result of menorrhagia, in 25 cases (5%) due to perimenopausal troubles and in 21
cases (4.2%) due to organic pathology (myoma or endometrial hyperplasia). In 286
cases, women had not previously used an IUD. In 4 cases women had experienced
spontaneous lost, in 6 cases the IUD had moved towards the cervix, and in 3
cases the IUD had moved into the abdominal cavity, which required laparoscopy
surgery for extraction. After 6 months, 10% of the women had pain and 4.4% of
the women showed spotting for over 3 months. Menstrual bleeding had decreased in
the 92% of the cases, and after 6 months from insertion 77.8% of the women were
very satisfied with the LNGIUD.
Conclusions: The levonogestrel-releasing intrauterine device is the
contraceptive system of choice in women over 35 years old due to the ease of
insertion, the changes in the menstrual bleeding pattern and the acceptability
for the LNG-IUD of the user women.
