Continuation rates of levonorgestrel intrauterine device (Mirena) inserted
for non-contraceptive reasons after 6 months use
A.K. Abraham, S Radhakrishnan
Royal Free Hospital, London,, United Kingdom
Objective To determine the continuation rates of Levonorgestrel
intrauterine device inserted for non contraceptive reasons and evaluate
tolerability and efficacy of this device in the long term management of
gynaecological problems such as menorrhagia, dysmenorrhoea and as progesterone
arm of HRT
Methods Study was conducted on patients referred to tertiary hospital,
family planning clinic. This was a retrospective study conducted between January
2004 and December 2005. 46 case notes were reviewed at 6 weeks and 6 months
follow up. The inclusion criteria were patients with menstrual problems related
to 1) DUB and other pathologies like fibroids, endometriosis 2) Simple/cystic
hyperplasia 3) Pelvic pain 4) progesterone arm of HRT.
Results At 6 weeks follow up10 out of 46(24%) did not attend and at 6
months 22 out of 44(50%) were lost to follow up. 48% of those that retained the
coil were in the age group 41-50 at 6 weeks and 18%at 6 months, compared to age
group 21-30 of which 7% retained their coil at 6 weeks and none at 6 months.
Reasons for removal at 6 months were unacceptable bleeding in 25%, opting out
for alternate treatment in12%, expulsion or near expulsion in 25%, lower limb
oedema and puffiness in12%.
Discussion While a good option for management of menorrhagia, and as
progesterone component of HRT, removal rates(including expulsion) of 22% suggest
that more needs to be done before offering the Mirena coil as an alternative.