Levonogestrel-releasing intrauterine devices: clinical experience and acceptability

Levonogestrel-releasing intrauterine devices: clinical experience and


M. Díaz-Vega, S. Repolles, L. Ornat, J.V. Gonzalez-Navarro

Department of Obstetrics and Gynaecology, University Clinic of Zaragoza,


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.

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