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Introduction: Endometrial hyperplasia is associated with varying risk of endometrial cancer. The aim of this review is to assess effectiveness of levonorgestrel-releasing intrauterine system (LNG-IUS), compared to systemic progestins, in management of endometrial hyperplasia MATERIALS AND METHODS: A search on studies comparing LNG-IUS to systemic progestins was conducted on Scopus, Web of science, Cochrane, PubMed and Embase databases, from the date of inception to September 20 th , 2020. Studies were excluded if they were non-comparative, animal studies, review articles, case reports, case series, and conference papers. Primary outcomes include resolution/regression rate, failure rate, and hysterectomy rate. Analysis was pooled using random effect model and was expressed as pooled odds ratios (OR) and 95% confidence interval (CI). Quality assessment was performed using Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale (NOS) assessment tool. MOGGE Meta-analysis Matrix was used to illustrate multiple subgroup analyses., Results: Out of 341 studies retrieved from literature search, 12 were eligible. LNG-IUS yielded significantly higher resolution/regression rate (91.3% vs 68.6%, OR 3.42, 95% CI 1.86-6.30). Failure and hysterectomy rates were significantly lower in LNG-IUS group compared to systemic progestins' group (19.2% vs. 32.3%, OR 0.34, 95% CI 0.20-0.57 and 9.3% vs. 24.1%, OR 0.41, 95% CI 0.29-0.57, respectively). Subgroup analysis of studies including complex hyperplasia only did not show significant difference in resolution/regression rate was not statistically significant., Conclusion: LNG-IUS is associated with high success rate in management of women with endometrial hyperplasia. However, specific effectiveness of LNG-IUS on more advanced histologic subtypes is less studied., Competing Interests: Declaration of Competing Interest None, (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

STUDY QUESTION What are the regression and hysterectomy rates for women treated with the levonorgestrel-releasing intrauterine system (LNG-IUS) compared with oral progestogens for endometrial hyperplasia (EH)? SUMMARY ANSWER The LNG-IUS achieves higher regression and lower hysterectomy rates than oral progestogens in the treatment of complex and atypical hyperplasia. WHAT IS KNOWN ALREADY The LNG-IUS and oral progestogens are both equally used to treat women with EH. There is uncertainty about whether the LNG-IUS is a better therapy for EH. STUDY DESIGN, SIZE, DURATION This comparative cohort study included 344 women recruited from August 1998 until December 2010. PARTICIPANTS/MATERIALS, SETTING, METHODS Women with complex non-atypical or atypical EH were treated with the LNG-IUS (n = 250) or oral progestogens (n = 94) in a tertiary referral hospital. We evaluated the proportion of women who regressed or underwent hysterectomy after treatment with the LNG-IUS compared with oral progestogens by logistic regression adjusting for confounding. The time from diagnosis to regression was explored through a survival analysis. MAIN RESULTS AND THE ROLE OF CHANCE The follow-up rate was 95.3%. The mean length of follow-up in the two groups was 66.9 ± SD 35.1 months for the LNG-IUS and 87.2 ± SD 45.5 months for the oral progestogen group. Regression of hyperplasia was achieved in 94.8% (237/250) of patients with the LNG-IUS compared with 84.0% (79/94) of patients treated with oral progestogens (adjusted odds ratio (OR) = 3.04, 95% CI 1.36–6.79, P = 0.001). Hysterectomy rates were lower in the LNG-IUS group during follow-up (22.1, 55/250 versus 37.2%, 35/94, adjusted OR = 0.48, 95% CI 0.28–0.81, P < 0.004). Endometrial cancer was diagnosed in 8 (33%) women who had hysterectomy because of a failure to regress to normal histology during follow-up (n = 24). LIMITATIONS, REASONS FOR CAUTION The observational design cannot exclude residual confounding from unmeasured variables. WIDER IMPLICATIONS OF THE FINDINGS In treating EH, LNG-IUS achieves higher regression rates and lower hysterectomy rates than oral progestogens and should be the first-line therapy. Failure to achieve regression carries a high risk of underlying endometrial cancer and hysterectomy is advised. [ABSTRACT FROM PUBLISHER]

Abstract: Objective: To compare the diagnostic accuracy of dilatation & curettage (D&C) vs. endometrial aspiration biopsy in follow-up evaluation of patients treated with high-dose oral progestin plus levonorgestrel intrauterine system (LNG-IUS) for early-stage endometrial cancer (EC). Method: A prospective observational study was conducted with 11 patients with FIGO grade 1 or 2, clinical stage IA endometrioid adenocarcinoma. Patients were aged up to 40years wishing to preserve fertility treated with high-dose oral progestin plus LNG-IUS. Treatment response assessment was done at three month intervals. Endometrial tissues were obtained via endometrial aspiration biopsy with LNG-IUS in place and D&C after removal of LNG-IUS. We identified 28 cases; the histologic results were compared. Kappa statistics were used to assess the agreement of two methods. Results: Diagnostic concordance between examinations was assessed for 9 out of 28 cases examined (32.1%). These consisted of three cases with both examination results of normal, 3 cases with endometrioid adenocarcinoma, 1 case with complex endometrial hyperplasia, 2 cases with material insufficient for diagnosis. Endometrioid adenocarcinoma on D&C was diagnosed in 9 out of 28 cases, but from endometrial aspiration biopsy, only 3 of these 9 cases were diagnosed with endometrioid adenocarcinoma, giving the diagnostic concordance at 33% (kappa value=0.27). From endometrial aspiration biopsy, 17 out of 28 cases (60.7%) had material insufficiency for diagnosis. Conclusion: In patients treated with high-dose oral progestin plus LNG-IUS for early-stage EC, endometrial aspiration biopsy with LNG-IUS in place may be not reliable as a follow-up evaluation method. [Copyright &y& Elsevier]

Background: Heavy menstrual bleeding is an important health problem. Two frequently used therapies are the levonorgestrel intra-uterine system (LNG-IUS) and endometrial ablation. The LNG-IUS can be applied easily by the general practitioner, which saves costs, but has considerable failure rates. As an alternative, endometrial ablation is also very effective, but this treatment has to be performed by a gynaecologist. Due to lack of direct comparison of LNG-IUS with endometrial ablation, there is no evidence based preferred advice for the use of one of these treatment possibilities. Method/design: A multicenter randomised controlled trial, organised in a network infrastructure in the Netherlands in which general practitioners and gynaecologists collaborate. Women ⩾34 years with heavy menstrual bleeding, a Pictorial Blood Assessment Chart (PBAC) score exceeding 150 points and no future child wish can participate in the trial. After informed consent, women will be randomised to a strategy starting with a levonorgestrel releasing intrauterine system or a strategy starting with endometrial ablation. The primary outcome is the PBAC score at 24 months of follow-up. Secondary outcomes are patient satisfaction, complications, number of re-interventions, menstrual bleeding pattern, quality of life, sexual function, sick leave and costs. As predictors of effect of intervention we also meaure level of coagulation factors. Discusson: This study, considering both effectiveness and cost effectiveness of LNG-IUS versus endometrial ablation may well improve care for women with heavy menstrual bleeding. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To test the predictive ability of immunohistochemical estrogen receptor(ER), progesterone receptor (PR), COX-2, Mlh1, and Bcl-2 expressions for predicting the outcomes of regression and relapse in women with endometrial hyperplasia treated with the Levonorgestrel-releasing intrauterine system (LNG-IUS). Methods: We recruited prospectively all women diagnosed with complex or atypical complex hyperplasia that underwent treatment with LNG-IUS from August 1998 until September 2008. Immunohistochemistry was performed with conventional methods and recorded using a semi-quantitative score (Q score) by two blinded assessors. Women were followed with endometrial biopsies to record regression and relapse. The biomarker predictive ability was analysed using the Cox proportional hazards model. Results: The median follow-up was 72.1months (IQR 59.1–89.8). The Q score agreement between assessors was 82.6% (K statistic=0.801±0.036). The majority of study participants initially regressed to normal endometrium following LNG-IUS therapy (n=164 regressed; n=10 persisted). From the 164 women that regressed with LNG-IUS we were able to assess 152 women for relapse from which 18 relapsed. We found a weak association for persisted endometrial hyperplasia with ER and PR expressions with Q score on the 5th and 10th centiles. No associations were found for COX-2, Mlh1 and Bcl-2 protein expressions for regression and for any of the biomarkers for relapse. Conclusion: We found that poor expression of ER and PR is weakly associated with persisting endometrial hyperplasia and COX-2, Mlh1, and Bcl-2 expressions are not predictive. None of the biomarkers is predictive for relapse in women with endometrial hyperplasia treated with LNG-IUS. [Copyright &y& Elsevier]

Abstract: Background: The study was conducted to compare the levonorgestrel intrauterine system (LNG-IUS) and Copper T380A intrauterine device (IUD) in women with and without adenomyosis and to investigate the effects on menstruation and dysmenorrhea. Study Design: Women diagnosed as having adenomyosis on transvaginal ultrasound were assigned to receive LNG-IUS (Group 1, n=23), and women seeking contraception were assigned to receive either LNG-IUS (Group 2, n=25) or Copper T380A IUD (Group 3, n=26) for 12 months. Results: The LNG-IUS significantly improved the duration of menstrual bleeding, dysmenorrhea and hemoglobin levels at the 1st and 12th month of the treatment in Group 1 and Group 2 as compared to Group 3. Moreover, LNG-IUS had similar efficacy but significantly lower side effects when compared to Copper T380A regarding contraception. However, acne was significantly increased after insertion in women using LNG-IUS. Conclusions: The LNG-IUS results in significant improvements in adenomyosis-associated heavy menstrual bleeding and dysmenorrhea. Moreover, this study also shows that it is an effective contraceptive method with significantly lower side effects compared to CuT 380A IUD except for acne. [Copyright &y& Elsevier]

Objectives Intrauterine contracepives (IUCs) are highly effective and safe for use in all women, including those who are nulliparous. However, many myths and barriers prevent more widespread utilisation. The objective of this article was to explore the health care provider (HCP), health system and user issues that prevent more widespread use of IUCs, particularly among nulliparous women, and to present the evidence that supports achieving greater utilisation of these devices. Methods MEDLINE, PubMed and Embase were used to identify studies reporting attitudes and beliefs around IUCs, and clinical studies providing evidence of their risks and benefits. Results HCP, health system and user factors limiting use of IUCs were identified. The most widely explored barriers in published studies are those at the HCP level. User barriers are less well documented and health system barriers are mostly assessed through indirect evidence. Many, but not all, of the barriers can be reduced through greater understanding of the evidence. Conclusions Efforts need to be made to disseminate the evidence, which shows that few contraindications exist to IUC use. Addressing HCP lack of knowledge, training and confidence with IUC insertions, particularly in nulliparous women, could make a substantial positive impact on IUC utilisation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of endometrial biopsy followed by intrauterine system-releasing levonorgestrel (LNG-IUS) insertion in the treatment of women with menorrhagia. Method: This was a retrospective, non-comparative study. Ninety-two patients who had menorrhagia due to non-malignant causes were sequentially recruited into the study over a 3-year period (age range 29-51 years). Patients with a uterine size more than 12 weeks were not included. A LNG-releasing intrauterine system was inserted during the mid-cycle immediately after an endometrial biopsy was taken. One year after the closure of the study period, the women recruited were then contacted by telephone or by direct questioning at the outpatient clinic as to the outcome of the above treatment. Results: The most common (15%) complaint regarding bleeding patterns at 3-6 months after insertion was spotting and intermenstrual bleeding. Following the introduction of the LNG-IUS, six women required a hysterectomy for various reasons. The remaining 86 women (93.5%) continued the use of LNG-IUS. Conclusion: LNG-IUS following an endometrial biopsy is an effective treatment for menorrhagia due to benign causes and could be an alternative to other forms of medical and surgical treatments. [ABSTRACT FROM AUTHOR]

Abstract: The contraceptive profile of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena®) is well established, with efficacy similar to that achieved with sterilization and rapid return to fertility after discontinuation of use. The LNG-IUS is typically associated with transient menstrual disturbance during the first few months of use, but this usually settles with continued use, with a concomitant decrease in menstrual blood loss. Overall, the safety profile of the LNG-IUS has been well established across a wide population of women, and the available data do not suggest that the LNG-IUS adversely affects bone health or increase the risk of adverse cardiovascular events or breast and uterine cancers. This article reviews the literature to provide updated information on the risks and benefits associated with the LNG-IUS, particularly focusing on its use in contraception. [Copyright &y& Elsevier]

Abstract: Background: Use of the intrauterine device (IUD) in the United States has recently increased. New evidence for women with employer-sponsored health insurance permits analysis of variation and trends in such use. Study Design: A retrospective analysis of annual IUD insertion rates between 2002 and 2008 was conducted by evaluating claims from the MarketScan® Commercial Research Databases for US women insured by plans that covered IUD insertions. Estimates were weighted to be nationally representative. Results: IUD insertion rates increased from 1.6/1000 women of reproductive age to 9.8/1000 over 2002–2008 and varied substantially by state. Insertion rates of the levonorgestrel-releasing intrauterine system (LNG-IUS) increased from 0.4/1000 to 7.7/1000, whereas the insertion rates of copper T380A IUD (copper IUD) increased from 0.6/1000 to 1.5/1000. IUD insertions, which are most common among women aged 25–34 years, increased at roughly the same rate across all age groups. Conclusions: The sixfold increase in IUD insertion rates between 2002 and 2008 was accompanied by an increase in the share IUD use with the LNG-IUS from 40% to 85%. Substantial geographic and age variations existed. [Copyright &y& Elsevier]

Objective: To summarize current knowledge and view of nomenclature, differential diagnosis and treatment of abnormal uterine bleeding. Methods and results: Abnormal uterine bleeding (AUB) is a frequent medical condition, affecting 9-20% fertile-aged women, meaning also social issue, with impact on quality of life. There is general inconsistency in the nomenclature used to describe AUB. FIGO is presenting a new classification system derived from possible causes. Treatment options are medical hormonal or non-hormonal and surgical. Some of the medical options are widely used off-label. Conclusion: AUB can impact on general physical, mental and social well being. Treatment must be individualised, taking the clinical problem in its entirety into account, including the impact of the disease and the effect of its treatment on quality of life, fertile functions and plans. [ABSTRACT FROM AUTHOR]

BACKGROUND The effects of oral contraceptives (OCs) on mental health are not clear, and no study has been focused on the effects of the levonorgestrel-releasing intrauterine system (LNG-IUS) on mental health. The aim of this study was to analyse the association between the use of OCs and the LNG-IUS and psychological well-being and psychopathology. METHODS The associations between the current use of OCs and the LNG-IUS, and their duration versus mood symptoms [Beck Depression Inventory (BDI)], psychological well-being [(General Health Questionnaire-12 (GHQ-12)] and recent psychiatric diagnoses [(Composite International Diagnostic Interview (CIDI)] were examined among women who participated in the Finnish-population-based Health 2000 study. Analyses were performed on the 30- to 54-year-old sample (n = 2310); some of the analyses were extended to include the younger age group (18- to 54-year-old sample; n = 3223). RESULTS Overall, hormonal contraception was well tolerated with few significant effects on psychological well-being. The length of OC use was inversely associated with some BDI items (‘dissatisfaction, irritability, lost interest in people, earlier waking and lost interest in sex’), and directly associated with ‘worries about one's health’ (BDI) and with a current diagnosis of ‘alcohol dependence’ (CIDI). The current use of the LNG-IUS was inversely associated with ‘earlier waking’ (BDI) and with ‘impaired concentration’ (GHQ), while the length of LNG-IUS use was inversely associated with ‘strain’ (GHQ). CONCLUSIONS The influence of hormonal birth control on mental health is modest and mainly favourable. The length of current OC use seems to have some beneficial effects on mood although the longer the duration of use, the greater the association with a diagnosis of alcohol dependence. Knowledge of the use of hormonal contraception might be of value when assessing psychopathology in women. The cross-sectional design, with partly retrospective data collection, precludes any causal conclusions. [ABSTRACT FROM PUBLISHER]

Abstract: Background: The study was conducted to determine the feasibility of levonorgestrel–intrauterine system (LNG-IUS) insertion at three different times postpartum. Study Design: From August 2009 to January 2010, all women desiring LNG-IUS for postpartum contraception were offered enrollment into our study and randomized to three insertion times: immediate (within 10 min of placenta delivery), early (10 min to 48 h postpartum) or interval (≥6 weeks postpartum). Results: Forty-six women met inclusion criteria and were analyzed. There was no difference in utilization rates at 3 and 6 months between groups (p=.931). Expulsion rates were significantly higher and pain during insertion was significantly lower in the immediate and early groups (p<.001) when compared to the interval group. Conclusion: Insertion of LNG-IUS ≤48 h postpartum is feasible in our institution and may be associated with similar utilization at 6 months, increased expulsion rates and decreased pain at insertion when compared to placement after 6 weeks. [Copyright &y& Elsevier]

Abstract: Objective: To compare, whether women with menorrhagia, treated with either hysterectomy or LNG-IUS, differ in their cardiovascular risk profile during 10-year follow-up. Study design: A total of 236 women were randomized to treatment by hysterectomy (n =117) or LNG-IUS (n =119). Their cardiovascular risk factors were analyzed at baseline, at 5 years, and at 10 years. As 55 originally randomized to the LNG-IUS group had hysterectomy during the follow-up, all analyzes were performed by actual treatment modality. Main outcome measures: Waist circumference, body-mass index (BMI), blood pressure, and the levels of blood lipids, serum high-sensitivity CRP (hsCRP) and tumor necrosis factor alpha (TNF-α) were measured, and the use of medication for hypertension, diabetes, hypercholesterolemia, and ischemic heart disease was analyzed. Results: After 5 years, an increase in the use of diabetes medication during the follow-up was only detected in the hysterectomy group (from 1.7% to 6.7%, P =0.008 vs from 5.1% to 8.4%, P =0.08), as well as they had significantly higher serum levels of TNF-α (108.59pg/ml vs 49.02pg/ml, P =0.001) and hsCRP (1.55μg/ml vs 0.78μg/ml, P =0.038) at 5- and 10-years. There was no difference between the groups in the use of cardiovascular medication, neither was there difference in blood pressure, waist circumference, BMI, or concentrations of blood lipids. Conclusions: Hysterectomy seems to be associated with increased levels of serum inflammatory markers and increased diabetes medication, which in turn, may predispose individual to future cardiovascular events. [Copyright &y& Elsevier]

Abstract: Background: As a contraceptive method, we investigated whether the levonorgestrel-releasing intrauterine system (LNG-IUS) has any effect on uterine artery blood flow when compared with copper intrauterine device (IUD). Study Design: Sixty women with copper IUD and 60 women with LNG-IUS were included in the study. The age, gravidity, parity, body mass index (BMI) and menstrual flow pattern using a pictorial chart were recorded. All women were assessed by ultrasonography at the preinsertion period and 1 year after insertion. The pulsatility and resistance indices (PI and RI, respectively) of the uterine artery and endometrial thickness were evaluated in the preinsertion and postinsertion periods. Results: In copper IUD users, preinsertion and postinsertion ultrasonographic assessments were not significantly different. However, postinsertion RI was significantly higher compared with preinsertion RI in LNG-IUS users (p=.001). The PI was also increased 1 year after insertion, but it did not reach statistically significant levels (p=.08). Endometrial thickness was also significantly decreased in the postinsertion period in women with LNG-IUS (p=.04). Conclusion: The significant increase in uterine artery RI in LNG-IUS users 1 year after insertion might be due to its local progestational effects. It might also indicate the mechanism of the LNG-IUS in reducing menstrual blood flow. [Copyright &y& Elsevier]

To assess the feasibility of using medroxyprogesterone acetate (MPA) and levonorgestrel intrauterine system (LNG-IUS) to treat early-stage endometrial cancer in young women who want to preserve their reproductive potential.Prospective observational study of 5 young patients (mean [SD] age, 38.4 [4.8] years; range, 33-41 years) with a grade 1 endometrial cancer that is presumably confined to the endometrium. The subjects were given a daily oral dose of 500 mg of MPA and LNG-IUS placement. They were followed with dilation and curettage every 3 months.Complete remission was shown in 4 of 5 patients, and one patient showed partial remission. Biopsy results were negative in 2 patients at 3 months, in 1 patient at 6 months, and in 1 patient at 12 months. No treatment-related complications occurred. No recurrence was found during the follow-up period (mean [SD], 10.2 [3.6] months; range, 6-16 months).The concomitant use of MPA with LNG-IUS is feasible for conservative treatment of early-stage endometrial cancer in young women who want to preserve their reproductive potential. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the insertion procedure and continuation rates of the levonorgestrel releasing-intrauterine system (LNG-IUS) in nulliparous women who, due to fear of complications, are often denied this very effective contraceptive method. Methods A non-interventional study of 224 nulliparous women attending family planning services for insertion of a LNG-IUS. Results There were only six unsuccessful insertions. The insertions, mostly carried out by midwives, were regarded as easy by 72%% of the inserters. Nineteen women (9%%) considered the procedure to have been painless, 162 (72%%) moderately painful, and 39 (17%%), severely painful. At follow-up, 12--16 weeks post-insertion, 76%% (165/216) of the women were satisfied with their method. Women in the youngest age group were more satisfied than women in the oldest age group (75%% and 59%%, respectively). Only 5%% were dissatisfied. Neither perforations nor pregnancies were reported during the whole study period. Conclusion Our results support the current practice in Sweden of offering LNG-IUS routinely to nulliparous women. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena) with depot GnRH analogue (GnRH-a; gosareline acetate; Zoladex) on endometriosis-related chronic pelvic pain (CPP) in patients with severe endometriosis during 12 months. Design: Prospective, randomized, controlled study. Setting: The reproductive endocrinology unit of a tertiary, research and education hospital. Patient(s): Forty women with severe endometriosis (revised The American Fertility Society [AFS] classification >40) and endometriosis-related CPP and control groups were enrolled in the study. Intervention(s): The patients were treated with either LNG-IUS (n = 20) or GnRH-a (n = 20). The GnRH-a dose was repeated every 4 weeks for 24 weeks. Main Outcome Measure(s): Scores of CPP were evaluated using a visual analogue scale (VAS) and total endometriosis severity profile (TESP). Result(s): The TESP score decreased in the LNG-IUS group at first, third, and sixth month follow-up visits, whereas at the 12th month follow-up visit, the TESP scores were increased to values similar to pretreatment values. Although the VAS score had no significant alteration during the follow-up period in the LNG-IUS group, the GnRH-a group showed a significant decrease in the VAS score and TESP score at the end of 1 year. The LNG-IUS treatment showed a lower patient satisfaction. Conclusion(s): Both treatment modalities showed comparable effectiveness in the treatment of CPP-related endometriosis. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether regression of endometrial hyperplasia observed after 3 months of treatment with levonorgestrel impregnated intrauterine system device (LNG-IUS) was sustained after 6 months and whether these effects were still occurring synchronously with extinguished expression of progesterone receptors and increased apoptosis. Design. Retrospective population-based observational study. Setting. Six local hospitals and one university hospital in northern Norway. Population. Patients ( n = 41) with low and medium risk endometrial hyperplasia. Methods. Histopathological treatment response comparing LNG-IUS ( n = 25) and standard per oral medroxyprogesterone ( n = 16). Expression of progesterone receptor A (PR-A), progesterone receptor B (PR-B), ER-alpha, ER-beta, Bcl-2, BAX, Caspase-3 and metallothionein (MT) were investigated by immunohistochemistry; results were evaluated by a semi-quantitative H-score. Main outcome measures. Response to progestin treatment. Results. All the LNG-IUS treated patients had therapy response after 6 months. PR-A and PR-B in glands were almost extinguished for IUD users compared to the oral group. Estrogen receptors were also reduced. Co-existent changes in apoptosis were differently modulated in glands and stroma in the two treatment groups. Bcl-2 was different in glands and stroma in responders and non-responders to oral therapy. Conclusion. The study confirms that LNG-IUS can be safely used for 6 months as treatment for endometrial hyperplasia. The clinical effect is accompanied by almost extinguished PR-receptors in glands coinciding with modulation of apoptosis. The results strongly indicate that progestins activate non-classical initiated signaling pathways. [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aimed to increase use of long-acting reversible contraceptive (LARC) methods by women post-abortion. Study Design: Ten-week intervention at a public abortion clinic involving free access to three LARC methods (DMPA, LNG-IUS, Multiload Cu375); posters promoting LARC; updated information for clinic staff. Outcome measures: change in the proportion of women choosing LARC prior to and during the intervention; rate of follow-up and method retention at 6 weeks and at 6 months post-abortion. Results: Use of post-abortion LARC increased significantly from 44% at baseline (226/510) to 61% (310/510) during the intervention (p<.001). Use of LNG-IUS increased almost sixfold from 6% to 36%. Follow-up rates were 71% at 6 weeks (221/310) and 74% at 6 months (184/249). Method retention was 89% at 6 weeks (197/221) and 86% at 6 months (159/184). Conclusion: Uptake of LARC by women post-abortion can be achieved by increasing access to these methods — by eliminating cost and raising awareness and benefits of long-acting methods among both clinicians and patients. [ABSTRACT FROM AUTHOR]

Mirena is a long acting intrauterine hormone-releasing (LNG-IUS) contraceptive system with a flexible plastic T-shaped frame bearing a levonorgestrel(LNG)- containing cylinder which releases small doses levonorgestrel into the uterine cavity after insertion with maximum effect on the endometrium and minimum progestogenic side-effect. LNG causes thinning of the endometrium, atrophy of the endometrial glands and decidualisation of the endometrial stroma. The most common side-effect of LNG-IUS is unscheduled vaginal bleeding in the first 3 months, so proper counseling is needed. In some cases functional ovarian cysts may occur which are relatively small, symptomless and resolved spontaneously within a short time. Mirena is now licensed for the treatment of menorrhagia in UK because it reduces 97% of blood loss in 12 months uses. It is also an effective progestogenic endometrial protection in women with Hormone replacement therapy. There are conflicting evidence of LNG-IUS in the management of Fibroids uterus but it reduces fibroid related menstrual blood losses. It has also some beneficial effect in endometriosis and adenomyosis by reducing pain and blood loss. The LNG-IUS also reduces endometrial hyperplasia and may take place in the treatment of eartly endometrial cancer in some cases. The rate of ectopic pregnancy and pelvic inflammatory diseases are reduced in Mirena users compared with IUCD users. [ABSTRACT FROM AUTHOR]

Purpose: To report three cases of migrated levonorgestrel intrauterine device (LNG-IUS) into the pelvic/abdominal cavity removed laparoscopically with the aid of preoperative computed tomography (CT) scan imaging. Methods and Results: Three patients presenting with a missing LNG-IUS on examination and pelvic ultrasound are presented. A preoperative CT scan was performed, what helped in a successful removal of the LNG-IUS. The patients were discharged home the same day of the procedure. Conclusion: Our cases reinforce, besides the diagnosis of a migrated LNG-IUS by ultrasound, the fact that preoperative CT scan imaging assists in the diagnosis of the precise location of a migrated LNG-IUS into the pelvic/abdominal cavity and helps the physician in the prediction of the difficulty of the laparoscopic removal. [ABSTRACT FROM AUTHOR]

BACKGROUND: Consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS) is increasing. However, little is known about factors that predict the bleeding during consecutive use. The objective of this study was to analyse the possible factors which may predict the bleeding pattern during the first year of use of a second LNG-IUS. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Misoprostol has been studied intensively to produce cervical dilatation. To date, no studies have evaluated the effectiveness, safety or acceptability of this treatment for repeat intrauterine device insertions. Study Design: This study was a randomized, double-blind, placebo-controlled trial on the consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS). Women who had used their first LNG-IUS for 4 years and 3 to 9 months and opted for an immediate replacement with a second LNG-IUS received a single sublingual dose of 400 mcg misoprostol or placebo 3 h prior to the LNG-IUS insertion. Results: The proportion of easy insertions as judged by the investigator was 93% (40/43) in subjects randomized to misoprostol and 91% (42/46) in the placebo group (p=1.0 for the difference of proportions). No or mild pain at insertion was reported by 37% and 35% of subjects in the misoprostol and placebo groups, respectively. However, adverse events related to the study drug were more common in the misoprostol group. Conclusion: Sublingual misoprostol did not have a significant effect on the ease of insertion in subjects having a repeat insertion of the LNG-IUS. [Copyright &y& Elsevier]

Objective. Review the clinical experience with the frameless FibroPlant® levonorgestrel intrauterine system (FP-LNG-IUS). Study design. An open, prospective non-comparative contraceptive 5-year study; a 1-year MBL study in women with heavy menstrual bleeding (HMB), using a PBAC and a 2-year MBL study in women with HMB and with normal menstruation using the quantitative alkaline hematin method. A literature review on perforation rate with the frameless GyneFix® and FibroPlant®. Results. 304 insertions were performed with the FP-LNG-IUS. The total observation period was 11,299 woman-months. Only one pregnancy occurred. There were two expulsions and two uterine perforations at insertion during the first year. In the first 1-year MBL study, the median MBL decreased by more than 90%. In the second 2-year MBL study, MBL reduced drastically and 80% had amenorrhoea after 24 months. The ferritin values increased significantly. On a total of approximately 17,000 insertions, the perforation rate was between 1.2 and 2.0/1000 insertions. Conclusion. The frameless FP-LNG-IUS is an effective and well-tolerated long-acting reversible contraceptive and is also highly effective for the treatment of HMB. The perforation rate is similar to traditional copper and levonorgestrel-releasing intrauterine devices and systems. Strict adherence to the manufacturer's insertion instructions is recommended. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Heliövaara-Peippo S, Halmesmäki K, Hurskainen R, Teperi J, Grenman S, Kivelä A, Tomas E, Tuppurainen M, Paavonen J. The effect of hysterectomy or levonorgestrel-releasing intrauterine system on lower urinary tract symptoms: a 10-year follow-up study of a randomised trial. BJOG 2010;117:602–609. Objective To evaluate the effect of hysterectomy and levonorgestrel-releasing intrauterine system (LNG-IUS) on lower urinary tract symptoms (LUTS) among women treated for menorrhagia. Design Randomised controlled trial analysed by actual treatment. Setting Five university hospitals in Finland. Sample A cohort of 236 women, aged 35–49 years, referred for menorrhagia between 1994 and 1997. Methods Women were randomly assigned to treatment by hysterectomy ( n = 117) or LNG-IUS ( n = 119). Main outcome measures Lower urinary tract symptoms were evaluated by questionnaires at baseline, and after 6, 12 months, 5, and 10 years. Medications and operations for urinary incontinence were confirmed from medical records and national registries. Results Overall, 221 (94%) women took part in the 10-year follow-up evaluation. As 55 (46%) women originally randomised to the LNG-IUS group underwent hysterectomy, the results were analysed by actual treatment. Women treated by hysterectomy used more medication for urinary incontinence than LNG-IUS users (12% versus 1%) (OR 9.45, 95% CI 1.24–71.87, P = 0.006). Three hysterectomised women and one LNG-IUS user underwent surgery for stress urinary incontinence (SUI). Women treated by hysterectomy had more urinary tract infections (UTIs) than LNG-IUS users (OR 3.20, 95% CI 1.47–6.96, P = 0.002). Feeling of incomplete emptying (OR 3.00, 95% CI 1.00–9.05, P = 0.04) and SUI (OR 1.83, 95% CI 1.01–3.32, P = 0.04) were more common among women treated by hysterectomy. No differences between the study arms were noted in urge urinary incontinence or by the Urinary Incontinence Severity Score. A multivariate model showed that UTIs were associated with hysterectomy ( P = 0.004). Conclusions Hysterectomy increases the risks for incomplete emptying, lower UTIs and SUI. [ABSTRACT FROM AUTHOR]

We performed immunohistochemical analysis of estrogen (ERα) and progesterone receptors (PRA and PRB), phosphatase and tensin homolog (PTEN) and aromatase in endometrial hyperplasia treated with Mirena® (levonorgestrel-releasing intrauterine system; LNG-IUS) and explored their prognostic significance. The baseline pre-treatment endometrial hyperplasia of a selected prospective cohort was analyzed [complex ( n = 29) and atypical ( n = 5)]. Study participants were categorized into those that showed endometrial regression (responders, n = 28) and those that showed non-regression or histological progression to atypia or malignancy (non-responders, n = 6). Immunohistochemical expression was expressed as a histological score (HS). Responders compared to non-responders showed significantly higher HSs for estrogen and progesterone receptors. Absence of estrogen and progesterone receptors predicted non-responder status with likelihood ratios of 9.33 (95% CI 2.19–39.81) and 2.92 (95% CI 1.47–5.79), respectively. Neither PTEN nor aromatase expression were associated with LNG-IUS therapy responsiveness. Responsiveness of endometrial hyperplasia to LNG-IUS therapy may be determined through analysis of baseline estrogen and progesterone receptors, but these exploratory findings require confirmation in a larger dataset. [ABSTRACT FROM AUTHOR]

Background: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive. However, during early months of use unscheduled vaginal bleeding is common, sometimes leading to discontinuation. This study aimed to determine whether intermittent administration of progesterone receptor modulator CDB-2914 would suppress unscheduled bleeding during the first 4 months after insertion of the LNG-IUS.Methods: CDB-2914 150 mg, in divided doses, or placebo tablets, were administered over three consecutive days starting on Days 21, 49 and 77 after LNG-IUS insertion, in a double-blind randomized controlled trial of women aged 19-49 years, newly starting use of LNG-IUS. Daily bleeding diaries were completed for 6 months, and summarized across blocks as percentage days bleeding/spotting (BS%).Results: Of 69 women randomized to receive CDB-2914, and 67 placebo, 61 and 55, respectively, completed the trial. BS% decreased with time in both arms, but showed a much steeper treatment-phase gradient in the placebo arm (P < 0.0001), so that a benefit of CDB-2914 in the 28 days after first treatment (-11% points, 95% CI -19 to -2), converted to a disadvantage by 64 days after the third treatment (+10% points, 95% CI 1-18).Conclusions: The effect of CDB-2914 on BS% was initially beneficial but then by third treatment was disadvantageous. Nevertheless, only 3% (4/136) of all women discontinued LNG-IUS. These findings give insight into possible mechanisms and suggest future research directions. ISRCTN Trial no. ISRCTN58283041; EudraCT no. 2006-006511-72. [ABSTRACT FROM AUTHOR]

Objective: The use of a levonorgestrel intrauterine system (LNG-IUS) is useful in preventing pregnancy and for the treatment of menstrual disturbances. A smooth or symptom-free transition to and through menopause is possible when LNG-IUS is combined with estrogen therapy. Unfortunately the majority of physicians are generally unaware of this usefulness combined hormonal therapy in the pre-, peri- and postmenopausal women. Design and method: Based on long-term clinical experience with LNG-IUS in the form of Femilis®, 104 women where followed from the premenopause through the menopausal transition into the postmenopause. These perimenopausal women received supplemental 17 β-estradiol by gel or patch, or orally as estradiol valerate. Patients received one or two separate Femilis insertions at 5 year intervals. Main outcome measures included acceptability and continued use of the combined regimen for the treatment of climacteric symptoms and for prevention of cardiovascular disease, osteoporosis and other adverse effects caused by estrogen deprivation. Results: The average age at insertion was 48 years (range 28–58) and the total duration of use was 137 months (range 80–161). The Femilis LNG-IUS was well tolerated as the number of removals for LNG-IUS-related reasons was low. The LNG-IUS was well retained in the uterine cavity as no expulsions were observed. Seven women were lost to follow-up. Eighty-six women (82%) opted for replacement of an LNG-IUS at expiry after 5 years and continued with the estrogen therapy. Conclusion: Intrauterine progestogen delivery for endometrial suppression in combination with estrogen therapy in the symptomatic perimenopausal women is highly practical as it combines the benefits of prevention of endometrial proliferation and treatment of menorrhagia and hyperplasia, if present. In addition, the contraceptive effect of locally administered LNG is highly desirable as many perimenopausal women run considerable risk of unintended pregnancy. For these reasons, the author views this regimen as one of the most effective, safest and best accepted route resulting in high patient compliance. It is important to convey this message to general practitioners as well as women. [ABSTRACT FROM AUTHOR]

Objective. The purpose of this study was to evaluate the changes in lower abdominal pain and back pain among women with menorrhagia treated by hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS). Design. A randomized controlled trial. Setting. Five university hospitals in Finland. Sample. A total of 236 women, aged 35–49 years. Methods. Women were randomly assigned to treatment by hysterectomy ( n = 117) or LNG-IUS ( n = 119). Main outcome measures. Frequency and intensity of lower abdominal pain and back pain were evaluated by questionnaires at baseline and after 6 months, 12 months and 5 years. Results. By six months, women in both groups had less frequent back pain than before treatment ( p < 0.001). Lower abdominal pain decreased only in the hysterectomy group ( p = 0.02) with significant differences between the groups. Between 12 months and 5 years, frequency of lower abdominal pain ( p = 0.05) and back pain ( p = 0.002) decreased more in the LNG-IUS group than in the hysterectomy group. Between baseline and five years, the lower abdominal pain score (including frequency and intensity of pain) decreased in both groups ( p < 0.001, p = 0.01). Back pain score decreased only in the LNG-IUS group and the difference between the groups was significant ( p = 0.02). However, some women experienced more pain after both treatments than before treatment. In multivariate analyses, LNG-IUS use was associated with a decrease in lower abdominal pain and back pain. Conclusions. In the treatment of menorrhagia, both hysterectomy and LNG-IUS decrease lower abdominal pain. LNG-IUS use, but not hysterectomy, has beneficial effects on back pain. [ABSTRACT FROM AUTHOR]

Levonorgestrel-releasing Intrauterine System (LNG-IUS) is licensed for use as a contraceptive, for the treatment of heavy menstrual bleeding and during estrogen replacement therapy. It is publicized as a local source of progestogen with minimal systemic adverse effects. However, there is overwhelming evidence of elevated serum and tissue levels of levonorgestrel, and high discontinuation and dissatisfaction rates amongst users. The guidelines of The National Institute for Health and Clinical Excellence (NICE), United Kingdom recommended that the healthcare professionals should be aware that upto 60% of women discontinue using LNG-IUS within 5 years because of unscheduled bleeding, pain, and/or systemic progestogenic adverse effects. This article highlights these issues to healthcare professionals to ensure that the rates of adverse effects are not underestimated, and full information are made available to women to enable them making an informed choice. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: In a RCT, we have previously shown that the levonorgestrel intrauterine system (LNG-IUS, Mirena®) produces a decidual response protecting the endometrium at one year follow-up. We here report on the long-term follow-up of this group of women, to test the hypothesis that a LNG-IUS could prevent the pro-proliferative uterine responses of tamoxifen for up to 4.5 years. Methods: A randomised-controlled trial of postmenopausal women who had taken at least one year of adjuvant tamoxifen therapy. Results: One hundred twenty-two women were recruited. Nine were found to be ineligible after randomisation. The average duration of follow-up was 26.25 months (IQR 14.5–36 months) in the surveillance group and 24.2 months (IQR 13.75–32.5 months) in the LNG-IUS group. Women with LNG-IUS in situ at the time of final assessment had decidualised endometrium, and no polyps. In the surveillance group new polyps arose in 8 cases. There were 3 new polyps in the group initially randomised to LNG-IUS, one in a patient who did not have the device inserted and 2 occurred in patients following the removal of the LNG-IUS. Univariate Cox proportional hazards regression models identified only endometrial thickness at trial entry as a statistically significant variable (HR 1.12, 95% CI 1.02 to 1.22, p =0.01) for the development of polyps. Conclusion: This study confirms that LNG-IUS induces benign endometrial changes and prevents endometrial polyps but only during its use in women taking tamoxifen. Endometrial thickness is a risk factor for the development of polyps. [Copyright &y& Elsevier]

Twelve months after insertion, menstrual blood loss, leiomyoma size and hemoglobin concentrations were still affected by LNG-IUD (Mirena), a levonorgestrel-releasing vertical stem composed of polydimethylsiloxane with a T-shaped polyethylene frame. A total of 52 mg of LNG in the device was released, at 20 μg per day. Mirena is a good contraceptive and therapeutic choice whose local effects include i) thickening of the cervical mucus, ii) inhibition of normal sperm motility and function inside the uterus and fallopian tubes, preventing fertilization, and iii) prevention of endometrial proliferation. Previous methods of treatment of perimenopausal menorrhagia had been synthetic progesterone pills (progestins) and NSAIDs. Leiomyoma and abnormal uterine bleeding are major causes of hysterectomy in Albania. In this prospective study, conducted between January 2007 and March 2009, 57 cases were evaluated. Each of the cases was evaluated through transvaginal ultrasound and a hemogramma test. Patient health was evaluated at three, six and twelve months after insertion of Mirena. Five patients withdrew. By March 2009, 27 patients had been followed up 12 months after insertion. The mean age of the patients was 46.8 years old (ranging from 42.2 to 49.8 years). [ABSTRACT FROM AUTHOR]

Abstract: Background: This study aims to assess the effects of levonorgestrel-releasing intrauterine system (LNG-IUS) on lipid metabolism in an Asian population using Ortho Gynae T380 copper containing (nonhormonal) intrauterine device (IUD) as a control. Study Design: Ninety-two healthy women requesting IUD for contraception were randomly allocated to the two groups and were followed up at 6-, 12- and 18-month intervals. Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), apolipoprotein A-I (Apo A-I) and apolipoprotein B were measured pre insertion and at each visit following insertion. Results: There was a marginally significant reduction in TC level in the LNG-IUS group. HDL-C showed a significant reduction in the LNG-IUS group at 6 months but reverted back to its preinsertion value by 1 year. TG, LDL-C and the cholesterol ratios remained stable. Levels of Apo A-I and B also showed no significant reduction in both groups, and their ratios remained stable and insignificant. Conclusion: In this randomized comparative study among our local Asian population, it is assuring to note that the LNG-IUS does not have any adverse effects on lipid metabolism. [Copyright &y& Elsevier]

Objective: To evaluate the effect of the levonorgestrel intrauterine system (LNG-IUS) and TCU 380A on the subendometrial vascularization and the uterine artery blood flow during the midluteal phase. Design: Prospective clinical trial. Setting: Teaching hospital. Patient(s): The trial included 27 patients who received the LNG-IUS compared with 25 patients who received the TCU 380A. Intervention(s): The subendometrial blood flow was evaluated using power Doppler analysis, uterine artery pulsatility index (PI), and resistance index (RI) just before inserting the intrauterine device in the midluteal phase and 3 months after. Main Outcome Measurement(s): Power Doppler analysis, PI, RI, and endometrial thickness. Result(s): There were no significant differences in subendometrial vascularization between the groups. Pulsatility index and RI variability (before and after) increased and endometrial thickness reduced in LNG-IUS users. We used the multiple logistic regression model to examine the potential confounding bias (age and parity). The LNG-IUS was independently associated with increased PI. Conclusion(s): No subendometrial microvascularization difference was found between the groups. It is the first direct evidence that LNG-IUS reduced uterine artery blood flow, even after controlling for age and parity. [ABSTRACT FROM AUTHOR]

Abstract: Background: A better understanding of the uterine and endometrial vascularization in intrauterine device (IUD)-induced side effects is clearly of paramount importance in terms of both physiological and pathophysiological changes and may permit assessment for future therapeutic treatments. The aim of the study was to quantify the subendometrial microvascularization and uterine artery blood flow in IUD-induced side effects using power Doppler analysis as well as pulsatility index (PI) and resistance index (RI) in the exact midluteal phase 3 months after IUD insertion. There were 27 patients using the levonorgestrel-releasing intrauterine system and 25 patients using TCu 380A. Study Design: This study has a prospective clinical trial design. Results: There is an increased subendometrial blood flow in patients with severe dysmenorrhea and/or bleeding, after controlling for IUD type, age and parity. Moreover, the PI and RI were not different in such women. Conclusion: The results provide new data on the bleeding patterns related to these IUD types that may be relevant during contraception use. This method could be used as a prognostic factor to better evaluate women for the risk of developing dysmenorrhea and/or bleeding after IUD insertion. [Copyright &y& Elsevier]

Abstract: Background: The study was conducted to assess outcomes among women using the levonorgestrel-releasing intrauterine system (LNG-IUS). Study Design: The data were collected via a retrospective claims database analysis of 152 women. Two nested cohorts were further distinguished based on length of follow-up: two and three continuous years (n=73 and n=29, respectively). Results: Over 90% had a single insertion, and fewer than 4% experienced an LNG-IUS-related complication. Thirteen percent of women experienced menorrhagia in the year preceding insertion; this figure dropped to 12.5%, 1.2% and 0% in the 1, 2 and 3 years postinsertion. Mean number of gynecology-related visits decreased from four to two in the overall cohort, from seven to four in the cohort with 2 years of follow-up and from nine to four in the cohort with 3 years of follow-up. Conclusion: LNG-IUS use prevented pregnancy in all patients and was associated with decreased vaginal bleeding starting in the second year postinsertion. [Copyright &y& Elsevier]

The article presents an evidence-based review concerning the effectiveness and safety of intrauterine contraception in women. Information on the two types of intrauterine devices, the copper-bearing intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (LNGIUS), were presented. The authors note that copper IUD and LNG-IUS are more cost-effective than the combined oral contraceptive pills and injectable contraceptives.

Abstract: Background: The study was conducted to evaluate the cytopathological findings and vaginal flora in cervical smear samples from women using the levonorgestrel-releasing intrauterine system (LNG-IUS) for a period of up to 7 years. Study Design: Postinsertion cytology examinations were conducted on 187 women who had an LNG-IUS inserted between April and September 1998 in the family planning clinic of the Universidade Estadual de Campinas. Results: During the 7 years of follow-up, a high frequency of candidiasis was found from the fourth through the seventh year of use in comparison to the first year of use. No significant results were found with respect to cytopathological abnormalities or other microbiological alterations following insertion of the LNG-IUS. Conclusion: Use of the LNG-IUS had no effect on cervical smears over the 7-year follow-up period; however, an increase occurred in the frequency of candidiasis. [Copyright &y& Elsevier]

Objectives: Nearly one third of women complain of heavy menstrual bleeding during their reproductive years. Hysterectomy and levonorgestrel-releasing intrauterine system (LNG-IUS) are effective treatment options for menorrhagia. However, the influence of these two treatment modalities on ovarian function remains unclear. The aim of the study was to evaluate the effect of hysterectomy or LNG-IUS on ovarian function. Methods: Of 107 women, aged 35-49 years, referred for menorrhagia to the University of Helsinki, Finland, 54 were randomised to hysterectomy group and 53 to LNG-IUS group. Serum concentrations of inhibin B were measured at baseline, at 6-month, and at 12-month follow-up visits. The pulsatility indeces (PI) of ovarian and intraovarian arteries were measured by transvaginal ultrasound on the same visits. Changes in outcome measures between the groups were tested by Student's t-test for independent samples and within the group by Wilcoxon signed rank test. To test association between outcome variables and explaining factors a multiple linear regression model was used. Results: Serum inhibin B concentrations decreased after the first 6 months in both groups (P<0.05). No change was observed in PI of the ovarian arteries in either group. PI of the intraovarian arteries decreased at 6 and 12 months (P<0.05) in the hysterectomy group, which was not seen among LNG-IUS users. Change in PIs between the treatment arms was also significant (P<0.05). In multiple linear regression model treatment modality explained the change in serum inhibin B concentration and the change in PI of intraovarian artery (P<0.05). Conclusions: Hysterectomy but not LNG-IUS alters intraovarian blood flow and may impair ovarian function. [ABSTRACT FROM AUTHOR]

Objective To compare among women with menorrhagia the effect of hysterectomy or levonorgestrel-releasing intrauterine system (LNG-IUS) on sexual functioning . Design A randomised controlled trial. Setting Five university hospitals in Finland. Sample A total of 236 women, aged 35–49 years. Methods Of the women, 117 were treated by hysterectomy and 119 by LNG-IUS. Main outcome measures Sexual functioning was evaluated by modified McCoy sexual scale at baseline and at 6 months, 12 months, and 5 years after initiation of treatment (hysterectomy or application of LNG-IUS). Results Among women treated by hysterectomy, sexual satisfaction increased and sexual problems decreased. Among LNG-IUS users, satisfaction with partner decreased. In addition to treatment modality ( P= 0.02), estrogen therapy ( P= 0.01), smoking ( P= 0.001), night sweats ( P= 0.03), vaginal dryness ( P= 0.04), hot flushes ( P= 0.01), and having someone to ask for advice ( P= 0.03) and to share worries ( P= 0.01) explained changes in sexual functioning. Conclusions Among women with menorrhagia, hysterectomy improves sexual functioning, whereas LNG-IUS does not have such a positive effect. [ABSTRACT FROM AUTHOR]

This study investigated the acceptability of the levonorgestrel-releasing intrauterine device (LNG-IUS) as contraception among young, single women after termination of pregnancy. Twenty subjects, with a median age of 21 years, had LNG-IUS inserted immediately after suction termination of first-trimester pregnancy. The subjects were followed-up at 6 weeks, 3 months, 6 months and 12 months. Fifteen subjects (75%) had other pregnancies terminated in the past. There were no serious complications or pregnancies. The acceptability of the LNG-IUS was generally above 86% during each follow-up visit. A total of seven (35%) subjects were lost to follow-up at different periods of the study. Overall, four subjects (22%) had the LNG-IUS removed. Nine subjects were seen at the end of the 1-year study period and all continued with the LNG-IUS for contraception. Side effects were commonly observed and irregular vaginal bleeding was the most common. We conclude that the LNG-IUS may be an acceptable method among selective young, single, nulliparous clients after termination of pregnancy and could be offered as an option of contraception to them. However, the small sample size and the high lost-to-follow-up rate are the major limitations of this study. [Copyright &y& Elsevier]

The objective of the study was to evaluate, clinically and sonographically, the time required for the progestative effect of the levonorgestrel-releasing intrauterine system (IUS, Mirena) to be manifested. Doppler flow of the cervical branch and spiral artery of the uterine artery, as well as the endometrial width (up to day 10 of the cycle), were evaluated in 36 women carrying levonorgestrel-releasing IUS 1–2 months after insertion of the device compared to 4–6 months after insertion. The rate of intermenstrual bleeding was reduced from 44% during the first 2 months, to only 8% of women after 4–6 months of use. Complete cessation of menstrual bleeding occurred in 5% after 2 months and in 66% after 4–6 months following insertion. While there was no change in the Doppler flow in the cervical branch of the uterine artery between both groups, there was a significant reduction in the subendometrial flow in the spiral artery. This observation was reinforced by the demonstration of significant reduction in endometrial thickness in the following 4 months of use. The present study has demonstrated that the local progestative effect of the levonorgestrel-releasing IUS on the endometrium is already manifested within a period of 3 months and over after insertion. [Copyright &y& Elsevier]