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Recommendations for Contraceptive Use |
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Levonorgestrel-Releasing IUDs |
Q.2 Should the LNg IUD be
discontinued because of extended amenorrhea or steroidal effects?
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| a) Extended amenorrhea? No. Amenorrhea is expected and is not a medical reason for removal.
Emphasis should be on counseling, including reassurance that amenorrhea with LNg IUDs is
to be expected and is safe, as well as counseling on the benefits of amenorrhea.
However, if the woman does wish to have the LNg IUD
removed, her wishes should be respected. |
a) The intrauterine release of
levonorgestrel converts the endometrium to a nonproliferative stage, which is insensitive
to ovarian estradiol. The result of this complete suppression of the endometrium is a
sharp reduction of the duration of bleeding and menstrual blood loss. The reduction of
bleeding is so intensive that in about 20% of women there is no bleeding at all in spite
of completely normal ovarian function; therefore, amenorrhea is common and normal for
women using LNg IUDs. Women who are well informed
about the possibility of amenorrhea may consider it to be a convenience/advantage. Also,
hemoglobin levels increase with LNg IUD use, thereby benefiting women with anemia.
- Andersson K, Odlind V, Rybo G.
Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a
randomized comparative trial. Contraception 1994;49(1):56-72.
- Xiao B, Zeng T, Wu S, Sun H, Xiao N.
Effect of levonorgestrel-releasing intrauterine device on hormonal profile and menstrual
pattern after long-term use. Contraception 1995;51(6):359-65.
- Sivin I, Stern J, Coutinho E, Mattos
CE, el Mahgoub S, Diaz S, et al. Prolonged intrauterine contraception: a seven-year
randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380 Ag IUDs.
Contraception 1991;44(5):473-80.
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| b) Steroidal effects? No. However, the LNg IUD should be removed if the client
experiences intolerable or unacceptable side effects, attributable either to the IUD or to
systemic steroidal effects. |
b) Steroidal side effects such
as acne, weight change, nausea, headache, have been found to be prevalent in Nordic
countries. However, the gross discontinuation rate due to all of these side effects was
only 2.7 per 100 women in a European multicenter study.
- Luukkainen, T, Allonen H, Haukkamaa M,
Holma P, Pyorala T, Terho J, et al. Effective contraception with the
levonorgestrel-releasing intrauterine device: a 12-month report of a European multicenter
study. Contraception 1987;36(2):169-79.
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