“You cannot have first space and then things to

put into it, any more than you can have first a

grin and then a cheshire cat to fit into it”

Alfred North Whitehead

Professor J. V. T. Luukkainen

THE LEVONORGESTREL IUSTHE LEVONORGESTREL IUS A NEW HORIZON IN A NEW HORIZON IN

TARGETED CONTRACEPTIONTARGETED CONTRACEPTION

Dr. Nagendra S. SardeshpandeDr. Nozer K Sheriar

Aviva Clinic For WomenMumbai

LEVONORGESTREL IUS

(LNG IUS)

Small T- shaped frame made

of polydimethylsiloxane.

Contains a capsule with

52mg LNG releasing 20 µg

Levonorgestrel / 24 hours.

MATERIALS & METHODS MATERIALS & METHODS

A retrospective study of 25 patients with

LNG IUS inserted and 35 patients with

Multiload 250 (MLCu 250) inserted

between 2002-2004 with a follow up

period of 3 months to 2 & 1/2 yrs.

PARITYPARITYAGE OF PATIENTSAGE OF PATIENTS

PATIENT CHARACTERISTICSPATIENT CHARACTERISTICS

%%

4

29

52

69

40

24

00

10

20

30

40

50

60

70

<25 25-35 35-45 >45

48

69

42

26

5 6 50

0

10

20

30

40

50

60

70

1 2 >3 None

LNG IUS

MLCu 250

*

* P < 0.05

PRIOR MENSTRUAL PATTERNPRIOR MENSTRUAL PATTERN

MENSTRUAL PATTERN

LNG IUS MLCu 250

Normal 11 (48) 32 (91.3)

Menorrhagia 3 (12) 2 (5.8)

Polymenorrhagia 2 (8) 0

Oligomenorrhagia 8 (32) 1 (2.9)

Amenorrhoea 1 (4)

-

PRIOR DYSMENORRHOEAPRIOR DYSMENORRHOEA

DYSMENORRHOEA

LNG IUS NO (%)

ML Cu 250 NO (%)

Present

12 (48)

4 (12)

Absent

13 (52)

31 (88)

INDICATIONS FOR INSERTIONINDICATIONS FOR INSERTION

INDICATIONLNG IUS

NO (%)

MLCu 250

NO (%)

Contraception &

Menorrhagia8 (32) -

Contraception 6 (24) 33 (94.2)

Menorrhagia 5 (20) -

IUCD induced

menorrhagia 3 (12) -

Tamoxifen 2 (8) -

OC pill complications 1 (4) 2 (5.8)

GYNECOLOGICAL DISEASEGYNECOLOGICAL DISEASE

DISEASELNG IUS

NO (%)

MLCu 250

NO (%)

Adenomyosis 7 (28) 1 (2.9)

Leiomyomas 5 (20) 3 (8.7)

Endometrial

hyperplasia5 (20) -

Endometrial polyps 3 (12) -

Ovarian endometriosis 1 (4) -

COEXISTING DISEASECOEXISTING DISEASE

DISEASELNG IUS NO (%)

MLCu 250NO (%)

Breast Cancer 2 (8) -

Angioplasty 1 (4) -

Anemia 1 (4) -

Asthma 1 (4) 1 (2.9)

Migraine 1 (4) 1 (2.9)

CONCOMITTANT PROCEDURES CONCOMITTANT PROCEDURES PERFORMED DURING INSERTIONPERFORMED DURING INSERTION

PROCEDURELNG IUSNO (%)

MLCu 250NO (%)

Hysteroscopy / D& C 10(40) -

Hysteroscopic polypectomy 3 (12) -

D&C 2 (8) -

MTP 2 (8) 3 (8.5)

IUCD removal 3 (12) -

FOLLOW UPFOLLOW UP

MENSTRUAL PATTERN

LNG IUS MULTILOAD 250

3 MTHS (25 PTS) NO (%)

12 MTHS (22 PTS) NO (%)

3 MTHS (35 PTS) NO (%)

12 MTHS (27 PTS) NO (%)

Normal 5 (20) - 12 (34) 24 (89)

Menorrhagia 1 (4)* - 10 (29)* 3 (11)

Polymenorrhoea 1 (4) - 2 (6) -

Oligomenorrhoea 4 (16) 14 (64)* - -

Hypomenorrhoea 13 (52)* 6 (27) -

Amenorrhoea 1 (4) 2 (9) 11 (31)

Dysmenorrhoea 2 (8)* 1 (4.5) 12 (34)* 4 (15)* P < 0.05

FOLLOW UPFOLLOW UP

MENSTRUALPATTERN

LNG IUS ML Cu 250

18 MTHS(14 PTS) NO (%)

30 MTHS (8 PTS) NO (%)

18 MTHS (19 PTS) NO (%)

30 MTHS (14 PTS) NO (%)

Normal - - 18 (95) 14 (100)

Menorrhagia - - 1 (5) -

Polymenorrhoea - - - -

Oligomenorrhoea 11 (79)* 6 (75) - -

Hypomenorrhoea 1 (7) - -

Amenorrhoea 2 (14) 2 (25) - -

Spotting - - - -

Dysmenorrhoea - - 1 (5) 1 (7)

* P < 0.05

POST INSERTION PROBLEMSPOST INSERTION PROBLEMS

POST INSERTION PROBLEMS

LNG IUS NO (%)

MLCu 250NO (%)

Leucorrhoea 1 (4) 5 (14.3)

Premenstrual spotting 1 (4) 3 (8.7)

Acne 2 (8) -

Expulsion - 1 (2.9)

Removal Dissatisfaction Desiring Pregnancy

2 (8)1 (4)1 (4)

5 (14.3)4 (11.6)

1 (4)

HIGHLIGHTSHIGHLIGHTS

LNG IUS is an ideal long term contraceptive (Pearl index 0.14)

with pregnancy rate 79-96 / 100 pts /1 yr after removal.

Anderson K. Contraception, 1994.

LNG IUS reduces menstrual blood loss by 82-96% and

significantly reduces dysmenorrhoea.

Lahteenmaki P. Br Med J, 1998.

LNG IUS is associated with a marked increase in Hb, serum

ferritin and serum iron.

Wood C. Mod Med Aust, 1999.

Contraceptive effect lasts for 5 yrs and endometrial protection

upto 8 yrs.

Luukkainen T. Acta Obstet Gynecol Scand, 1992.

The LNG IUS has continuation rates of 47- 64% which could

be improved with personnel training and extensive counseling

of patients.

Pakarinen P, et al. Sem Reprod Med.

CONCLUSIONCONCLUSION

● In view of its specific indications, the LNG IUS was

inserted more often in an older age group.

● The LNG IUS offers significant benefit in menorrhagia.

● The LNG IUS significantly ameliorates dysmenorrhoea.

● With extensive counselling and proper patient selection,

high continuation rates can be achieved with the LNG

IUS.

“He that will not apply new remedies must

expect new evils; for time is the greatest

innovator”

Francis Bacon