Levonorgestrel-releasing intra-uterine systems as female contraceptives

ABSTRACT

Introduction: The availability and use of long-acting reversible contraceptives (LARCs), such as levonorgestrel intrauterine systems (LNG-IUSs), have increased in recent times.

Areas covered: The authors provide a narrative review of the LNG-IUSs currently available worldwide as female contraceptives (LNG-IUS 13.5, 19.5 and 52 mg). Specific features of the devices and their parameters of efficacy and tolerability were considered as outcomes.

Expert opinion: The one-handed 3.8-mm-diameter inserter of LNG-IUS 13.5 mg and 19.5 mg may be particularly suitable in nulliparous women. While LNG-IUSs 13.5, 19.5 mg and LNG 52 mg should be used by women simply looking for an effective contraceptive method for up to 3, 4 or 5 years, LNG-IUS 52 mg has also been approved for the treatment of heavy menstrual bleeding and endometrial protection during hormone replacement therapy. LNG-IUS 52 mg is ideal for women who are experiencing a certain hyperestrogenic hormonal environment, with heavy menstrual bleeding due to hormonal imbalances, adenomyosis or fibroids, in the case of symptomatic endometriosis or for endometrial protection during hormone estrogenic replacement therapy in non-hysterectomized women.

KEYWORDS:

• Levonorgestrel
• intra-uterine system
• efficacy
• contraception
• long acting reversible contraceptive
• Jaydess
• Skyla
• Kyleena
• Liletta
• Levosert
• Mirena
• adverse event
• compliance
• bleeding
• benefit

Article highlights

• All of the IUSs available contain the second-generation progestin derived from 19-nortestosterone LNG at different dosages (total content: 13.5, 19.5 and 52 mg).

• LNG-IUS 13.5 mg (Jaydess/Skyla) and 19.5 mg (Kyleena) are approved only for contraception for up to 3 and 5 years of use, respectively. Their narrow diameter inserter may be particularly suitable for nulliparous women.

• LNG 52 mg (Liletta/Levosert) has a current approved use of 4 years for contraception.

• LNG-IUS 52 mg (Mirena) is approved in more than 100 countries worldwide for contraception for up to 5 years, but in some places, it is also approved for the treatment of heavy menstrual bleeding and endometrial protection during hormone replacement therapy.

This box summarizes key points contained in the article.

Declaration of Interest

G Grandi has been a lecturer and member of advisory boards for Teva Pharmaceuticals, Bayer Healthcare, Effik S.A., Sandoz and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. One referee discloses that they’ve worked as a consultant for Merck & Co., Bayer Healthcare, Allergan and Cooper Surgical.

Additional information

Funding

This manuscript has not been funded.