Why perimenopausal women should consider to use a levonorgestrel intrauterine system

Abstract

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.

Chinese abstract

目的: 左炔诺孕酮宫内节育系统(LNG-IUS)可用于避孕和治疗月经失调。LNG-IUS联合雌激素治疗可以帮助患者平稳或无症状的转变过渡到绝经期。不幸的是大多数医生不知道这种治疗绝经前、围绝经期和绝经后妇女的有效联合激素疗法。

设计和方法: 基于LNG-IUS的Femilis®型号的长期临床经验, 随访观察了104名从绝经过渡的围绝经期到绝经后期的妇女。这些围绝经期妇女补充使用17β-雌二醇凝聚或贴片, 或口服戊酸雌二醇。患者使用1个或每5年更换分别使用2个 Femilis。主要观察指标包括可接受性, 继续使用该方案治疗更年期症状, 以及对心血管疾病、骨质疏松和其他雌激素缺乏以及不良反应的预防作用。

结果: 使用者的平均年龄为48岁(28-58岁), 总使用时间为137 个月(80-161个月)。Femilis LNG-IUS耐受性好, 因LNG-IUS相关原因取出者很少。LNG-IUS均保留于子宫腔, 无患者取出。7名妇女失访。86名妇女(82%)选择当5年期满后更换LNG-IUS, 继续接受雌激素治疗。

结论: 宫腔内释放孕激素可抑制子宫内膜生长, 联合雌激素治疗有症状的围绝经期妇女已经广泛应用, 还具有阻止子宫内膜增殖、治疗月经过多和内膜增生的作用。此外, 许多围绝经期妇女承担非计划妊娠的风险, 局部释放左炔诺孕酮的避孕效果非常令人满意。鉴于这些原因, 作者认为该方案为最有效、安全、患者依从性高的可接受方法之一。将该信息传达给全科医生和妇女是非常重要的。

• Contraception
• EPT
• LNG-IUS
• menopausal transition
• perimenopause

Declaration of interest

Dirk Wildemeersch, MD, PhD, has conducted research in the field of non-hormonal and hormonal, framed and frameless intrauterine devices for 30 years. The author alone is responsible for the content and writing of this paper.