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Elsayed M, Dardeer KT, Khehra N, Padda I, Graf H, Soliman A, Makram AM, Zeiss R, Schönfeldt-Lecuona C. The potential association between psychiatric symptoms and the use of levonorgestrel intrauterine devices (LNG-IUDs): A systematic review. World J Biol Psychiatry 2023; 24:457-475. [PMID: 36426589 DOI: 10.1080/15622975.2022.2145354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/21/2022] [Accepted: 11/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Levonorgestrel (LNG)-intrauterine devices (IUDs) are an effective method of contraception; however, there is growing evidence regarding potential psychiatric side effects such as depressive symptoms, anxiety, and suicidal thoughts. Therefore, we conducted this systematic review to summarise the psychiatric effects of using LNG-IUDs. METHODS We searched six databases (MEDLINE, Web of Science, Scopus, Science Direct, Cochrane Library, and PsycInfo), and we included all study designs. The included studies were extracted, quality assessed, and qualitatively summarised. RESULTS Out of the screened studies, only 22 were finally included. While ten studies showed increased depressive symptoms, two studies showed reduced symptoms. Moreover, one study showed increased anxiety, another one reported an increased risk of suicide, four studies concluded no association with depressive symptoms, and four other studies showed uncertainty about a potential association but mentioned other psychiatric symptoms. CONCLUSION Despite unreliable data, many studies report psychiatric symptoms associated with LNG-IUDs, predominantly depression. Gynaecologists, general practitioners, and psychiatrists should therefore be aware of these potential risks, especially depressive symptoms and suicidality. Counselling patients about these risks should be mandatory. Further studies should investigate the absolute risk of mental disorders associated with LNG-IUDs and other hormonal contraceptives.KEY MESSAGESMany researchers are reporting adverse psychiatric events associated with levonorgestrel intrauterine devices (LNG-IUDs).Despite their effectiveness, a proper psychiatric assessment should be done before inserting LNG-IUDs.Proper counselling regarding the depressive symptoms and suicidality should be done by the treating obstetrician.Further studies should investigate the absolute risk of mental disorders associated with LNG-IUDs and other hormonal contraceptives.
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Affiliation(s)
- Mohamed Elsayed
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
- Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Nimrat Khehra
- Saint James School of Medicine, Arnos Vale, St Vincent & Grenadines
| | | | - Heiko Graf
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Amr Soliman
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | | | - René Zeiss
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
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Martínez Pérez A, Terrón Barroso J, Alayón Hernández N, Ariza Chana N. Métodos anticonceptivos de larga duración (LARC): características de las usuarias, tasa de continuidad y efectividad. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2023. [DOI: 10.1016/j.gine.2022.100800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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3
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Iyengar S, Iyengar K, Anand A, Suhalka V, Jain M. Observational study of feasibility and acceptability of the levonorgestrel-releasing intrauterine device as a long-acting reversible contraceptive in a primary care setting in India. Contracept X 2022; 4:100079. [PMID: 35856048 PMCID: PMC9287359 DOI: 10.1016/j.conx.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sharad Iyengar
- Action Research and Training for Health Society, Udaipur, Rajasthan, India
- Corresponding author.
| | - Kirti Iyengar
- Sexual & Reproductive Health Specialist, Udaipur, Rajasthan, India
| | - Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
| | - Virendra Suhalka
- Action Research and Training for Health Society, Udaipur, Rajasthan, India
| | - Manju Jain
- Action Research and Training for Health Society, Udaipur, Rajasthan, India
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Gormley R, Vickers B, Cheng B, Norman WV. Comparing options for females seeking permanent contraception in high resource countries: a systematic review. Reprod Health 2021; 18:154. [PMID: 34284794 PMCID: PMC8290533 DOI: 10.1186/s12978-021-01201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. METHODS We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle-Ottawa Scale to assess risk of bias and excluded studies with medium-high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. RESULTS Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium-high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. CONCLUSIONS Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. SYSTEMATIC REVIEW REGISTRATION PROSPERO [CRD42016038254].
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Affiliation(s)
- Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Brian Vickers
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Brooke Cheng
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Wendy V Norman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada. .,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK. .,Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
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Karakoyun T, Podhaisky HP, Frenz AK, Schuhmann-Giampieri G, Ushikusa T, Schröder D, Zvolanek M, Lopes Da Silva Filho A. Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study. JMIR Med Inform 2021; 9:e24633. [PMID: 34255688 PMCID: PMC8317031 DOI: 10.2196/24633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 03/04/2021] [Accepted: 04/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone–based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods The MyIUS app is classified as a medical device and uses an artificial intelligence–based bleeding pattern prediction algorithm to estimate a woman’s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting.
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Affiliation(s)
| | | | | | | | | | - Daniel Schröder
- BAYOOMED Medical Software Development, BAYOONET AG, Darmstadt, Germany
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Desai K, Almeida B, Miteva M. Understanding Hormonal Therapies: Overview for the Dermatologist Focused on Hair. Dermatology 2021; 237:786-791. [PMID: 33465769 DOI: 10.1159/000512888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/08/2020] [Indexed: 11/19/2022] Open
Abstract
Hormones have an intimate relationship with hair growth. Hormonal replacement therapy is used to treat menopausal symptoms and to provide protection from chronic diseases for which postmenopausal women may be at risk. Additionally, hormonal therapies are prescribed for contraception and treatment of acne. Considering the widespread use of such therapies, there is a demand for further understanding of their implications in hair disorders. This article reviews the specific properties of current estrogen- and progesterone-containing hormonal treatments and their implications for the patient with hair loss. The complexity of the task comes from the paucity of data and discrepancy in the literature on the effect of the specific hormonal-receptor activities.
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Affiliation(s)
- Karishma Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA,
| | | | - Mariya Miteva
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Turan G, Yalcin Bahat P, Aslan Cetin B, Peker N. The effect of a levonorgestrel-releasing intrauterine device on female sexual function. J OBSTET GYNAECOL 2020; 41:269-274. [PMID: 32498582 DOI: 10.1080/01443615.2020.1755630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study aimed to evaluate the effect of a levonorgestrel-releasing intrauterine system (LNG-IUS) on the sexual function of women. Participants who had abnormal uterine bleeding (AUB) complaints with LNG-IUSs were included (study registration: Kanuni Sultan Suleyman Training and Research Hospital, 2018/10/34). The demographic data of all participants were recorded. The female sexual function index (FSFI) questionnaire was used to participants before the insertion of LNG-IUSs and 6 months after its insertion. FSFI scores were calculated at both timepoints and were compared. The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score application (p < .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS compared to those before LNG-IUS. As a result, the present study demonstrated that after LNG-IUS insertion, these women had higher FSFI scores.Impact StatementWhat is already known on this subject? There are many publications in the literature comparing the effects of LNG-IUSs, IUSs, OCs and other contraceptive methods on female sexuality. However, there are markedly few studies that compare sexual function before and after LNG-IUS insertion.What do the results of this study add? The total FSFI score after LNG-IUS insertion was significantly higher than the total FSFI score before the insertion (p < .001). The scores of the desire, arousal, lubrication, orgasm, satisfaction and pain categories significantly increased after LNG-IUS insertion compared to those before the application. The number of participants with FSFI scores ≥26.5 before LNG-IUS insertion was 17 (12.5%), and this number increased to 71 (52.5%) after the applicationWhat are the implications of these findings for clinical practice and/or further research? This study contributes to the literature because there are few researches that compare sexual function before and after LNG-IUS insertion. As a result of our study, sexual dysfunction decreased after LNG-IUS, and the scores increased in all sub-groups together with the total FSFI scores.
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Affiliation(s)
- Gokce Turan
- School of Medicine, Department of Obstetrics and Gynecology, Gazi University, Ankara, Turkey
| | - Pinar Yalcin Bahat
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Berna Aslan Cetin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nurullah Peker
- Department of Obstetrics and Gynecology, Dicle University Medical Faculty, Diyarbakır, Turkey
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8
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Teunissen AM, Merry AHH, Devies IEC, Roumen FJME. Differences in continuation rates and early removal between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg. EUR J CONTRACEP REPR 2019; 24:449-456. [PMID: 31696740 DOI: 10.1080/13625187.2019.1682134] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To investigate differences in continuation rates between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS) and factors associated with early removal.Methods: Study design: Retrospective consecutive cohort design.Cohort: Women with the insertion of the LNG-IUS for contraceptive or therapeutic use from 1 January 2006 through 1 January 2009 at the Zuyderland Medical Centre, The Netherlands, with a follow-up of 5 years. The continuation period and reasons of early removal were noted. Univariable and multivariable analysis were performed.Results: Follow-up was possible in 2481 women, 1855 (74.8%) in the contraception group, and 626 (25.2%) in the therapy group. Multivariable Cox proportional hazards models showed, that therapeutic use was associated with an increased risk of early removal of the LNG-IUS (HR 1.23; 95% CI 1.08-1.41), as was having one child (HR 1.20; 95% CI 1.04-1.38), and a decreased risk with advancing age (HR 0.96; 95% CI 0.95-0.97). In both groups, an unacceptable bleeding pattern and adverse events were the main reasons of early removal, resulting in very low continuation rates over the years.Conclusion: Therapeutic use, having one child and a younger age are independent risk factors of early removal of the LNG-IUS, in contrast with previous LNG-IUS use which is associated with a lower risk. In both the contraception group and the therapy group, the main reasons for LNG-IUS discontinuation are continuation with a new LNG-IUS, and no more need for an LNG-IUS (for contraception or therapy). An unacceptable bleeding pattern or adverse events are associated with the lowest continuation rates in both groups.
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Affiliation(s)
- Anna M Teunissen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Audrey H H Merry
- Zuyderland Medical Centre, Zuyderland Academy, Heerlen/Sittard-Geleen, The Netherlands
| | - Ingrid E C Devies
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
| | - Frans J M E Roumen
- Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands
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Cohen MA, Simmons KB, Edelman AB, Jensen JT. Tamoxifen for the prevention of unscheduled bleeding in new users of the levonorgestrel 52-mg intrauterine system: a randomized controlled trial. Contraception 2019; 100:391-396. [PMID: 31226322 PMCID: PMC6875606 DOI: 10.1016/j.contraception.2019.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine if a course of oral tamoxifen initiated following placement of a levonorgestrel 52-mg intrauterine system (IUS) reduces bleeding/spotting days over 30 days. STUDY DESIGN In this single-center, double-blind, placebo-controlled trial, we recruited women ages 15-45 years initiating the levonorgestrel 52-mg IUS. We randomized eligible women to tamoxifen 10 mg or placebo twice daily for 7 days starting 21 days after levonorgestrel 52-mg IUS insertion. Participants tracked bleeding/spotting days via daily electronic diaries for 30 days after starting drug treatment. We assessed participant satisfaction with their bleeding pattern and the IUS using a visual analog scale (0-100 mm). A sample size of 42 provided 80% power to detect a difference of 7 bleeding/spotting days in 30 days by two-sample t test, accounting for an expected 20% dropout rate. RESULTS From September 2016 to January 2018, 42 women enrolled. A total of 34 women provided complete bleeding/spotting data, and 30 women provided satisfaction data. Mean bleeding/spotting days over 30 days did not differ between tamoxifen (12.0±5.8 days) and placebo users (16.8±9.0 days), p=.08. We found no significant differences in mean satisfaction with bleeding profiles (51 mm tamoxifen vs. 59 mm placebo, p=.48) or with the IUS (83 mm vs. 75 mm, p=.36) between groups. Both groups reported similar rates of adverse events, with no serious adverse events reported. CONCLUSION A course of oral tamoxifen did not improve early breakthrough bleeding or satisfaction in new users of the levonorgestrel 52-mg IUS. IMPLICATIONS Although tamoxifen treatment caused a trend toward modest bleeding/spotting day reduction in new levonorgestrel 52-mg IUS users, bleeding satisfaction did not improve. Future studies of tamoxifen treatment for IUS-related bleeding issues may be best targeted toward users with ongoing bleeding irregularities or lower-dose IUS products which cause more bleeding irregularities.
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Affiliation(s)
- Megan A Cohen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239.
| | - Katharine B Simmons
- The Permanente Medical Group, Department of Obstetrics & Gynecology, 2500 Merced Street, San Leandro, CA 94577
| | - Alison B Edelman
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239
| | - Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, UHN 50, Portland, Oregon 97239
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Malmborg A, Brynhildsen J, Hammar M. A survey of young women's perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:75-80. [PMID: 31395237 DOI: 10.1016/j.srhc.2019.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 06/13/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Few studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. STUDY DESIGN A secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. MAIN OUTCOME MEASURES Were self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. RESULTS A negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p < 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8-13.8). The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1-11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2-6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). CONCLUSIONS The women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.
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Affiliation(s)
- Agota Malmborg
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
| | - Jan Brynhildsen
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
| | - Mats Hammar
- Department of Obstetrics and Gynaecology, and Department of Clinical and Experimental Medicine, Linköping University, University Hospital, SE 58185 Linköping, Sweden.
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Evans SF, Brooks TA, Esterman AJ, Hull ML, Rolan PE. The comorbidities of dysmenorrhea: a clinical survey comparing symptom profile in women with and without endometriosis. J Pain Res 2018; 11:3181-3194. [PMID: 30588070 PMCID: PMC6300370 DOI: 10.2147/jpr.s179409] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Dysmenorrhea is a common disorder that substantially disrupts the lives of young women. The frequency of 14 associated symptoms both within and outside the pelvis was determined. Patients and methods Symptom questionnaires were completed by 168 women with dysmenorrhea, allocated to three groups based on their diagnostic status for endometriosis confirmed (Endo+), endometriosis excluded (Endo-), or endometriosis diagnosis unknown (No Lap). Those with endometriosis confirmed were further divided into current users (Endo+ Hx+) and non-users of hormonal treatments (Endo+ Hx-). Users of hormonal treatments were further divided into users (Endo+ Hx+ LIUCD+) and non-users (Endo+ Hx+ LIUCD-) of a levonorgestrel-releasing intra-uterine contraceptive device (LIUCD). The frequency and number of symptoms within groups and the effect of previous distressing sexual events were sought. Results Women with and without endometriosis lesions had similar symptom profiles, with a mean of 8.5 symptoms per woman. Only 0.6% of women reported dysmenorrhea alone. The presence of stabbing pelvic pains was associated with more severe dysmenorrhea (P=0.006), more days per month of dysmenorrhea (P=0.003), more days per month of pelvic pain (P=0.016), and a diagnosis of migraine (P=0.054). The symptom profiles of the Endo+ Hx+ and Endo+ Hx- groups were similar. A history of distressing sexual events was associated with an increased number of pain symptoms (P=0.003). Conclusion Additional symptoms are common in women with dysmenorrhea, and do not correlate with the presence or absence of endometriosis lesions. Our study supports the role of central sensitization in the pain of dysmenorrhea. The presence of stabbing pelvic pains was associated with increased severity of dysmenorrhea, days per month of dysmenorrhea, days per month of pelvic pain, and a diagnosis of migraine headache. A past history of distressing sexual events is associated with an increased number of pain symptoms.
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Affiliation(s)
- Susan F Evans
- School of Medicine, University of Adelaide, Adelaide, SA, Australia,
| | - Tiffany A Brooks
- School of Psychology, University of South Australia, Adelaide, SA, Australia
| | - Adrian J Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia.,James Cook University, Cairns, QLS, Australia
| | - M Louise Hull
- Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, SA, Australia
| | - Paul E Rolan
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
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12
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Smith K, Nayyar S, Rana T, Archibong AE, Looney KR, Nayyar T. Do Progestin-Only Contraceptives Contribute to the Risk of Developing Depression as Implied by Beta-Arrestin 1 Levels in Leukocytes? A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1966. [PMID: 30205587 PMCID: PMC6163405 DOI: 10.3390/ijerph15091966] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 02/07/2023]
Abstract
We reported previously that reduction in beta-arrestin 1 (β-AR 1) protein levels in peripheral blood mononuclear leukocytes (PBMC) significantly correlated with the severity of depressive symptoms in reproductive women. In this pilot study, we used β-AR 1 protein levels in PBMC as a marker for developing depressive symptoms and the Hamilton Depression Rating Scale (HAM-D) scores to assess potential mood-related side effects of oral contraceptive use for routine birth control among women. We evaluated 29 women in this study. We enrolled the participants in three groups: Estrogen-progestin combination-oral contraceptives (COC, n = 10), progestin-only contraceptives (POC, n = 12), and non-hormonal or no contraceptives (NC, n = 7). We determined the β-AR 1 protein levels in PBMCs by enzyme-linked immunosorbent assay (ELISA). We found that women in the POC group had significantly higher HAM-D scores compared to those in the COC (p < 0.0004) and NC (p < 0.004). The levels of β-AR 1 protein were significantly attenuated in women in the POC group compared to women in the NC group (p = 0.03). Our findings suggest that the use of POC is a potential risk factor for developing depressive symptoms.
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Affiliation(s)
- Keisha Smith
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
| | - Sanket Nayyar
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
| | - Tanu Rana
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
| | - Anthony E Archibong
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
| | - Kimberly R Looney
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
| | - Tultul Nayyar
- Department of Neuroscience & Pharmacology, Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA.
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Abstract
Adverse reactions to hormonal contraceptives are a common patient concern. Alopecia, an adverse reaction to androgen activity caused by the progestin component of hormonal contraceptives, can cause considerable psychosocial distress for women. This article discusses how to identify the level of androgen activity in certain progestins, how increased androgen activity can lead to hair loss, and alternatives for patients experiencing androgenic alopecia due to high androgen index contraceptives.
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Bellows BK, Tak CR, Sanders JN, Turok DK, Schwarz EB. Cost-effectiveness of emergency contraception options over 1 year. Am J Obstet Gynecol 2018; 218:508.e1-508.e9. [PMID: 29409847 DOI: 10.1016/j.ajog.2018.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 12/28/2017] [Accepted: 01/22/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND The copper intrauterine device is the most effective form of emergency contraception and can also provide long-term contraception. The levonorgestrel intrauterine device has also been studied in combination with oral levonorgestrel for women seeking emergency contraception. However, intrauterine devices have higher up-front costs than oral methods, such as ulipristal acetate and levonorgestrel. Health care payers and decision makers (eg, health care insurers, government programs) with financial constraints must determine if the increased effectiveness of intrauterine device emergency contraception methods are worth the additional costs. OBJECTIVE We sought to compare the cost-effectiveness of 4 emergency contraception strategies-ulipristal acetate, oral levonorgestrel, copper intrauterine device, and oral levonorgestrel plus same-day levonorgestrel intrauterine device-over 1 year from a US payer perspective. STUDY DESIGN Costs (2017 US dollars) and pregnancies were estimated over 1 year using a Markov model of 1000 women seeking emergency contraception. Every 28-day cycle, the model estimated the predicted number of pregnancy outcomes (ie, live birth, ectopic pregnancy, spontaneous abortion, or induced abortion) resulting from emergency contraception failure and subsequent contraception use. Model inputs were derived from published literature and national sources. An emergency contraception strategy was considered cost-effective if the incremental cost-effectiveness ratio (ie, the cost to prevent 1 additional pregnancy) was less than the weighted average cost of pregnancy outcomes in the United States ($5167). The incremental cost-effectiveness ratios and probability of being the most cost-effective emergency contraception strategy were calculated from 1000 probabilistic model iterations. One-way sensitivity analyses were used to examine uncertainty in the cost of emergency contraception, subsequent contraception, and pregnancy outcomes as well as the model probabilities. RESULTS In 1000 women seeking emergency contraception, the model estimated direct medical costs of $1,228,000 and 137 unintended pregnancies with ulipristal acetate, compared to $1,279,000 and 150 unintended pregnancies with oral levonorgestrel, $1,376,000 and 61 unintended pregnancies with copper intrauterine devices, and $1,558,000 and 63 unintended pregnancies with oral levonorgestrel plus same-day levonorgestrel intrauterine device. The copper intrauterine device was the most cost-effective emergency contraception strategy in the majority (63.9%) of model iterations and, compared to ulipristal acetate, cost $1957 per additional pregnancy prevented. Model estimates were most sensitive to changes in the cost of the copper intrauterine device (with higher copper intrauterine device costs, oral levonorgestrel plus same-day levonorgestrel intrauterine device became the most cost-effective option) and the cost of a live birth (with lower-cost births, ulipristal acetate became the most cost-effective option). When the proportion of obese women in the population increased, the copper intrauterine device became even more most cost-effective. CONCLUSION Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.
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Affiliation(s)
- Brandon K Bellows
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT; SelectHealth, Murray, UT.
| | - Casey R Tak
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Jessica N Sanders
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
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Kaislasuo J, Heikinheimo O, Lahteenmaki P, Suhonen S. Menstrual characteristics and ultrasonographic uterine cavity measurements predict bleeding and pain in nulligravid women using intrauterine contraception. Hum Reprod 2015; 30:1580-8. [DOI: 10.1093/humrep/dev102] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/20/2015] [Indexed: 11/13/2022] Open
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Cameron IT. The levonorgestrel intrauterine system: the benefits of reduced bleeding. EUR J CONTRACEP REPR 2014; 6 Suppl 1:27-32. [DOI: 10.3109/ejc.6.s1.27.32] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Youm J, Lee HJ, Kim SK, Kim H, Jee BC. Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system. Int J Gynaecol Obstet 2014; 126:165-9. [DOI: 10.1016/j.ijgo.2014.02.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Revised: 02/06/2014] [Accepted: 04/08/2014] [Indexed: 11/16/2022]
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Abstract
OBJECTIVE To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project. METHODS We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC) (intrauterine devices [IUDs] and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (N=6,153). RESULTS Twenty-four month continuation rates for long-acting reversible contraception and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% compared with 77%), whereas the implant continuation rate was significantly lower (69%, P<.001) compared with IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill [OCP] 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate [DMPA] 38%; P=.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio 0.29, 95% confidence interval 0.26-0.32) compared with women who selected a non-LARC method. CONCLUSION Intrauterine devices and the implant have the highest rates of continuation at 24 months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier. LEVEL OF EVIDENCE II.
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Luukkainen T, Pakarinen P. Medicated intrauterine devices for contraception and their therapeutic effects. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.1.2.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Zhao S, Deng J, Wang Y, Bi S, Wang X, Qin W, Huang Z, Li L, Mi X, Han L, Chang Q, Li J. Experience and levels of satisfaction with the levonorgestrel-releasing intrauterine system in China: a prospective multicenter survey. Patient Prefer Adherence 2014; 8:1449-55. [PMID: 25364235 PMCID: PMC4211859 DOI: 10.2147/ppa.s68299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although surveys conducted in Western countries have shown that the levonorgestrel-releasing intrauterine system (LNG-IUS; Mirena(®)) is well accepted by European women, its acceptance by Chinese women is not yet clearly known. The purpose of this study was to analyze the experiences and levels of satisfaction with Mirena among Chinese women living in 12 different cities. METHODS In total, 1,021 women who attended 21 medical centers for insertion of Mirena were invited to complete a questionnaire regarding their contraceptive decision at baseline (preinsertion), and two further questionnaires on their experience and satisfaction with Mirena at 3-6 months and 1 year after insertion. RESULTS At baseline, 36% of women self-reported heavy or very heavy menstrual bleeding, while 41% reported normal bleeding. The majority of women (98%) were satisfied with the preinsertion counseling, during which contraceptive reliability was identified as the most important reason for considering Mirena. Continuation rates for Mirena were 99% at 3-6 months and 93% at 12 months after insertion, and most women (92% and 93%, respectively) had less bleeding at these times. The percentage of women who rated Mirena as better than their previous contraceptive method was 63%. Overall, around 90% of respondents were very satisfied or rather satisfied with Mirena, and 64% stated that they would recommend it to their friends. CONCLUSION These data suggest that continuation and satisfaction rates with Mirena were very high, and that the device is well accepted by Chinese women.
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Affiliation(s)
- Shuping Zhao
- The Affiliated Hospital of the Medical College Qingdao University, Qingdao, People’s Republic of China
| | - Jihong Deng
- Kunming Maternal and Child Health Hospital, Kunming, People’s Republic of China
| | - Yan Wang
- Hubei Maternity and Child Health Hospital, Wuhan, People’s Republic of China
| | - Shiliang Bi
- West China Second University Hospital, Sichuan University, Chengdu, People’s Republic of China
| | - Xiaoye Wang
- Peking University Third Hospital, Beijing, People’s Republic of China
| | - Wen Qin
- Changzhou Maternity and Child Health Hospital, Affiliated to Nanjing Medical University, Jiangsu, People’s Republic of China
| | - Zirong Huang
- The Affiliated Women’s Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Li Li
- Guangzhou Women and Children’s Medical Center, Guangzhou, People’s Republic of China
| | - Xin Mi
- Maternity and Child Health Care Hospital, Shunyi District, Beijing, People’s Republic of China
| | - Liping Han
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, People’s Republic of China
| | - Qing Chang
- Southwest Hospital, Chongqing City, Chongqing, People’s Republic of China
| | - Jian Li
- Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, People’s Republic of China
- Correspondence: Jian Li, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, 251 Yaojia Yuan Road, Beijing, People’s Republic of China, Tel +86 10 5227 5418, Fax +86 10 5227 5418, Email
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Weisberg E, Bateson D, McGeechan K, Mohapatra L. A three-year comparative study of continuation rates, bleeding patterns and satisfaction in Australian women using a subdermal contraceptive implant or progestogen releasing-intrauterine system. EUR J CONTRACEP REPR 2013; 19:5-14. [PMID: 24229367 DOI: 10.3109/13625187.2013.853034] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-acting reversible contraceptive methods (LARCs) are safe, highly effective, readily reversible, and require no action on the part of the user following insertion. Early discontinuation may put women at increased risk of unintended pregnancy. METHODS Following insertion of a progestogen-only subdermal implant or intrauterine system (IUS) at Family Planning NSW, women 18 years and older completed a questionnaire about their choice. At 6 weeks, 6, 12, 24 and 36 months by telephone or online they completed a questionnaire about bleeding patterns, side effects, satisfaction, and reasons for discontinuation. RESULTS Two hundred IUS users and 149 implant users were enrolled. The former were generally older, married or in a de-facto relationship, and had children. Forty-seven percent of implant users discontinued within three years compared to 27% of IUS users (p = 0.002). In the first two years amenorrhoea was more frequent in implant users. Frequent bleeding/spotting was more prevalent in the first year of IUS use but over time was twice as prevalent in implant users. Infrequent bleeding/spotting was more common in IUS users. CONCLUSION Both devices are highly effective and acceptable cost-effective methods. While LARCs should be promoted to women of all ages seeking contraception, early discontinuation due to unacceptable bleeding highlights the need for pre-insertion counselling.
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Affiliation(s)
- Edith Weisberg
- * Sydney Centre for Reproductive Health Research , FPNSW, Sydney , Australia
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Cihangir U, Ebru A, Murat E, Levent Y. Mechanism of action of the levonorgestrel-releasing intrauterine system in the treatment of heavy menstrual bleeding. Int J Gynaecol Obstet 2013; 123:146-9. [DOI: 10.1016/j.ijgo.2013.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 05/14/2013] [Accepted: 07/25/2013] [Indexed: 11/30/2022]
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Kumari J, Malik S, Dua M. True Mirena failure: Twin pregnancy with Mirena in situ. J Midlife Health 2013; 4:54-6. [PMID: 23833537 PMCID: PMC3702068 DOI: 10.4103/0976-7800.109640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Mirena levonorgestrel intrauterine system (LNG-IUS) is a very reliable method of contraception with the failure rate comparable to sterilization. We present a case of failure of the Mirena intrauterine device in situ in a woman with twin gestational sac with positive Beta Human Chorionic Gonadotropin (β HCG) within 2 years of insertion. Although LNG-IUS is one of the most effective methods of contraception, the risks of failure should always be kept in mind and the women be appropriately counseled before its use.
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Affiliation(s)
- Jyoti Kumari
- Department of Obstetrics and Gynecology, Southend Fertility and IVF Centre, Max Hospital, Gurgaon, India
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Cook L, Fleming C. What is the actual cost of providing the intrauterine system for contraception in a UK community sexual and reproductive health setting? JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2013; 40:46-53. [DOI: 10.1136/jfprhc-2012-100377] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Further evidence for lack of negative associations between hormonal contraception and mental health. Contraception 2012; 86:470-80. [DOI: 10.1016/j.contraception.2012.02.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 12/22/2022]
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Seeber B, Ziehr SC, Gschlieβer A, Moser C, Mattle V, Seger C, Griesmacher A, Concin N, Concin H, Wildt L. Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system. Contraception 2012; 86:345-9. [DOI: 10.1016/j.contraception.2012.01.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/21/2012] [Accepted: 01/27/2012] [Indexed: 11/12/2022]
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Dal'Ava N, Bahamondes L, Bahamondes MV, de Oliveira Santos A, Monteiro I. Body weight and composition in users of levonorgestrel-releasing intrauterine system. Contraception 2012; 86:350-3. [DOI: 10.1016/j.contraception.2012.01.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 10/28/2022]
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Ahonkallio S, Santala M, Valtonen H, Martikainen H. Cost-minimisation analysis of endometrial thermal ablation in a day case or outpatient setting under different anaesthesia regimens. Eur J Obstet Gynecol Reprod Biol 2012; 162:102-4. [DOI: 10.1016/j.ejogrb.2012.01.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/25/2011] [Accepted: 01/29/2012] [Indexed: 11/16/2022]
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Stoegerer-Hecher E, Kirchengast S, Huber JC, Hartmann B. Amenorrhea and BMI as independent determinants of patient satisfaction in LNG-IUD users: cross-sectional study in a Central European district. Gynecol Endocrinol 2012; 28:119-24. [PMID: 21848413 DOI: 10.3109/09513590.2011.588751] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study investigated the satisfaction of women carrying the LNG-IUD and determined influencing factors, especially considering bleeding patterns and body mass index (BMI). DESIGN Cross sectional study. SETTING Gynecological offices in a Central European district. PARTICIPANTS 1825 women aged between 18 and 60 years. MEASUREMENT While sitting in the waiting room, voluntary patients had to answer a questionnaire about their experiences with the levonorgestrel intrauterine device. One question was used to determine whether the women were current, former or not users of the intrauterine coil. RESULTS 415 women who had some experiences with Mirena were found. Overall, 266 (65.7%) were "very satisfied," 83 (20.5%) "quite satisfied," 18 (4.4%) "moderate satisfied," 19 (4.7%) "less satisfied," and the same amount "really not satisfied" with the hormonal coil. Women with amenorrhea were more often "very satisfied" in general, than women with hypermenorrhea (178 (67.9%) vs. 3 (1.1%) p < 0.001). Concerning bleeding patterns, 295 (74.1%) were "very satisfied" and 23 (5.8%) "really not satisfied". 203 (91.0%) of all amenorrhoeic women were "very satisfied" with their bleeding patterns, but only 2 (9.5%) of all women with hypermenorrhea (p < 0.001 for α = 0.05). Amenorrhea particularly occurred in women who had a significantly lower body mass index (24.4 ± 4.4 kg/m(2) vs. 27.6 ± 6.5 kg/m(2) in women with hypermenorrhea, p = 0.018 for α = 0.05). After allocating women to the widely used BMI-categories (underweight, normal weight, overweight, obese class I and II) it was evident, that normally weighted women tend toward amenorrhea as well at the beginning of LNG-IUD use as well after 4-5 years of use. In contrast to this, overweighed and obese women tend more often to amenorrhea at the end of use, but not at the beginning (72.7% and 55.6% vs. 25.0% and 0%). Women with a lower BMI were more often "very satisfied" concerning bleeding patterns, but not concerning the general satisfaction. CONCLUSION Our study showed much evidence, that amenorrhea occurs more often in women with lower BMI contrary to women with a higher one-especially at the beginning of LNG- IUD use. Furthermore amenorrhea was mostly considered to be a positive menstrual change.
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Short M, Dallay D, Omokanye S, Hanisch JU, Inki P. Acceptability of the levonorgestrel releasing-intrauterine system and etonogestrel implant: One-year results of an observational study. EUR J CONTRACEP REPR 2011; 17:79-88. [DOI: 10.3109/13625187.2011.636088] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The benefits and risks of using a levonorgestrel-releasing intrauterine system for contraception. Contraception 2011; 85:224-34. [PMID: 22067761 DOI: 10.1016/j.contraception.2011.08.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 08/05/2011] [Accepted: 08/05/2011] [Indexed: 11/24/2022]
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.
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Marions L, Lövkvist L, Taube A, Johansson M, Dalvik H, Øverlie I. Use of the levonorgestrel releasing-intrauterine system in nulliparous women – a non-interventional study in Sweden. EUR J CONTRACEP REPR 2011; 16:126-34. [DOI: 10.3109/13625187.2011.558222] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Munro MG, Critchley HOD, Broder MS, Fraser IS. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113:3-13. [PMID: 21345435 DOI: 10.1016/j.ijgo.2010.11.011] [Citation(s) in RCA: 732] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Accepted: 01/07/2011] [Indexed: 02/07/2023]
Abstract
There is general inconsistency in the nomenclature used to describe abnormal uterine bleeding (AUB), in addition to a plethora of potential causes-several of which may coexist in a given individual. It seems clear that the development of consistent and universally accepted nomenclature is a step toward rectifying this unsatisfactory circumstance. Another requirement is the development of a classification system, on several levels, for the causes of AUB, which can be used by clinicians, investigators, and even patients to facilitate communication, clinical care, and research. This manuscript describes an ongoing process designed to achieve these goals, and presents for consideration the PALM-COEIN (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified) classification system for AUB, which has been approved by the International Federation of Gynecology and Obstetrics (FIGO) Executive Board as a FIGO classification system.
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Affiliation(s)
- Malcolm G Munro
- Department of Obstetrics and Gynecology, University of California, Los Angeles, USA.
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Heikinheimo O, Lehtovirta P, Aho I, Ristola M, Paavonen J. The levonorgestrel-releasing intrauterine system in human immunodeficiency virus-infected women: a 5-year follow-up study. Am J Obstet Gynecol 2011; 204:126.e1-4. [PMID: 21035781 DOI: 10.1016/j.ajog.2010.09.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 08/08/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We sought to assess the effects of long-term use and safety of the levonorgestrel-releasing (LNG)-intrauterine system (IUS) among human immunodeficiency virus (HIV)-infected women in comparison with HIV-infected women not using the device. STUDY DESIGN Fifteen women using the LNG-IUS and their 25 age- and CD4(+) lymphocyte count-matched control subjects with annual follow-up data were followed up for 5 years. RESULTS No unplanned pregnancies or pelvic infections occurred among the LNG-IUS users. Altogether, 12 (80%) of the LNG-IUS users continued its use up to 5 years. Annual CD4(+) lymphocyte counts were similar in the LNG-IUS users and control subjects throughout the follow-up period. The hemoglobin levels increased initially (P < .005) and remained higher among the LNG-IUS users (P < .02). Pap smears displayed non-squamous intraepithelial lesion cytology in ≥ 85% of cases in both groups. CONCLUSION No unfavorable effects on the course of HIV infection were noted during long-term use of the LNG-IUS. Dual protection by means of an LNG-IUS and condoms might be an ideal contraceptive strategy for HIV-infected women.
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Bednarek PH, Jensen JT. Safety, efficacy and patient acceptability of the contraceptive and non-contraceptive uses of the LNG-IUS. Int J Womens Health 2010; 1:45-58. [PMID: 21072274 PMCID: PMC2971715 DOI: 10.2147/ijwh.s4350] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Indexed: 11/23/2022] Open
Abstract
Intrauterine devices (IUDs) provide highly effective, long-term, safe, reversible contraception, and are the most widely used reversible contraceptive method worldwide. The levonorgestrel-releasing intrauterine system (LNG-IUS) is a T-shaped IUD with a steroid reservoir containing 52 mg of levonorgestrel that is released at an initial rate of 20 μg daily. It is highly effective, with a typical-use first year pregnancy rate of 0.1% - similar to surgical tubal occlusion. It is approved for 5 years of contraceptive use, and there is evidence that it can be effective for up to 7 years of continuous use. After removal, there is rapid return to fertility, with 1-year life-table pregnancy rates of 89 per 100 for women less than 30 years of age. Most users experience a dramatic reduction in menstrual bleeding, and about 15% to 20% of women become amenorrheic 1 year after insertion. The device's strong local effects on the endometrium benefit women with various benign gynecological conditions such as menorrhagia, dysmenorrhea, leiomyomata, adenomyosis, and endometriosis. There is also evidence to support its role in endometrial protection during postmenopausal estrogen replacement therapy, and in the treatment of endometrial hyperplasia.
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Affiliation(s)
- Paula H Bednarek
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
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Concin H, Bösch H, Hintermüller P, Hohlweg T, Mursch-Edlmayr G, Pinnisch B, Schmidl-Amann S, Schulz-Greinwald G, Unterlerchner D, Wagner T, Mattle V, Wildt L, Fiala C. Use of the levonorgestrel-releasing intrauterine system: an Austrian perspective. Curr Opin Obstet Gynecol 2010; 21 Suppl 1:S1-9. [PMID: 20019650 DOI: 10.1097/01.gco.0000361658.98177.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Approximately 12 million women worldwide use the levonorgestrel-releasing intrauterine system (IUS), with approximately 180,000 users of this IUS currently reported in Austria. A patient satisfaction study of 591 women in Austria revealed a high number of 'very satisfied' (79%) and 'satisfied' (19%) patients. Reliability, comfort, excellent compatibility and less severe, shorter and less painful monthly periods were the most frequently named advantages of the levonorgestrel-releasing IUS. Medication-induced cervical priming before insertion can be carried out on a routine or selective basis (for example in nullipara, in women who have undergone cervical conisation or in women who have previously experienced painful insertion). There is, at present, no evidence of an increased rate of breast cancer through use of the levonorgestrel-releasing IUS. A directly comparative study with oral contraceptives in young nullipara showed excellent results for the levonorgestrel-releasing IUS, with no perforations, inflammation or pregnancies.
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Affiliation(s)
- Hans Concin
- Department of Obstetrics and Gynaecology, Landeskrankenhaus Bregenz, Bregenz, Austria.
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Warner P, Guttinger A, Glasier AF, Lee RJ, Nickerson S, Brenner RM, Critchley HOD. Randomized placebo-controlled trial of CDB-2914 in new users of a levonorgestrel-releasing intrauterine system shows only short-lived amelioration of unscheduled bleeding. Hum Reprod 2010; 25:345-53. [PMID: 19897857 PMCID: PMC2806180 DOI: 10.1093/humrep/dep377] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- P Warner
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
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Murat Naki M, Tekcan C, Ozcan N, Cebi M. Levonorgestrel-releasing intrauterine device insertion ameliorates leiomyoma-dependent menorrhagia among women of reproductive age without a significant regression in the uterine and leiomyoma volumes. Fertil Steril 2009; 94:371-4. [PMID: 19896649 DOI: 10.1016/j.fertnstert.2009.09.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 10/20/2022]
Abstract
Levonorgestrel- (LNG) releasing intrauterine device (IUD) insertion revealed significant reduction in visual bleeding scores and spotting with an increase in amenorrhea and uterine pulsatility index scores. LNG-IUD can be considered as a simple and effective alternative to surgical treatment in the management of leiomyoma-dependent menorrhagia of reproductive-age women.
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Affiliation(s)
- Mehmet Murat Naki
- Obstetrics and Gynecology Department, Dr Lutfi Kirdar Kartal Research and Training Hospital, Kartal, Istanbul, Turkey.
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Abstract
OBJECTIVES To assess the profile of long-acting reversible contraceptives (LARCs) users in Europe. METHODS A random sample of women aged 15-49 years in 14 European countries (Germany, France, UK, Spain, Italy, Russian Federation, Estonia, Latvia, Lithuania, Austria, Czech Republic, Denmark, Norway, and Sweden) underwent web-based or computer-aided face-to-face interviews in June 2006. In this paper data pertaining to a subgroup of women using LARCs are presented. RESULTS A total of 11,490 women participated in the full study. Of these, 1,188 (10%) women were LARC (hormonal implant, injectables, levonorgestrel-releasing intrauterine system [LNG-IUS], copper intrauterine device [Cu-IUD]) users. The age of the LARC users exceeded 30 years for 57-91% of them. Furthermore, more than half of them found convenience an extremely important factor when selecting the LARC as a contraceptive method. As compared to those wearing a Cu-IUD, women using hormonal LARCs experienced fewer physical and emotional symptoms that appeared or worsened during menstruation. CONCLUSIONS LARCs have their place in the contraceptive market in Europe. The most popular LARCs among European women were the LNG-IUS and the Cu-IUD; both were mainly used by women who had children and had no wish to have more in the future.
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Affiliation(s)
- Sergio Haimovich
- Department of Obstetrics and Gynaecology, Del Mar University Hospital IMAS, Paseo Maritimo 25-29, Barcelona 08003, Spain.
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Abstract
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.
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Affiliation(s)
- Ayman A A Ewies
- Obstetrics and Gynaecology Department, The Ipswich Hospital NHS Trust, Maternity Block, Heath Road, Ipswich, Suffolk, IP4 5PD, UK.
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Rose S, Chaudhari A, Peterson CM. Mirena (Levonorgestrel intrauterine system): a successful novel drug delivery option in contraception. Adv Drug Deliv Rev 2009; 61:808-12. [PMID: 19445984 DOI: 10.1016/j.addr.2009.04.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/28/2009] [Indexed: 10/20/2022]
Abstract
This manuscript serves as a review of Mirena, the levonorgestrel intrauterine system (LNG IUS) as a very successful drug delivery system. The LNG IUS has a very high contraceptive efficacy rate, and low rates of patient discontinuation. In addition to its contraceptive benefits, most users experience a decrease in menstrual bleeding over the 5 years of use. LNG IUS has also been used for management of menorrhagia, dysmenorrhea, adenomyosis, and endometrial hyperplasia in some cases. The LNG IUS provides long term efficacy, high rates of compliance, rapid return to fertility, and minimal adverse effects during use.
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Robinson R, China S, Bunkheila A, Powell M. Mirena® intrauterine system in the treatment of menstrual disorders: A survey of UK patients' experience, acceptability and satisfaction. J OBSTET GYNAECOL 2009; 28:728-31. [DOI: 10.1080/01443610802462605] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J. Cost effectiveness of contraceptives in the United States. Contraception 2009; 79:5-14. [PMID: 19041435 PMCID: PMC3638200 DOI: 10.1016/j.contraception.2008.08.003] [Citation(s) in RCA: 225] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Revised: 08/16/2008] [Accepted: 08/18/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND The study was conducted to estimate the relative cost effectiveness of contraceptives in the United States from a payer's perspective. METHODS A Markov model was constructed to simulate costs for 16 contraceptive methods and no method over a 5-year period. Failure rates, adverse event rates and resource utilization were derived from the literature. Sensitivity analyses were performed on costs and failure rates. RESULTS Any contraceptive method is superior to "no method". The three least expensive methods were the copper-T intrauterine device (IUD) (US$647), vasectomy (US$713) and levonorgestrel (LNG)-20 intrauterine system (IUS) (US$930). Results were sensitive to the cost of contraceptive methods, the cost of an unintended pregnancy and plan disenrollment rates. CONCLUSION The copper-T IUD, vasectomy and the LNG-20 IUS are the most cost-effective contraceptive methods available in the United States. Differences in method costs, the cost of an unintended pregnancy and time horizon are influential factors that determine the overall value of a contraceptive method.
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Affiliation(s)
- James Trussell
- Office of Population Research, Princeton University, Princeton, NJ 08540, USA.
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Abstract
BACKGROUND There is growing evidence of women's dissatisfaction with the levonorgestrel-releasing intrauterine system (LNG-IUS) because of a high incidence of adverse effects. OBJECTIVE To quantify the continuation rate and users' satisfaction, and identify symptoms associated with early removal before the 5-years effective life-time. METHOD A questionnaire was sent to 212 women, who had LNG-IUS inserted from 1 January 1998 to 31 December 2003 at The Ipswich Hospital, UK. RESULTS The response rate was 76% (n = 161), 16 of the respondents were excluded and the data of 145 are presented. The continuation rate was 85%, 70%, 59%, 56%, 50% and 50% at 6 months, 1, 2, 3, 4 and 5 years, respectively. The total number of women who had the LNG-IUS removed before 5 years was 72 (50%), and the median duration of use was 270 days (range 4-1460). The reasons for early removal were unscheduled bleeding, progestogenic adverse effects, abdominal pain and others in 40 (28%), 32 (22%), 19 (13%) and 19 (13%) women, respectively. Only 73 (50%) women were satisfied with LNG-IUS. CONCLUSIONS Our findings are similar to recent reports, and this information should be readily available to women to enable them to make an informed choice.
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Affiliation(s)
- Suzanna Daud
- Department of Gynaecology, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
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Abstract
PURPOSE OF REVIEW The rapid increase in the world population makes it mandatory to develop new contraceptive methods. Disseminating reversible inexpensive and practical hormonal methods to developing countries is a target of many international agencies and funds. RECENT FINDINGS The safety of combined oral contraceptives is the main issue. The main guideline is to find women at risk before prescribing combined oral contraceptives. Lowering the estrogen dose should be attempted. New progestins are emerging, but their safety can be assessed only retrospectively. There is an increasing trend to extend the cycles in order to have fewer bleeding days. Progestin-only contraception seems safer than estrogen-progestin combinations in relation to thromboembolic events. A new progestin-only pill and the levonorgestrel intrauterine system have a good acceptability and high continuation rate. New administration methods are being developed and the possible role of mifepristone has been investigated. SUMMARY There are more contraceptive choices available than ever before. To educate healthcare providers as to the methods available and to inform and educate consumers are cornerstones for successful contraception.
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O'Brien S, Gupta J, Najia S, Yehia M. Update on female sterilisation: report from an international symposium on considerations for assessing long-term failure rates. JOURNAL OF FAMILY PLANNING AND REPRODUCTIVE HEALTH CARE 2008; 34:13-8. [DOI: 10.1783/147118908783332212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Paterson H, Clifton J, Miller D, Ashton J, Harrison-Woolrych M. Hair loss with use of the levonorgestrel intrauterine device. Contraception 2007; 76:306-9. [PMID: 17900442 DOI: 10.1016/j.contraception.2007.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 04/27/2007] [Accepted: 06/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND The levonorgestrel intrauterine device (IUD) has associated systemic side effects. However, there is little published information about the risk of alopecia. STUDY DESIGN Review of both the New Zealand Intensive Medicines Monitoring Programme (IMMP) data on alopecia associated with levonorgestrel IUD and the international evidence. METHODS The IMMP uses Prescription Event Monitoring to study the safety of medicines during the postmarketing period. All reported cases of alopecia with levonorgestrel IUD use were identified in the IMMP databases and assessed for causality. World Health Organization (WHO) spontaneous reporting data were also obtained. RESULTS Five reports of alopecia associated with the levonorgestrel IUD were identified in the IMMP database. From the cohort of insertions during 2000-2001, the estimated cumulative incidence of alopecia was 0.33% (95% CI 0.07-0.95) in the responder population. The WHO database contained a further 68 reports. CONCLUSIONS Counselling prior to insertion of the levonorgestrel IUD should include information on systemic effects, including the possibility of alopecia.
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Affiliation(s)
- Helen Paterson
- Department of Women's and Child Health, University of Otago, Dunedin 9054, New Zealand.
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de Jonge ET, Yigit R, Molenberghs G, Straetmans D, Ombelet W. Predictors of oligoamenorrhea at 1-year follow-up in premenopausal women using a levonorgestrel-releasing intrauterine system. Contraception 2007; 76:91-5. [PMID: 17656176 DOI: 10.1016/j.contraception.2007.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/21/2007] [Accepted: 04/14/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The study was conducted to identify predictors of oligoamenorrhea at 12 months in levonorgestrel-releasing intrauterine system (LNG-IUS) users. DESIGN A 12-month observational study. SETTING Gynecologic outpatient clinic in a large regional hospital in Flanders, Belgium. POPULATION OR SAMPLE A total of 150 women who had made an informed decision to use a LNG-IUS either as a method of contraception or to manage menorrhagia. METHODS All women were premenopausal and first-time users. The variables recorded prior to insertion on Days 1 to 5 of the menstrual cycle were age, parity, body mass index, indication for LNG-IUS use, prior contraceptive use, menstrual bleeding history, length of the uterine cavity, endometrial thickness, number of antral follicles, serum follicle-stimulating hormone, inhibin B and anti-Müllerian hormone. Menstrual bleeding pattern, patient satisfaction or wish to discontinue the method was noted at 3, 6 and 12 months of follow-up visits. MAIN OUTCOME MEASURES Menstrual bleeding pattern (amenorrhea, oligomenorrhea, menorrhagia) at 12 months was taken as the primary outcome measurement. Patient satisfaction was followed as a secondary outcome. RESULTS Oligoamenorrhea was associated with a high patient satisfaction. A bleeding period less than 5 days, absence of severe uterine bleeding at baseline, LNG-IUS use for contraception and oligoamenorrhea at 3 months were predictors of a favorable outcome at 12 months in a univariate analysis. The absence of severe bleeding prior to LNG-IUS insertion was the only clinically useful predictor of favorable outcome in the multivariate analysis (odds ratio 0.13, 95% confidence interval 0.02-0.66). CONCLUSIONS Patient profiling as described is not helpful in counselling women for intentional LNG-IUS use, especially not if it is planned as a method of managing menorrhagia.
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Affiliation(s)
- Eric T de Jonge
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg Campus Sint Jan, 3600 Genk, Belgium.
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Inki P. Long-term use of the levonorgestrel-releasing intrauterine system. Contraception 2007; 75:S161-6. [PMID: 17531611 DOI: 10.1016/j.contraception.2006.12.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 12/16/2006] [Indexed: 10/23/2022]
Abstract
Since its launch in Finland in 1990, the levonorgestrel-releasing intrauterine system (LNG IUS) has become available in more than 100 countries throughout the world, with most countries also having the approval for the treatment of idiopathic menorrhagia and protection from endometrial hyperplasia during estrogen replacement therapy. After its introduction in Finland and Scandinavian countries, the LNG IUS has been available in most European countries since the mid to late 1990s and in the United States since 2001. Studies on the repeat use of the LNG IUS with second and third consecutive IUSs have shown high continuation rates and low rates of adverse effects. During repeat use of the LNG IUS, the bleeding pattern changes toward an increasing amenorrhea rate. With regard to the menorrhagia indication, the 5-year follow-up results of a randomized comparative trial of the LNG IUS and hysterectomy have shown equal satisfaction and improvement in health-related quality of life with both treatments. Although a proportion of women assigned to the LNG IUS group eventually underwent hysterectomy, the continuation rate of the LNG IUS for menorrhagia is clearly superior to that of conventional medical therapy (e.g., oral progestins). Use of the LNG IUS in combination with estrogen therapy in women undergoing menopausal transition seems to be well tolerated and associated with a favorable bleeding pattern.
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Affiliation(s)
- Pirjo Inki
- Bayer Schering Pharma AG, D-13342 Berlin, Germany.
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