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MIRENA

The levonorgestrel intrauterine system

Dr. Ramiro Molina Cartes
Professor at the Faculty of Medicine, University of Chile

WRC Director Center for Reproductive Medicine and Integral Development Adolescent

The Levonorgestrel-releasing intrauterine system, classified as an IUS consists of a T of 32 mm. by 32 mm. It is made of polyethylene, which in the stem or vertical cylinder has a wrapper or elastomer comprising a polydimethylsiloxane mixture containing 52 mg of LNG. The drug is controllably released through a membrane.

Use is tested to 5 years of use, although there are jobs in which their efficacy is maintained up to 7 years. The initial release rate is 20 micrograms in 24 hours at the end of 5 years releases 10 micrograms in 24 hours.

The IUS is an ideal choice for women with children who want a reliable and long term. It is also an excellent choice after childbirth or when they believe that the family is complete and preferred periods shorter, lighter and less painful.

The most notable effects of this "IUS are high contraceptive efficacy and reduction in the amount of menstrual flow, with the decline in both volume and days menstrual bleeding.

In 20% of users are amenorrheic in the first year of use. However, in the beginning of use may occur increased bleeding, or spotting, which regulates between 3 and 6 months of use, being equal to Copper-T, but with large individual variations.

The risk of salpingitis or pelvic inflammatory disease (PID) associated with the insertion is low, however the clinician should be aware of this complication.

Mechanism of Action

1. Prevents endometrial proliferation, which leads to thinning of the endometrium, which remains inactive.
2. The cervical mucus becomes scarce and dense.
3. It works well with ovulation disorders, without being anovulatory in all cycles.
4. Inhibits sperm motility and function normally in the uterus and fallopian tubes, preventing fertilization. Effects have been reported at these concentrations of LNG in sperm capacitation by both direct action of progesterone receptors in the acrosome of spermatozoa and the effects of endometrial secretions altered in this training process. Pearl
index reaches 0.1 per 100 women observation.

Additional benefits

There are additional benefits of using the LNG IUS with, such as inactivation of the endometrium resulting in less blood loss and increased hemoglobin, decreased dysmenorrhea, and a decrease Inflammatory Processes Pelvic.

ectopic pregnancies reach 1 in 5000 users per year have been work-jos published showing the effect on the reduction of fibroids, endometriosis rate and the protection of the endometrium in patients treated with tamoxifen in patients with breast cancer.

This beneficial effect of contraception has not placed as an alternative in hormone replacement therapies for endometrial protection.

The IUS has a high rate of acceptability and continuation rate of 80% per year in various clinical studies. The recovery of fertility, once removed, is similar devices with Cu.

The cumulative gross conception rate is 79.1% annually and is comparable to natural conception rate. The release of only 20 micrograms of LNG decreases the risk of ectopic pregnancy, being 1 in 5,000 women per year, this is a decrease of 90% of ectopic pregnancies in non-users of contraception.

References and further reading

1.Barbosa et al. Ovarian function DURING use of a levonorgestrel-releasing IUD. Contraception 42: 51-66, 1990
2. Silverberg et al. Endometrial morphology DURING long-term use of levonorgrstrel-releasing intrauterine device. Int J Gynecol Path 5:235-241, 1986
3. Toivonen et al. Protective effect of intrauterine release of levonorgrstrel on pelvic Infection; three years comparative experience of levonorgestrel releasing devices and cooper. Obstet. Gynecol, 77: 261-264.1990
4.Nilsson et al. Pattern of ovulation and bleeding with a low levonorgestrel-releasing intrauterine device. Contraception21 :2:155-164, 1980
5. Hidalgo et al. Bleeding patterns and clinical performsnce of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception, 65:129-132,2002

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