in nonhormonal methods, like copper IUDs, has contributed to greater acceptance by women.
with the hands in the front pockets) and the Nova-T whose arms are placed above the stem in the inserter (like a diver with arms above the head). Device component materials can be divided into the following groups: inert, copper, and hormone.
medicated (e.g., copper and levonorgestrel-containing) devices gradually and completely replaced inert IUDs.
like a miniature harpoon. GyneFix is available in Mexico, Mongolia, Vietnam, Bolivia, Europe, China, Kenya, and Indonesia. Research demonstrated comparable efficacy to the TCu380A IUD over 8 years though more insertion failures, expulsions, and pregnancies in the first year of use.22,23
of HMB is an approved indication throughout the world for Mirena and in every country outside the United States for Liletta31,32; a HMB trial for Liletta to have this approval in the United States is currently under way (ClinicalTrials.gov NCT03642210). The LNG 52 mg IUS is about as effective as endometrial ablation for HMB treatment.33,34,35 The high local levels of LNG at the endometrium provide strong suppression of proliferation useful for a variety of gynecologic conditions, and the literature supports off-label use for endometrial protection in women using tamoxifen, for postmenopausal women receiving estrogen therapy, for treatment of endometrial hyperplasia, and for dysmenorrhea.36,37,38,39,40,41,42,43
lower-dose LNG IUSs as it is approved for treatment of HMB and endometrial protection during hormone replacement therapy in many countries (but not the United States). Though we lack comparative studies, the higher local and systemic levels with the 52 mg IUS appear a more sensible choice than lower-dose IUSs for hyperestrogenic situations such as treatment of endometrial hyperplasia, treatment of HMB, and pelvic pain. Still, many women of all ages have concerns about hormonal dose, and counseling for IUD choice should include the pros and cons of the lower-dose systems. While not an approved option for HMB, the lower-dose LNG-IUS offers an alternative to a copper IUD in women with concerning menstrual bleeding or pain histories who would prefer to minimize hormonal dose.
5. IUDs DO NOT increase the risk of ectopic pregnancy and CAN be used by women with a previous ectopic.69,70,71,72,73,74,75,76
7. IUDs CAN be inserted immediately postpartum, including after first- and second-trimester abortions.80,81,82,83,84,85,86,87
9. Prophylactic antibiotics are NOT necessary prior to IUD insertion.93
10. Women at risk for STIs CAN use IUDs.60
changes provide a primary contraceptive effect.101 The available data strongly support prevention of fertilization via thickened mucus as the primary mechanism of action in LNG-IUS users. The high local release of LNG leads to the development of a progestin-mediated thickening of cervical mucus. This was demonstrated by light microscopy of cervical mucus, which showed a barrier to sperm penetration in LNG-IUS users compared to nonhormonal users (Figure 6.2).102 The high efficacy of the LNG-IUS in preventing pregnancy is incontrovertible. This is most likely due to lack of sperm penetration through highly unfavorable cervical mucus. Limitations of the certainty of this statement come from the lack of scientific data demonstrating the quantity, motility, and function of sperm with LNG-IUS use. However, high levels of local LNG may have deleterious effects on spermegg interaction through interference with sperm transport, capacitation, and the acrosome reaction.103 In addition, LNG delivered from the IUD may impair oviduct transport via an effect on tubal motility.104,105,106 Efficacy may also be augmented by modest decreases in ovulatory function during early use of the LNG-IUS. After the first year, cycles are ovulatory in 50% to 75% of women, regardless of their bleeding patterns.107
salpingectomy within 132 hours of the LH peak. The experimental group included 56 women with a variety of inert, copper and hormonal IUDs. Their tubal flushings were compared to 115 women using no contraception. The tubal flushings returned eggs from 39% of IUD users and 56% of control participants. The uterine flushing returned no eggs from IUD users and 4 from the 115 control subjects. A subset of participants with retrieved eggs reported intercourse from 70 hours before to 11 hours after the LH peak and had evidence of spermatozoa in their cervical mucus. None of the 14 IUD users had eggs with evidence of fertilization versus 10 of 20 control participants whose eggs showed 2- to 8-cell postfertilization development.108
Reduction of heavy menstrual bleeding (FDA approved for Mirena), abnormal uterine bleeding, and improvement of related anemia (LNG 52 mg)33,72,73,74,75,76,77,78,79,80,81,82,83,84,85
Reduction of menstrual bleeding in women with hemostatic disorders and in anticoagulated women (LNG 52 mg)87,88,89,90,91,92,93
Treatment of primary dysmenorrhea (LNG 52 mg)116
Reduction of myoma prevalence as well as uterine volume and bleeding associated with myomas (LNG 52 mg)94,98,99,100,101
Treatment of endometriosis and pain associated with endometriosis (LNG 52 mg)52,53,117,118,119,120,121,122,123,124
Decrease in uterine volume and pain associated with adenomyosis (LNG 52 mg)115
Protection against polyps associated with postmenopausal estrogen therapy or tamoxifen treatment (LNG 52 mg)36,38,39,40,41,42,117,118,119
Conservative treatment of endometrial hyperplasia or low-risk endometrial cancer (LNG 52 mg)52,120,121,122,123,124,129
LNG-IUS.129 However, these women may require earlier replacement (e.g., before 5 years) of the LNG-IUS if heavy bleeding returns.124,125,126,127,129,140,141