Long-term use of intrauterine systems (IUS) carries specific health risks
the verdict
CONTESTED
contested - the weight sits with the supporting side
refutedsupported
the weight of evidence
4 sources for · 0 against
The listed sources discuss intrauterine systems and their general use or short-term effects, but do not provide sufficient specific evidence to fully support health risks associated with long-term use.
Background: The levonorgestrel intrauterine systems (LNG-IUS) is widely used, but few studies report incidence rates of side-effects of LNG-IUS. Objectives: The purpose of this study was to investigate short term side effects of LNG-IUS and to compare the side effects at different dosages of LNG-IUS’s. Search strategy: We searched electronic databases (MEDLINE, Embase, Cochrane) for RCT’s and observational studies between January 1970 and April 2019 published in English. Selection criteria: Studies including women seeking contraception and receiving a LNG-IUS, compared to either women without hormonal contraception or a different dosage of a LNG-IUS. Data Collection and analysis: We evaluated randomized controlled trials with the Cochrane Risk of Bias tool and observational studies with ROBINS-I. For outcomes with data from at least two studies, meta-analysis was conducted using RevMan (version 5.3). The quality of evidence was assessed using the GRADE. Main results: We found an increase in risk of nervousness, depression, ovarian cysts and of amenorrhea. One study compared two different LNG-IUSs and found a decreased risk of developing ovarian cysts and an uncertain risk of ectopic pregnancies and mood swings in low dose LNG-IUS. Conclusions: We found that LNG-IUS increases risk of nervousness, depression, ovarian cysts and amenorrhea but the quality of evidence was low and the absolute risk small. Low-dosage LNG-IUS decreases the risk of ovarian cysts compared to high dose. To achieve higher quality of evidence, further studies are needed. Funding: No funding was received for this study. Keywords: LNG-IUS, LNG-IUD, side-effects, ovarian cysts, amenorrhea, depression, ectopic pregnancies
Background
Adenomyosis is a benign gynecological condition, where endometrial glands and stroma invades the myometrial walls of the uterus. The disease is thought to be estrogen-dependent, but the etiology, as well as the prevalence, is currently unknown. Known risk-factors are previous uterine surgery and parity, although the disease has been found also in nulligravida with no previous uterine trauma. Adenomyosis can cause severe dysmenorrhea, menorrhagia, chronic pelvic pain and infertility. Historically diagnosis has been made post hysterectomy by pathologists, however with transvaginal ultrasound (TVUS) as well as MRI the condition is now possible to identify with non-invasive methods. Hysterectomy has previously been seen as the golden standard treatment for adenomyosis, but may cause long-term side effects such as genitovaginal prolapse. It also carries a substantial risk of short term complications such as infections and organ damage. Symptomatic treatment such as the levonogestrel intrauterine system (LNG-IUS) can be effective, however there is a risk of expulsion and irregular bleedings.
Women in the USA currently may choose between several intrauterine contraception (IUC) devices, the TCu380A copper T intrauterine device (IUD), the LNG-20 intrauterine system (IUS) containing 52 mg of levonorgestrel, and the LNG-14 containing 13.5 mg of levonorgestrel IUS. IUCs continue to be the most popular reversible method of contraception worldwide and are currently the choice of more than 180 million women. All available devices offer effective, reversible, long-term contraception. The copper and levonorgestrel IUCs each manifest a unique profile of benefits and side effects. Women using the copper IUD generally maintain their menstrual cycles, but may experience increased menstrual bleeding. Women who use the LNG-IUSs experience endometrial suppression which results in an alteration of bleeding patterns; 20 % of LNG-20 users and 6 % of LNG-14 users will become amenorrheic within 1 year. IUCs are reversible, as effective as permanent sterilization and are considered Tier 1 for contraceptive effectiveness. These devices should be encouraged for use among all women, including adolescents and women with HIV. The LNG-20 is as effective as medical or surgical management for heavy menstrual bleeding. Following removal of the copper IUD and the LNG-20, fertility returns at comparable rates as in the general population.
Abstract Objective. To compare the bleeding patterns associated with the 3-year use of copper intrauterine devices (Cu-IUD) or 13.5-mg levonorgestrel-releasing intrauterine systems (LNG-IUS) in clinical practice. Design. Single-centre, double-blind, randomized, parallel group, Phase IV study. Setting. Gynaecology office. Population or Sample. Women seeking long-term contraception, eligible to use Cu-IUD/LNG-IUS. Methods. At baseline and at months 3, 6, 12, 24 and 36 after placement, we recorded the number of bleeding days and quantity of bleeding: self-reported bleeding intensity, the Pictorial Blood Assessment Chart (PBAC) and haemoglobin/ferritin levels and haematocrit. The frequency and intensity of dysmenorrhoea and spotting, and of adverse events were also recorded. Main Outcome Measures. Bleeding days and quantity of bleeding in 90-day reference periods (RPs). Results. One-hundred six women aged 32.5±6.7 years participated in the study: 55 women were randomized to LNG-IUS and 51 to Cu-IUD. The median number of bleeding days and the bleeding intensity (self-perceived and PBAC score) were significantly lower with LNG-IUS throughout the study (P <0.001), with a greater reduction during RP2 (month 2 for PBAC). Ferritin levels increased with LNG-IUS and decreased with Cu-IUD. The frequency and intensity of dysmenorrhoea decreased significantly more with LNG-IUS vs Cu-IUD. The median number of spotting days was 0 or close to 0 throughout the study with both devices. Conclusio
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