Intracervical and fundal administration of levonorgestrel for contraception: endometrial thickness, patterns of bleeding, and persisting ovarian follicles.
OBJECTIVE
To study the prevalence of persisting ovarian follicles and to assess the endometrial changes and patterns of vaginal bleeding over 1 year of use of a 20 micrograms/24 h levonorgestrel-releasing intracervical contraceptive device.


METHODS
Prospective, randomized study.


METHODS
Two family planning clinics in Helsinki, Finland.


METHODS
Women requesting intrauterine hormonal contraception.


METHODS
Insertion of a levonorgestrel-releasing intracervical contraceptive device into the cervical canal (group 1, n = 151) or fundally into the uterine cavity (group 2, n = 147) for contraception.


METHODS
Transvaginal ultrasonography of the ovaries and endometrium at insertion and 3, 6, and 12 months after insertion. Data on bleeding were collected using menstrual diary cards.


RESULTS
Persisting ovarian follicles were found in < 8% of women. In both groups, the amount of endometrial tissue decreased significantly in 3 months. The incidence of amenorrhea during the 1st year was higher in the fundal insertion group.


CONCLUSIONS
The number of persisting follicles was low. Follicles resolved within 6 to 8 weeks. No association was found between persisting follicles and problems of bleeding. Compared with intracervical insertion, fundal insertion resulted in more uniform endometrial suppression and fewer days of bleeding and spotting.
Pakarinen
P I
PI
Steroid Research Laboratory, University of Helsinki, Finland.
Suvisaari
J
J
Luukkainen
T
T
Lähteenmäki
P
P
D000328:Adult; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects; D004717:Endometrium / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects; D006080:Ovarian Follicle / Q000000981:diagnostic imaging / Q000187:drug effects / Q000502:physiology*; D045167:Progesterone Congeners / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012984:Software; D013997:Time Factors; D014463:Ultrasonography; D014592:Uterine Hemorrhage / Q000209:etiology / Q000503:physiopathology*
D003271:Contraceptive Agents, Female; D045167:Progesterone Congeners; D016912:Levonorgestrel