title: A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy.
abstract: OBJECTIVE
  To investigate endometrial histology, bleeding, and the effects of replacing the levonorgestrel intrauterine system (LNG IUS, Mirena/Levonova, Leiras Oy, Turku, Finland) after 5 years of combined use with estrogen.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Private outpatient clinic.
  
  
  METHODS
  Forty postmenopausal women started hormone replacement therapy with LNG IUS and either a patch (50 microg/24 h) or oral (2 mg) estradiol valerate protocol. Thirty-nine completed 12 months of treatment. Twenty-nine of them had used LNG IUS with continuous estradiol replacement therapy for 5 years. Seven of them volunteered to a 3-month treatment-free period before reinsertion; 22 opted for immediate reinsertion.
  
  
  METHODS
  Endometrial sampling for histology, endometrial thickness, and location of the LNG IUS by ultrasound at removal and after washout. The women completed bleeding diaries from 3 months prior to removal to 3 months after reinsertion.
  
  
  METHODS
  Endometrial histology was evaluated and estrogen and progestin effects were also investigated. Endometrial thickness was measured. Bleeding was examined based on bleeding diaries. The investigator and the women evaluated the insertion, removal, and reinsertion of the LNG IUS.
  
  
  RESULTS
  At 6 and 12 months endometrial histology was nonproliferative. At removal, all endometria were suppressed and a strong progestin effect was seen. The thickest endometrium was 3.6 mm. After washout, all seven endometria were atrophic. Before the IUS was replaced, 26 women were amenorrheic, whereas three had minor spotting. After replacement 5 women had no bleeding and an additional 10 women had only spotting. The bleeding or spotting discontinued within 18 days. The insertion of LNG IUS was characterized as easy by the investigator and it was well tolerated by the women. Cervical dilatation and/or paracervical blockade was used in 10 insertions.
  
  
  CONCLUSIONS
  Intrauterine levonorgestrel effectively protects against endometrial hyperplasia. In most women it induces amenorrhea, which is only temporarily affected by replacement of the LNG IUS.
authors.affiliation: Tampere Gynecology Center, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Varila
authors.forename: T
authors.initials: T
authors.lastname: Wahlström
authors.forename: I
authors.initials: I
authors.lastname: Rauramo
mesh_terms: D015331:Cohort Studies; D020878:Device Removal; D016503:Drug Delivery Systems; D004359:Drug Therapy, Combination; D004717:Endometrium / Q000187:drug effects / Q000473:pathology; D004958:Estradiol / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D006801:Humans; D015994:Incidence; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D008499:Medical Records; D008875:Middle Aged; D045167:Progesterone Congeners / Q000008:administration & dosage* / Q000627:therapeutic use; D011446:Prospective Studies; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology
chemical_list: D045167:Progesterone Congeners; D004958:Estradiol; D016912:Levonorgestrel