Levonorgestrel-releasing intrauterine system: uses and controversies.
This article provides a perspective on the use of the levonorgestrel-releasing intrauterine system as a contraceptive method and as therapy in different situations, as well as presenting the corresponding controversies and unresolved issues. All studies have reported high contraceptive efficacy, an improvement in menstrual blood loss in women with idiopathic menorrhagia, menorrhagia due to thrombophilic diseases and fibroids, and excellent endometrial protection during postmenopausal estrogen therapy. Moreover, the device is able to reduce pelvic pain and dysmenorrhea as well as improve the staging of endometriosis and adenomyosis, and to control, albeit partially, endometrial hyperplasia. The expectation is that in years to come the number of hysterectomies and female sterilizations will fall due to increased use of the device, including use by patients with endometriosis and HIV-positive women. It would also be desirable to develop a smaller device for postmenopausal women and nulligravidas.
Bahamondes
Luis
L
Department of Obstetrics and Gynecology, School of Medicine, University of Campinas, Caixa Postal 6181, Campinas, SP, Brazil. bahamond@caism.unicamp.br
Bahamondes
M Valeria
MV
Monteiro
Ilza
I
D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D004714:Endometrial Hyperplasia / Q000188:drug therapy; D004715:Endometriosis / Q000188:drug therapy; D004717:Endometrium / Q000187:drug effects; D015914:Estrogen Replacement Therapy / Q000009:adverse effects; D005260:Female; D005831:Genital Diseases, Female / Q000188:drug therapy*; D015658:HIV Infections / Q000188:drug therapy; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D007889:Leiomyoma / Q000188:drug therapy; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008595:Menorrhagia / Q000188:drug therapy; D018570:Risk Assessment; D019851:Thrombophilia / Q000188:drug therapy; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel