title: The levonorgestrel-releasing intrauterine system: Safety, efficacy, and patient acceptability.
abstract: The levonorgestrel-releasing intrauterine system (LNG-IUS) is a safe, effective and acceptable form of contraception used by over 150 million women worldwide. It also has a variety of noncontraceptive benefits including treatment for menorrhagia, endometriosis, and endometrial hyperplasia. The LNG-IUS has also been used in combination with estrogen for hormone replacement therapy and as an alternative to hysterectomy. Overall, the system is very well tolerated and patient satisfaction is quite high when proper education regarding possible side effects is provided. However, despite all of the obvious benefits of the LNG-IUS, utilization rates remain quite low in the developed countries, especially in the United States. This is thought to be largely secondary to the persistent negative impressions from the Dalkon Shield intrauterine experience in the 1970s. This history continues to negatively influence the opinions of both patients and health care providers with regards to intrauterine devices. Providers should resolve to educate themselves and their patients on the current indications and uses for this device, as it, and intrauterine contraception in general, remains a largely underutilized approach to a variety of women's health issues.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
authors.forename: Megan N
authors.initials: MN
authors.lastname: Beatty
authors.forename: Paul D
authors.initials: PD
authors.lastname: Blumenthal
references.citation: Maturitas. 2007 Jun 20;57(2):210-3
references.pmid: 17270370
references.citation: Fertil Steril. 1997 Sep;68(3):426-9
references.pmid: 9314908
references.citation: Contraception. 1994 Jan;49(1):56-72
references.pmid: 8137626
references.citation: Contraception. 1991 Nov;44(5):473-80
references.pmid: 1797462
references.citation: Eur J Obstet Gynecol Reprod Biol. 2006 Apr 1;125(2):259-64
references.pmid: 16246481
references.citation: Hum Reprod Update. 2008 May-Jun;14(3):197-208
references.pmid: 18400840
references.citation: Am J Obstet Gynecol. 2006 Nov;195(5):1272-7
references.pmid: 17074548
references.citation: N Engl J Med. 2009 Jan 15;360(3):268-79
references.pmid: 19144942
references.citation: Fertil Steril. 2003 Aug;80(2):305-9
references.pmid: 12909492
references.citation: Am J Obstet Gynecol. 2008 Apr;198(4):373.e1-7
references.pmid: 18177833
references.citation: Contraception. 2007 Jun;75(6 Suppl):S2-7
references.pmid: 17531612
references.citation: Contraception. 2003 Jul;68(1):31-4
references.pmid: 12878284
references.citation: Eur J Gen Pract. 2004 Sep;10(3):82-7
references.pmid: 15534571
references.citation: Contraception. 2003 Feb;67(2):87-91
references.pmid: 12586318
references.citation: Lancet. 2001 Feb 10;357(9254):443
references.pmid: 11273068
references.citation: Contraception. 2007 Jun;75(6 Suppl):S55-9
references.pmid: 17531618
references.citation: Eur J Obstet Gynecol Reprod Biol. 2009 Apr;143(2):128-9
references.pmid: 19181433
references.citation: Hum Reprod. 2007 Oct;22(10):2647-52
references.pmid: 17652452
references.citation: Lancet. 2001 Jan 27;357(9252):273-7
references.pmid: 11214131
references.citation: Contraception. 2008 Apr;77(4):227-9
references.pmid: 18342643
references.citation: JAMA. 2002 Jul 17;288(3):321-33
references.pmid: 12117397
references.citation: JAMA. 1998 Aug 19;280(7):605-13
references.pmid: 9718051
references.citation: Contraception. 1999 Sep;60(3):173-5
references.pmid: 10640162
references.citation: Contraception. 2007 Mar;75(3):185-92
references.pmid: 17303487
references.citation: Contraception. 1993 Jul;48(1):1-12
references.pmid: 8403900
references.citation: Br J Obstet Gynaecol. 1998 Jun;105(6):592-8
references.pmid: 9647148
references.citation: Contraception. 2007 Jun;75(6 Suppl):S152-4
references.pmid: 17531608
references.citation: Gynecol Oncol. 2008 Oct;111(1):68-73
references.pmid: 18684496
references.citation: Hum Reprod. 2005 Jul;20(7):1993-8
references.pmid: 15790607
references.citation: Obstet Gynecol. 1992 Jun;79(6):963-7
references.pmid: 1579323
references.citation: Hum Reprod. 2005 Sep;20(9):2653-60
references.pmid: 15905289
references.citation: Obstet Gynecol. 2005 Jan;105(1):223-32
references.pmid: 15625179
references.citation: Aust N Z J Obstet Gynaecol. 2004 Jun;44(3):247-51
references.pmid: 15191451
references.citation: Contraception. 2006 Sep;74(3):249-58
references.pmid: 16904420
references.citation: Obstet Gynecol. 2002 Apr;99(4):608-13
references.pmid: 12039121
references.citation: Hum Reprod. 2005 Mar;20(3):789-93
references.pmid: 15608040
references.citation: Acta Obstet Gynecol Scand. 1999 Sep;78(8):716-21
references.pmid: 10468065
references.citation: Contraception. 2006 Nov;74(5):376-81
references.pmid: 17046378
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD002126
references.pmid: 16235297
references.citation: Steroids. 2000 Oct-Nov;65(10-11):693-7
references.pmid: 11108878
references.citation: Am J Obstet Gynecol. 2008 Mar;198(3):248-53
references.pmid: 18221924
references.citation: Contraception. 2007 Oct;76(4):292-6
references.pmid: 17900440
references.citation: Eur J Contracept Reprod Health Care. 1998 Dec;3(4):190-3
references.pmid: 10036601
references.citation: Eur J Obstet Gynecol Reprod Biol. 2008 Aug;139(2):169-75
references.pmid: 18440693
references.citation: Contraception. 2009 Jan;79(1):24-8
references.pmid: 19041437
references.citation: Cochrane Database Syst Rev. 2001;(2):CD001327
references.pmid: 11405986
references.citation: J Fam Plann Reprod Health Care. 2004 Apr;30(2):99-108; quiz 109
references.pmid: 15086994
references.citation: Contraception. 2006 May;73(5):528-31
references.pmid: 16627040
references.citation: Contraception. 1993 Feb;47(2):169-75
references.pmid: 8449017
references.citation: Climacteric. 2000 Sep;3(3):199-211
references.pmid: 11910622