title: The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: a clinical review.
abstract: Estrogen replacement therapy (ERT) is a well-established method of managing climacteric symptoms in women approaching the menopause, but it is associated with a significant risk of endometrial hyperplasia if unopposed by concomitant progestogen administration. The levonorgestrel-releasing intrauterine system (LNG-IUS) offers a highly effective method of minimizing this risk and has additional benefits beyond endometrial protection. The LNG-IUS provides excellent contraception, which may still be necessary in perimenopausal women, and is suitable for women with underlying conditions that may preclude their use of estrogen-containing contraceptive methods. It can effectively manage bleeding problems through the transition from perimenopause into menopause, with many women developing amenorrhea. The LNG-IUS is well tolerated with a favorable safety profile, which generally mirrors that of women of reproductive age using it for contraception only. Moreover, the LNG-IUS plus ERT combination does not appear to be associated with clinically relevant effects on plasma lipids or other markers of cardiovascular risk. Women using the LNG-IUS plus ERT also experience improvements in quality of life, and adherence and continuation rates are high. This review will summarize the clinical evidence for the use of the LNG-IUS plus ERT in peri- and postmenopausal women and present the key attributes of this combined therapy.
authors.affiliation: * Department of Gynecology, University Hospital , Ghent , Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Depypere
authors.forename: P
authors.initials: P
authors.lastname: Inki
mesh_terms: D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D004714:Endometrial Hyperplasia / Q000139:chemically induced / Q000517:prevention & control*; D015914:Estrogen Replacement Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D047648:Perimenopause; D017698:Postmenopause; D011788:Quality of Life
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: EFFICACY; ENDOMETRIAL PROTECTION; ESTROGEN REPLACEMENT THERAPY; LEVONORGESTREL-RELEASING INTRAUTERINE SYSTEM; MENOPAUSE; MENSTRUAL BLEEDING PROFILE; SAFETY