Non-contraceptive health benefits of intrauterine hormonal systems

Non-contraceptive health benefits are now recognized as an important aspect of the overall impact of all hormonal contraceptives. The levonorgestrel-releasing intrauterine systems (LNG IUS) are particularly effective at producing a number of health benefits for women using the LNG IUS as a contraceptive (reduced menstrual bleeding; reduced dysmenorrhea and the potential for prevention of a number of gynecological conditions in the longer term, such as iron-deficiency anemia, endometrial hyperplasia, uterine fibroids, acute episodes of pelvic inflammatory disease, endometriosis and perhaps others). The LNG IUS also has the potential to specifically treat a range of pre-existing gynecological conditions such as heavy menstrual bleeding due to a wide range of underlying causes, endometrial hyperplasia, uterine fibroids, adenomyosis, and endometriosis.These health benefits should be recognized as a key component in the decision-making process for individual women in choosing a specific type of hormonal or other contraceptive. Investment in research into the very substantial health benefits of hormonal contraceptives, such as the LNG IUS, has generally been ignored in comparison with the massive investment into understanding the often subtle or rare complications of hormonal contraceptive use. Both are important, but there is a real need to define more accurately those women who will benefit most from these health benefits.     

Assessment of menstrual blood loss in women with ideopathic menorrhagia using the frameless levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of a "low-dose" levonorgestrel (LNG)-releasing intrauterine system (IUS) on the amount of menstrual blood loss (MBL) in women with ideopathic menorrhagia. METHODS: Menstrual blood loss was assessed with the visual assessment technique in 12 Belgian FibroPlant-LNG users with menorrhagia. In addition, ferritin levels were measured. RESULTS: The median MBL, evaluated by the visual scoring technique, decreased by more than 90%. The ferritin levels increased significantly during treatment with the levonorgestrel system. CONCLUSION: This study confirms previous MBL studies conducted with the FibroPlant-LNG IUS demonstrating the efficacy of the LNG-IUS to significantly reduce the amount of MBL in women with menorrhagia. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The therapeutic effect of this contraceptive method is highly desirable, particularly in women with heavy bleeding or anemia, as other treatment modalities are less effective, more costly, more invasive or inaccessible. The simple design characteristics and anchoring system account for minimizing the occurrence of complaints of pain and expulsion.     

Assessment of menstrual blood loss in Brazilian users of the frameless copper-releasing IUD with copper surface area of 330 mm2 and the frameless levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of two types of IUDs on the amount of menstrual blood loss (MBL): the frameless copper-releasing intrauterine device (IUD) with copper surface area of 330 mm2 (GyneFix; Contrel Research, Ghent, Belgium) and the frameless levonorgestrel (LNG)-releasing intrauterine system (IUS) releasing 14 microg per day (FibroPlant-LNG; Contrel Research). Heavy and abnormal MBL is the main reason for discontinuation of intrauterine devices. METHODS: In 20 Brazilian women using GyneFix 330 and 32 using FibroPlant-LNG, respectively, MBL was measured by the quantitative alkaline hematin technique. In addition, ferritin levels were measured in GyneFix 330 and FibroPlant-LNG users. RESULTS: MBL with GyneFix 330, measured over a 24-month period, increased but was less when compared with TCu380A. Ferritin levels with GyneFix 330 were not affected in contrast with TCu380A. In FibroPlant-LNG users, mean MBL decreased by about 90% and ferritin levels increased significantly. CONCLUSIONS: The authors confirm earlier reports that, especially for women with low body iron stores and heavy menstrual bleeding, there is an order of preference for IUD use to minimize MBL. The choice should first be a progestin-releasing IUS, then a copper IUD, which has the least effect on menstrual bleeding, such as the frameless GyneFix IUD.     

Assessment of menstrual blood loss in Belgian users of a new T-shaped levonorgestrel-releasing intrauterine system

OBJECTIVE: This study was conducted to evaluate the effect of a T-shaped levonorgestrel-releasing intrauterine system (Femilis, LNG IUS) on the amount of menstrual blood loss (MBL) in women with and without menorrhagia. The daily release of the LNG IUS was approximately 20 mug. MATERIALS AND METHODS: In 60 Belgian women, less than 48 years of age at study enrollment, using the Femilis LNG IUS for 4 to more than 30 months, MBL was assessed with the visual assessment technique. Twenty-eight women had normal menstrual periods at baseline (menstrual score <185) and 32 women had idiopathic menorrhagia (menstrual score > or =185). RESULTS: Menstrual blood loss scores dropped significantly during the observation period in all women except one. The median menstrual score at baseline in women with normal menstrual bleeding was 140 (range 80-160) and dropped to a median score of 5 (range 0-150) at follow-up, a decrease of 96%. In the 32 women with menorrhagic bleeding at baseline, menstrual flow dropped from a median score of 232 (range 185-450) at baseline to a median score of 3 (range 0-50) at follow-up, a decrease of 99%. Twenty women developed amenorrhea (33%): 10 in the group of women with normal menstruation and 10 in those women with menorrhagia. Most of the remaining women had oligomenorrhea requiring the use of a few panty-liners only. In one woman, MBL did not decrease, thus requiring further evaluation. CONCLUSION: The impact on MBL of this new 20 mug/day LNG-releasing IUS confirms other studies with devices releasing the same or lower amounts of LNG. The strong endometrial suppression is the principal mechanism explaining the effect on MBL. The strong effect on MBL of this contraceptive method offers an important health benefit and improvement in quality of life, particularly in women with heavy bleeding and anemia, as other treatment modalities are less effective, more costly, more invasive or not readily available.     

Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study

This 1-year randomized study was carried out at family-planning clinics of two university hospitals to compare the safety and acceptability of a levonorgestrel-releasing intrauterine system (LNG IUS) and oral contraceptives (OCs) in young nulliparous women. The study population consisted of 200 women aged 18-25 years seeking contraception. Ninety-four women entered the LNG IUS group and 99 entered the OC group. Continuation rates, reasons leading to discontinuation, adverse events, menstrual questionnaires, subjective well-being and sexual behavior were evaluated. Nineteen women (20%) in the LNG IUS group discontinued the study during the 1-year observation period, and 27 discontinued (27%) in the OC group. The most common reason (31%) for discontinuation in the IUS group was pain. In the OC group, hormonal side effects were the predominant medical reason for study termination. The safety and acceptability of the LNG IUS for contraception was observed to be as good as with OCs, with a high continuation rate.     

Bleeding and spotting with the levonorgestrel 13.5 mg intrauterine system: the impact of insertion timing

ObjectiveTo assess the impact of early versus late menstrual cycle insertion on bleeding/spotting in the 90 days following levonorgestrel (LNG) 13.5 mg intrauterine system (IUS) insertion.Study designIn this observational study, participants received a LNG 13.5 mg IUS and provided 90 days of bleeding/spotting data by answering the following daily text: “Have you had no flow (0), spotting (1), or bleeding (2) today?” We dichotomized insertion timing as early (days 1–7 from last menstrual period) and late (remainder of menstrual cycle) and compared bleeding/spotting between the two groups in the 90- and 30-day reference periods. We used multivariate regression methods to study associations between cycle day at insertion, parity, historical bleeding, recent hormonal contraceptive use and bleeding/spotting.ResultsIn the 90-day dichotomous analysis (n=125), we found no differences in the number of days of bleeding/spotting, bleeding or spotting between the early and late insertion groups. In the 30-day dichotomous analysis (n=131), early insertion was associated with fewer days of bleeding than late insertion (5±3 vs. 7±4 days, p<.01). Recent hormonal contraceptive users experienced fewer days of bleeding than new users (5±4 vs. 7±3 days, p<.01). In the 90- and 30-day regression models, earlier insertion was associated with fewer days of bleeding (p=.02, p=.02). Recent contraceptive use was associated with fewer days of bleeding/spotting (90-day, p=.03) and fewer days of bleeding (30-day, p<.01). Nulliparity was associated with spotting (30-day, p=.04).ConclusionsEarly cycle insertion does not impact 90-day bleeding/spotting. Early cycle insertion and recent hormonal contraceptive use decrease 30-day bleeding.ImplicationsThe LNG 13.5 mg IUS may be inserted throughout the menstrual cycle with small differences in bleeding patterns in the 30 but not the 90 days following insertion. Shared decision making should determine timing of insertion.     

Ease of insertion, contraceptive efficacy and safety of new T-shaped levonorgestrel-releasing intrauterine systems

OBJECTIVE: The objective of the study was to evaluate ease of insertion, contraceptive performance and safety, in parous and nulliparous women, of two new T-shaped levonorgestrel (LNG)-releasing intrauterine systems (LNG-IUS), Femilistrade mark (parous women) and Femilis Slim (nulliparous women), releasing 20 mug of LNG per day. An ancillary objective was to evaluate expulsion and user continuation. DESIGN AND METHODS: An open, prospective, noncomparative study (interim analysis). Two hundred thirty-five insertions were performed in fertile women seeking contraception. Of these, 143 (60.8%) parous women were fitted with Femilis and 92 (39.2%) nulliparous women were fitted with Femilis Slim. The LNG-IUS was inserted using a simplified push-in technique (without folding the cross-arms in the insertion tube). RESULTS: This paper is the first report with the Femilis LNG-IUS. The push-in technique of insertion was considered simple and safe. Insertion was reported "easy" in virtually all women (97.9%). Pain at insertion was absent in 24.7% and "mild" in 67.7% of women. With respect to pain, there were no statistical differences between the parous and nulliparous group. At the time of study analysis, the total number of women-months of use was 1769.7. Seventy-six women had the Femilis IUS in place for periods in excess of 1 year. The study was well followed up with lost to follow-up of only two women. No pregnancies were observed. There was one expulsion in the nulliparous and one in the parous group. Ten removals were performed for medical reasons (mainly bleeding and pain). One pelvic infection occurred in a nulliparous woman caused by Chlamydia trachomatis, which was resolved without removing the IUS. There were no other serious adverse events reported. Both Femilis and Femilis Slim were well tolerated, which resulted in a high continuation rate (94.04%). CONCLUSION: The Femilis LNG-IUS is an effective contraceptive and is easily inserted. The simple and safe insertion procedure could be an advantage for use by nonspecialist providers such as nurses, midwives, general practitioners, and for those not inserting intrauterine devices regularly. Femilis Slim could be an attractive long-term contraceptive option in young and adolescent women.     

Subject and clinician experience with the levonorgestrel-releasing intrauterine system

BACKGROUND: Because use of intrauterine contraception is now expanding, this article reports early US clinical experience with the levonorgestrel-releasing intrauterine system (LNG IUS) and assesses subjects' and clinicians' judgment of the adequacy of product information and the overall level of product satisfaction in order to provide insight to new providers of the LNG IUS. STUDY DESIGN: Multicenter, open-label, uncontrolled, Phase IIIb study. Investigators had no prior experience with the LNG IUS. Subjects and investigators completed surveys and questionnaires at 3, 6 and 12 months. RESULTS: A total of 509 women, aged 18 to 45 years, were enrolled in this study between July 2000 and June 2002, and 506 (99.4%) received a LNG IUS after the first (488/506, 95.9%) or second (18/20, 90%) insertion attempt. Insertion was rated as "easy" by 91.8% of investigators. Continuation rate at 12 months was 79%. Primary reasons for premature discontinuation were expulsion (4.5%) and menstrual cycle problems (3.8%). Most subjects (84.5%) indicated a high level of satisfaction with the LNG IUS. CONCLUSION: Over 95% of women had successful insertions of the LNG IUS at first attempt, and less than 1% were unsuccessful after two attempts. Both clinicians and subjects were highly satisfied with product information and their experience with the LNG IUS. One-year continuation rates were comparable to those of other reversible methods.     

Menstrual problems and side effects associated with long-term TCu 380A IUD use in perimenopausal women

The study assessing menstrual problems and side effects associated with long-term TCu 380A intrauterine device (IUD) use in perimenopausal women is reported. Fifty perimenopausal TCu 380A IUD acceptors who had IUD inserted after age 40 and used IUD at least 36 months were recruited. The mean age of acceptors at time of insertion was 44.2 years with an average parity of two live births. The mean body weight at insertion was 62.13 kg. Most of the bleeding patterns were regular cycles. Intermenstrual bleeding and pelvic pain were the side effects most often reported. No pregnancies, pelvic inflammatory disease, or IUD expulsions occurred during the follow-up period. This study suggests that the use of TCu 380A IUD in perimenopausal women is safe and effective.     

Three-year efficacy and acceptability of the GyneFix 200 intrauterine system

OBJECTIVE: This study was conducted to evaluate the efficacy of a "mini" version of the frameless intrauterine system (IUS; GyneFix), which has a copper surface area of approximately 200 mm(2). The small GyneFix version consists of four copper cylinders instead of six and is only 2 cm long. MATERIALS AND METHODS: A total of 392 insertions were performed in an open nonrandomized study in parous (76%) and nulligravid/nulliparous (24%) women in Belgium and China. This interim analysis reports on 13,699 women-months of use. All women were followed-up for a minimum of 12 months, up to 3 years and longer. RESULTS: Four pregnancies occurred with the GyneFix 200 IUS in this study, of which one occurred after unnoticed expulsion of the device, yielding a cumulative failure rate of 0.48 at 3 years. The cumulative removal rate for medical reasons was 1.65 at 3 years and the expulsion rate was 0.39. These low event rates resulted in a high continuation of use (93.92 at 3 years). Neither perforations nor pelvic inflammatory disease cases were encountered in this study. CONCLUSION: The present study suggests that the GyneFix 200 IUS is highly effective and probably as effective as the standard GyneFix IUS. This is attributed to the anchoring of the device to the fundus of the uterus, promoting its contraceptive action. The total surface area of the device, releasing a maximum amount of copper ions, is the fundamental difference between it and conventional IUDs and is probably essential in obtaining the high contraceptive efficacy seen in this study. The small total surface area of the GyneFix 200 IUS also minimizes menstrual bleeding and is an improvement over larger types of conventional IUDs, as indicated by the low removal rate for abnormal bleeding with the small GyneFix.     

Uterine perforation in women using a levonorgestrel-releasing intrauterine system

OBJECTIVE: To determine an estimated incidence of uterine perforations related to the insertion of a levonorgestrel-releasing intrauterine system (LNG IUS) and to identify possible risk factors. DESIGN: Retrospective, case report study. SETTING: Hospitals in Limburg, the Netherlands. METHODS: Gynecologists in hospitals in Limburg were asked about uterine perforations related to the insertion of a LNG IUS between 1999 and 2002. The charts of the reported perforations were studied. Data on the patient, doctor, insertion, diagnosis and removal were collected for every reported uterine perforation. RESULTS: In Limburg, the estimated incidence of uterine perforations related to the insertion of a LNG IUS is 2.6 per 1000 insertions. Insertion in lactating women, even beyond 6 weeks after delivery, was shown to be an important risk factor. CONCLUSIONS: Complete registration of complications provides a greater insight into the actual incidence of LNG IUS-related uterine perforations and their possible consequences. This may eventually lead to a decrease in complications.     

Cancer and contraception: Release date May 2012 SFP Guideline #20121

As a result of advances in cancer diagnosis and treatment, young women within the reproductive-aged group are now more likely to survive cancer. Reproductive-aged women with cancer may be interested in deferring pregnancy either temporarily or permanently at cancer diagnosis, during therapy or after treatment. Currently, there are limited guidelines to aide clinicians in managing the contraceptive needs in this special population. After reviewing the evidence regarding the safety and efficacy of available methods of contraception for women who have been diagnosed with cancer, the Society of Family Planning recommends that women of childbearing age who are being treated for cancer avoid combined hormonal contraceptive methods (containing estrogen and progestin) when possible because they may further increase the risk of venous thromboembolism (VTE) (Level A). The copper T380A intrauterine device, a highly effective, reversible, long-acting, hormone-free method, should be considered the first-line contraceptive option for women with a history of breast cancer (Level A), although for women being treated with tamoxifen, the levonorgestrel-containing intrauterine system (IUS) which decreases endometrial proliferation may be preferable (Level B). Women who develop anemia may benefit from use of a progestin-containing contraceptive (Level A). Women who develop osteopenia or osteoporosis following chemotherapy should avoid the progestin-only contraceptive injection (Level B). More information is needed in many areas. There are insufficient data to evaluate the risk of VTE when progestin-only contraceptives are used by women at high risk of VTE. Information is also needed on whether the levonorgestrel-containing IUS affects the risk of breast cancer recurrence and whether hormonal contraceptives affect the risk of breast cancer among women who have received chest wall, or "mantle field," radiation. Finally, studies of the safety and effectiveness of IUS use by women who are immunosuppressed and studies of whether progestin-only contraceptives affect the risk of fracture among cancer survivors or, more generally, women with osteopenia would be useful.     

左炔诺孕酮宫内缓释系统预防子宫内膜息肉复发的应用

目的:应用左炔诺孕酮宫内缓释系统(LNG-IUS,商品名曼月乐)与孕三烯酮预防功能性子宫内膜息肉,比较这两种治疗的优劣以及对妊娠结局的影响。方法:将60例有生育要求且合并功能性子宫内膜息肉患者按放置曼月乐或孕三烯酮药物治疗分曼月乐组和对照组。两组患者于宫腔镜下电切除术(HPE)后3~5d开始治疗方案,曼月乐组放置LNG-IUS;对照组患者口服孕三烯酮2.5mg∕次,2次∕周。连续治疗3个月。结果:3个月后曼月乐组子宫内膜息肉复发率为0%(0/30),对照组为13.3%(4/30);1年后复发率曼月乐组为3.3%(1/30),对照组为33.3%(10/30);2年复发率曼月乐组为10.0%(3/30),对照组为53.3%(16/30),曼月乐组与对照组比较差异均有统计学意义(P0.05)。结论:曼月乐IUS预防功能性子宫内膜息肉复发的效果优于孕三烯酮,值得临床应用。     

Safety of levonorgestrel 52 mg intrauterine system compared to copper intrauterine device: a population-based cohort study

ObjectiveTo compare the risk of all-cause death, hospitalizations (any cause), ectopic pregnancy, pelvic inflammatory disease or infection, uterine perforation, device removal, neuro-psychiatric drugs initiation, or new psychiatric visit(s) between levonorgestrel (LNG) 52 mg intrauterine system (IUS) and copper intrauterine device (IUD) users in France.Study designWe identified a historical cohort of women aged 20–55 years with a first dispensing of either LNG 52 mg IUS or copper-IUD between January 1, 2010, and December 31, 2014, in the French National Claims database, SNDS. We used propensity score matching to balance the two groups on baseline sociodemographic and clinical characteristics to minimize confounding. We estimated Cox proportional hazards models to compare health outcomes between LNG 52 mg IUS and copper-IUDs users.ResultsWe matched 9318 LNG 52 mg IUS users (mean age 36.2±6.8 years) to 10,185 copper-IUD users (mean age 35.4±7.1 years). After matching and age-adjustment, LNG 52 mg IUS users had a slightly higher risk of anxiolytic drugs initiation (HR 1.08, 95%CI 1.01–1.15) and device removal (HR 1.05, 95%CI 1.01–1.10) compared to copper-IUD users, with no differences for other studied outcomes.ConclusionFrench IUS users report slightly more anxiolytic treatment initiation and IUD removal compared to copper-IUD users. These results are consistent with a potential pharmacovigilance signal of anxiety-related disorders in LNG 52 mg IUS users.Implications statementIn French LNG 52 mg IUS users, there was slightly more anxiolytic treatment initiation and IUD removal compared to copper-IUD users. No risk difference was found for all-cause death, hospitalizations, ectopic pregnancy, pelvic disorders, and uterine perforation. We cannot exclude that the associations are related to differences in characteristics of women who chose each type of type of IUD.     

Economic analysis of contraceptives for women

OBJECTIVE: To examine from the health care services payer perspective the economic consequences of contraceptives available to women in the United States. METHODS: A Markov model was constructed to compare effectiveness and costs among nine contraceptive methods (including 3-month injectable, oral contraceptives, intrauterine device (IUD), intrauterine system (IUS), barrier methods and surgical methods). Primary health states included initial/continued use, method failure and method discontinuation with transitions every year for 5 years. Plan disenrollment was also incorporated in the model. Estimates for probabilities of events, resource used, and costs for the base-case were derived from a comprehensive literature review, average wholesale drug prices, the 2000 Medicare Reimbursement Fee Schedule and MEDSTAT's 2000 DRG Guide, in conjunction with expert opinion. Sensitivity analyses were performed on all variables. RESULTS: Aside from vasectomy, which was outside the scope of this study, the most effective methods were tubal ligation, levonorgestrel (LNG)-20 IUS and copper T 380A IUD. The least expensive methods (accounting for all costs) were LNG-20 IUS, copper T 380A IUD and 3-month injectable; the 5-year cost/person were $1646, $1678 and $2195, respectively. CONCLUSION: From a third-party payer perspective, LNG-20 IUS and copper T 380A IUD dominated all reviewed methods, except for tubal ligation. However, the small increase in contraceptive efficacy with tubal ligation has a high cost. IUD and IUS device costs have a significant impact on the relative cost-effectiveness of these two methods.     

Postplacental placement of intrauterine devices: A randomized clinical trial

ObjectiveTo compare the expulsion rate of the TCu380A intrauterine device (IUD) or levonorgestrel (LNG) 52 mg intrauterine system (IUS) up to 90 days after postplacental placement (10 min after delivery of the placenta).Study designRandomized trial (1:1) of women aged 18–43 years and ≥37 weeks pregnant enrolled during early or prodromal labor at the University of Campinas, Brazil. Follow-up was scheduled at 42 and 90 days after device placement. We confirmed the IUD or IUS location using ultrasonography. Multivariate logistic regression was used to assess variables associated with expulsion.ResultsWe enrolled 140 women, and assigned 70 to the TCu380A IUD and 70 to the IUS groups. By the 90-day follow-up visit, 22/60 women (36.7%) in the TCu380A IUD group had expelled the device, as had 12/60 women in the IUS group (20%). Thirty-three of the 34 expulsions had occurred by the 42-day visit. Multivariate analysis demonstrated that the expulsion odds ratio ([OR]; 95% confidence interval [CI]) was higher after vaginal delivery than after Cesarean delivery (OR 5.60; 95% CI 2.08–15.10; P < 0.00) and higher among women with one (OR 4.38; 95% CI 1.33–14.43; P 0.00) or three or more deliveries (including the present one) (OR 6.08; 95% CI 1.78–20.77; P 0.00) than those with two deliveries.ConclusionsPostplacental TCu380A IUD placement had a higher expulsion rate than the IUS, and the expulsion rate was higher among women who had a vaginal delivery than those who had a Cesarean delivery. Most of the expulsions occurred within 42 days.ImplicationsPolicy makers should increase the availability of both the TCu380A and the LNG intrauterine devices for the immediate postpartum period, even though the expulsion rate is higher than that after interval placement.     

Amenorrhea rates and predictors during 1 year of levonorgestrel 52 mg intrauterine system use

Objective

The objective was to evaluate amenorrhea patterns and predictors of amenorrhea during the first year after levonorgestrel 52 mg intrauterine system (IUS) placement.

Menstruation: choosing whether...and when

For many women in the United States, menstruation is a major health concern because menstrual disorders and other conditions that may be aggravated during menses (e.g., migraine headaches, epilepsy) carry substantial morbidity. Women today menstruate nearly 3 times as often as in primitive societies, and evidence suggests that frequent, repetitive menstrual cycles may increase health risks. Because the conventional 21/7 combination oral contraceptive (OC) regimen provides only limited relief for women with menstrual disorders, alternative OC regimens that reduce menstrual frequency have been proposed. A new OC formulation specifically designed to decrease menstrual bleeding to 4 times per year is currently under investigation. Most women welcome less frequent menses or even amenorrhea. Women who may derive particular benefit from reduced menstrual frequency include not only those with medical conditions directly caused or aggravated by menses, but also those serving in the military, female athletes, mentally-retarded women with menstrual hygiene problems, young teens, and perimenopausal women.     

Clinical performance of the levonorgestrel intra-uterine system in routine use by the UK Family Planning and Reproductive Health Research Network: 12-month report

Doctors working in general practice and at family planning clinics throughout the UK who collaborate in the UK Family Planning and Reproductive Health Research Network were responsible for the fitting of 692 Levonorgestrel Intra-uterine Systems (LNG IUS). This study was undertaken to determine the performance of the LNG IUS in British women in routine clinical use. The 12 months cumulative life-table event rates were: pregnancy 0.6, expulsion 4.5. The continuation rate was 70.6. Removals were also required for side effects, which may be due to absorbed levonorgestrel, the removal rate being 7.4. Positive effects include effective contraception and considerably reduced quantity of bleeding for most participants. A need was identified to counsel women about the early bleeding problems, including the possibility of oligomenorrhoea or amenorrhoea. This is considered to be very important as it will help women to persevere so that they can enjoy the longer-term benefits.     

异常子宫出血药物治疗进展

国际妇产科联盟月经疾病组（FMDG）提出异常子宫出血（abnormal uterine bleeding,AUB）是涵盖月经紊乱的术语,应摒弃月经过多和功能失调性子宫出血（dysfunctional uferine bleading,DUB）称谓。月经量过多术语推荐用严重出血（heavy menstrual bleeding,HMB）替代月经过多。FMDG把AUB按照病因的首字母分为9个系统,即PALM-COEIN。其中COEIN为非器质性因素引起的AUB,首选为药物治疗,包括抗纤溶制剂、非甾体类抗炎药（NSAIDs）、避孕药、孕激素和左炔诺孕酮宫内缓释系统（LNG-IUS）等。LNG-IUS是最有效的治疗特发性HMB的方法之一,可以长期有效地控制月经量。去氨加压素（desmopressin,DDAVP）在治疗凝血功能障碍患者HMB时有效。二甲双胍可调节多囊卵巢综合征（PCOS）妇女月经,并对子宫内膜增生性疾病孕激素抵抗的患者有治疗作用。另外,四相口服避孕药、氨甲环酸的新制剂、丹那唑的阴道制剂和阴道避孕环等是治疗HMB的可供选择新方法。