Levonorgestrel Intrauterine Device: Use and Precautions

Therapeutic action

Hormonal contraceptive, progestogen.

Indications

• Long-acting contraception.
• Long-term treatment of functional uterine bleeding.

Forms and strengths

Intrauterine device (IUD) containing 52 mg of levonorgestrel and releasing 20 micrograms daily on insertion.

Dose

• The IUD may be inserted at any moment of the cycle if it is reasonably certain the woman is not pregnant, including when switching from another form of contraception.
• For contraception, use condoms for 7 days after the insertion of the IUD if it is inserted over 7 days after the start of menstrual period, over 28 days postpartum if not breastfeeding, or over 7 days after an abortion.

Duration

• Contraception: as long as this method of contraception is desired and well tolerated, for max. 5 years, after which the IUD must be changed.
• Long-term treatment of functional uterine bleeding: according to clinical response.

Contra-indications, adverse effects, precautions

• Do not use in patients with breast cancer, cervical cancer, severe or recent hepatic disease, genital infection, active thromboembolic disorders, hydatidiform mole, or other gestational trophoblastic disease.
• May cause changes in bleeding patterns such as amenorrhoea or irregular lighter bleeding; rarely heavy prolonged bleeding; abdominal pain, headache, nausea, breast tenderness, acne, weight gain, and mood change.
• IUD insertion-related complications include expulsion of IUD, pelvic infection, and risk of uterine perforation during insertion.
• The contraceptive efficacy of levonorgestrel-releasing IUD does not seem to be reduced in women taking enzyme-inducing drugs.
• Pregnancy: contraindicated.
• Breast-feeding: no contra-indication.
• Fertility returns rapidly after removal.
• The IUD may be inserted within 48 hours after childbirth or, after that, insertion should be delayed until after 28 days postpartum.
• Read the manufacturer's instructions for insertion and removal.