Published: 2017-02-08

Levonorgestrel intrauterine releasing system: long term health impact

Urvashi Miglani, Pushpa Singh


Background: Menorrhagia, menstrual blood loss of more than 80 ml is a common health problem affecting 5-30% of women in India and accounts for 8% loss of economic wages annually. This study was conducted in PGIMER and Dr. RML Hospital New Delhi to evaluate the efficacy, acceptability and safety profile of LNG IUS (a non-invasive modality) in a variety of gynaecological disorders with associated menorrhagia.

Methods: This was a noncomparative longitudinal observational study conducted in PGIMER and Dr RML Hospital New Delhi from June 2009 to September 2013.All patients with menorrhagia with or without dysmenorrhoea were screened and in suitable cases, LNG IUS was inserted in the postmenstrual phase after counselling and informed consent. Menstrual pattern, mean bleeding days, hemoglobin and satisfaction level was noted before insertion, 6 months, 1 year and 2 years post insertion.

Results: 30 patients were recruited in the study over the first 2 years. 66.66% (20) had associated medical co morbidities. LNG IUS was spontaneously expelled in 2 (6.66%) and 3 subjects (10%) needed a hysterectomy due to persistent bleeding. The remaining 25 subjects continued with the device and these subjects had a significant decrease in mean bleeding days with associated significant rise in hemoglobin levels over 2 years.

Conclusions: LNG-IUS is an underused useful device for several gynecological disorders and is a boon especially for those with medical comorbidities and should be offered to all suitable subjects. 


LNG IUS, Heavy menstrual bleeding, Fibroids, Anemia

Full Text:



Harlow SD, Campbell O. MR. Epidemiology of menstrual disorders in developing countries: a systematic review. BJOG. 2004;111:6-16.

Milsom I. The levonorgestrel-releasing intrauterine system as an alternative to hysterectomy in perimenopausal women. Contraception. 2007;75(6 Suppl):S152-4.

Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009 May;113(5):1104-16.

Pintiaux A, Chabbert Buffet N, Foidart JM. Gynecological uses of a new class of steroids: the selective progesterone receptor modulators. Gynecol Endocrinol. 2009;25:67-73.

Berlex Pharmaceuticals. Mirena® Physician Information, July 2008. Available at: Accessed 24 June 2009.

Irvine GA, Campbell-Brown MB, Lumsden MA, Heikkilä A, Walker JJ, Cameron IT. Randomised comparative trial of the levonorgestrel intrauterine system and norethisterone for treatment of idiopathic menorrhagia. Br J Obstet Gynaecol. 1998;105(6):592-8.

Andrew M, Susanna M, Pirjo I. Ali K, Luis S. Levonorgestrel releasing Intrauterine system and Endometrial ablation in heavy menstrual bleeding :a systematic review and meta-analysis. Obstet Gynecol. 2009;113:1104-16.

Hurskainen R, Teperi J, Rissanen P, Aalto AM, Grenman S, Kivelä A, et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet. 2001;357(9252):273-7.

Lethaby A, Cooke I, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. Cochrane Database Syst Rev. 2005;4:CD002126.

Fong Y, Singh K. Medical treatment of a grossly enlarged adenomyotic uterus with the levonorgestrel-releasing intrauterine system. Contraception. 1999;60:173-5.

Cho S, Nam A, Kim H, Chay D, Park K, Cho DJ, et al. Clinical effects of the levonorgestrel releasing intrauterine device in patients with adenomosis. Am J Obstet Gynecol. 2008;198:373.e1-7.

Sheng J, Zhang WY, Zhang JP, Lu D. The LNG-IUS study on adenomyosis: a 3-year follow-up study on the efficacy and side effects of the use of levonorgestrel intrauterine system for the treatment of dysmenorrhea associated with adenomyosis Contraception. 2009;79:189-93.

Magalhães J, Aldrighi JM, de Lima GR. Uterine volume and menstrual patterns in users of the levonorgestrel-releasing intrauterine system with idiopathic menorrhagia or menorrhagia due to leiomyomas. Contraception. 2007;75(3):193-8.

Mercorio F, De Simone R, Di Spiezio Sardo A, Cerrota G, Bifulco G, Vanacore F, et al. The effect of a levonorgestrel-releasing intrauterine device in the treatment of myoma-related menorrhagia. Contraception. 2003;67(4) :277-80.

Tasci Y, Caglar GS, Kayikcioglu F Cengiz H, Yagci B, Gunes M. Treatment of menorrhagia with the levonorgestrel releasing intrauterine system: effects on ovarian function and uterus. Arch Gynecol Obstet. 2009;280:39-42.

Ferreira RA, Vieira CS, Rosa-E-Silva JC, Rosa-e-Silva AC, Nogueira AA, Ferriani RA. Effects of the levonorgestrel-releasing intrauterine system on cardiovascular risk markers in patients with endometriosis: a comparative study with the GnRH analogue. Contraception. 2010-02;81(2):117-22.

Lockhat FB, Emembolu JE, Konje JC. Serum and peritoneal fluid levels of levonorgestrel in women with endometriosis who were treated with an intrauterine contraceptive device containing levonorgestrel. Fertil Steril. 2005;83:398-404.

Daud S, Ewies AA. Levonorgestrel-releasing intrauterine system: why do some women dislike it? Gynecol Endocrinol. 2008;24:686-90.

National Institute for Health and Clinical Excellence. Heavy menstrual bleeding. In: NIHCE, eds. NICE Clinical Guidelines 44. India: NISCH; 2007.

Backman T, Huhtala S, Luoto R, Tuominen J, Rauramo I, Koskenvuo M. Advance information improves user satisfaction with the levonorgestrel intrauterine system. Obstet Gynecol. 2002;99:608-13.

Cade TJ, Quinn MA, Rome RM, Neesham D. Progestogen treatment options for early endometrial cancer. BJOG. 2010 Jun;117(7):879-84.

Pillai M, O’Brien K, Hill E. The levonorgestrel intrauterine system (Mirena) for the treatment of menstrual problems in adolescents with medical disorders, or physical or learning disabilities. BJOG 2010;117(2):216-21.