The levonorgestrel-releasing intrauterine system (LNG-IUS) is commonly used by gynaecologists and general practitioners as a contraceptive and to treat menorrhagia.
To identify the continuation rate and symptoms associated with early removal of the LNG-IUS before the 5 years effective life-time recommended by the manufacturer.
160 women who had a LNG-IUS inserted from 1st January 2000 till 31st December 2003 at Ipswich Hospital.
Retrospective case-notes review, and a questionnaire was sent to all women regarding the bleeding pattern, the side effects experienced, and the length of use. The number of questionnaires returned was 102 (response rate 64%).
In the 160 women, the LNG-IUS was inserted for menstrual problem, contraception and hormone replacement therapy in 129(80%), 30(19%) and 1(1%) women, respectively. The analysis of the data were done for 104 women. Fifty-six women were excluded because incomplete data, LNG-IUS spontaneous expulsion or wanting pregnancy. Fifty-six (54%) women still have the LNG-IUS in use. Forty-eight (46%) women have early removal of the LNG-IUS. The continuation rate was 84%, 72%, 63%, and 54% at 6 months, one year, two years, and more than two years, respectively. The median duration of use of the LNG-IUS in women who have LNG-IUS removed early was 260.5 (range from 4 to 1460 days).The reasons for early removal were unscheduled bleeding in 33 women (32%), progestogenic side effects in 14 women (13%) and abdominal pain in 16 women (15%)).
The continuation rate of the LNG-IUS is less than that in Finnish women, which was reported to be 93% and 87% in the first and second year, respectively.(Backman et al, 2002). A large study is required to quantify the continuation rate and satisfaction in The UK population. Adequate counselling before insertion of LNG-IUS is essential, and women should be informed about the rates of adverse side effects and removal reported in The UK population-based studies.