engleski

MIRENA – contraceptive and noncontraceptive benefit

Women today have a thirty year need for dependable contraceptive method, from condom to long term methods. Never the less, every month millions of women suffer from menstrual disorders such as menorrhagia, dysmenorrhea and other problems that can cause serious consequences. Even women with a problem– free cycles often find that menstruation disrupts their daily activities. This is why there is always a dilemma present in choosing the right contraceptive method which will not only provide high contraceptive effectiveness but also show noncontraceptive benefits. The levonorgestrel – releasing intrauterine system – IUS (Mirena) is a safe, reversible contraceptive method which provides high contraceptive reliability with the cumulative pregnancy rate of 0.5 – 1.1% over 5 years. Mirena has no interceptive effect and HCG remains negative in perimenstrual period. In comparison with copper IUD Mirena has a lower ectopic pregnancy rate (0.02% per 100 women – years over 5 years) as well as significantly lower rate of pelvic inflammatory disease -PID (0.7%, especially actinomycosis (Mirena 3%, copper IUD 20%. Mirena is a reverisble contraceptive method. Only 30 days after its removal, endometrium returns to normal and menstrual cycle is restored. Fertility rate upon removal equals to rate in women not using contraception and is around 80%. In addition to its high contraceptive reliability Mirena is rapidly becoming a desirable alternative for many women with concerns beyond contraception because of the unique way it delivers the hormone levonorgestrel to a women's body, as well as the beneficial effects this delivery system can provide. LNG-IUS hormone release has a direct atrophic effect on the endometrium, decreasing the thickness of the endometrium and because of this local effects bleeding is significantly reduced while pituitary and ovarian function remain normal. Menorrhagia is found in 13 – 15% of women, but excessive menstrual bleeding is found in almost 28% of women over age 42. The most common causes are adenomyosis, myoma, disfunctional uterine bleeding (DUB), endometriosis and other. Mirena is considerably efficient in treatment of menorrhagia even when it is caused by adenomyosis and myoma. Several authors have compared the efficacy of Mirena to hysteroscopic endometrial ablation in treatment of DUB. Both approaches showed similarly high effectiveness. Several authors also show that in women with adenomyosis who use Mirena have a 79% reduction of blood loss and 20-30% reduction of uterus volume. In another controlled trial that included 56 women on a waiting list for hysterectomy, 64% of those who received the Mirena, as compared with 14% of those in the control group, removed themselves from the list at the end of 6 month because they were satisfied with the symptoms control afforded by the Mirena. This difference was statistically significant. Systemic use of progestins in HRT is the main reason for side effects and discontinuation of HRT. Discontinuation rate after 1st year of HRT usage is 50 – 60%. Since Mirena has been shown to have a strong, localized progestogenic effect on the endometrium that effectively prevents hyperplasia it is used in combination with continuous use of low dose 17β estradiol – &laquo ; just add estrogen&raquo ; combination. Several studies have shown efficacy of Mirena in HRT. Affirmation of this HRT combination is especially noted after WHI findings in July 2002. Due to its contraceptive effectiveness and noncontraceptive benefits Mirena has a high continuation rate - 93% at first year and 65% at 5th year.

Mirena; intrauterine device; contraception; noncontraceptive benefits

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