Low-dose hormonal intrauterine contraception: New options

The article presents an analysis of the literature data on the modern possibilities of hormonal intrauterine contraceptive systems. Intrauterine systems (IUDs) are one of the most effective, safe and acceptable methods of contraception. According to statistics, about 1/3 of the female population of Russia, 1/2 – women of East Asia use IUD as contraception, which is most likely due to the lack of opportunity and desire for constant monitoring of the use of contraceptives (pills, patch, intravaginal ring). In a number of studies conducted in the last 10 years, there has been a more than threefold increase in the frequency of IUD use in women aged 15–24 years. Until recently, hormonal IUDs (Mirena) were usually used in women who gave birth, but the development of a new IUD, Kailin, containing 19.5 mg of levonorgestrel, is actively used in more than 30 countries around the world as a highly effective and acceptable method of contraception with a low content of LNG. Many studies have been conducted to investigate the effectiveness, acceptability and safety of IUD. Thus, in one of the largest prospective observational multicenter KYSS study, satisfaction with the use of IUD LNG was assessed for one year. The study included 1,114 women. The results of the study showed: satisfaction with this method of contraception in 86.1% of women, the desire to continue using Kailina – 81.4%, as well as a low percentage (16.9%) of adverse events. Therefore, IUD-LNG IUD is an effective, acceptable, safe method of contraception that allows to prevent the onset of unwanted pregnancy, including in young unborn women. 

1. Петров ЮА. Аспекты микробиологической и иммунной диагностики хронического эндометрита. Современные проблемы науки и образования. 2016;(4):9. Режим доступа: https://science-education.ru/ru/article/view?id=24811.

2. Miklavcic AY, Isaacs CR. Obstetrics-gynecology resident education regarding barrier and over-thecounter contraceptives: a national study. J Womens Health. 2012;21(11):1196–1200. https://doi.org/10.1089/jwh.2012.3546.

3. Радзинский ВЕ. Регулирование рождаемости в современном мире. StatusPraesens. Гинекология, акушерство, бесплодный брак. 2013;2(13):5–9. Режим доступа: https://elibrary.ru/ynkoan.

4. Baldwin MK, Jensen JT. Contraception during the perimenopause. Maturitas. 2013;76(3):235–242. https://doi.org/10.1016/j.maturitas.2013.07.009.

5. Купина АД, Петров ЮА, Шаталов АЕ. Современные представления о механизме действия внутриматочных контрацептивов. Медико-фармацевтический журнал «Пульс». 2019;21(8):77–83. https://doi.org/10.26787/nydha-2686-6846-2019-21-7-77-83.

6. Подзолкова НМ, Роговская СИ, Колода ЮА. Современная контрацепция: новые возможности и критерии безопасности. М.: ГОЭТАР-Медиа, 2013. 128 с.

7. Кузнецова ИВ. Современная внутриматочная контрацепция. Гинекология. 2012;(4):62–67. Режим доступа: https://omnidoctor.ru/library/izdaniyadlya-vrachey/ginekologiya/gn2012/gn2012_14_4/sovremennayavnutrimatochnaya-kontratseptsiya/.

8. Шестакова ИГ, Хамошина МБ, Кайгородова ЛА. Дифференцированный подход к назначению левоноргестрелвыделяющей внутриматочной системы. Доктор.Ру. 2014;96(8-2):5–11. Режим доступа: https://elibrary.ru/tkzzeb.

9. Уварова ЕВ. Внутриматочная система нового поколения с левоноргестрелом для контрацепции у нерожавших женщин. Репродуктивное здоровье детей и подростков. 2021;17(4):65–70. https://www.doi.org/10.33029/1816-2134-2021-17-4-65-70.

10. Dinehart E, Lathi RB, Aghajanova L. Levonorgestrel IUD: is there a longlasting effect on return to fertility? J Assist Reprod Genet. 2020;37(1):45–52. https://doi.org/10.1007/s10815-019-01624-5.

11. Reinecke I, Hofmann B, Mesic E, Drenth H-J, Garmann D. An Integrated Population Pharmacokinetic Analysis to Characterize Levonorgestrel Pharmacokinetics After Different Administration Routes. J Clin Pharmacol. 2018;58(12):1639–1654. https://doi.org/10.1002/jcph.1288.

12. Hofmann BM, Apter D, Bitzer J, Reinecke I, Serrani M, Höchel J, Merz M. Comparative pharmacokinetic analysis of levonorgestrel-releasing intrauterine systems and levonorgestrel-containing contraceptives with oral or subdermal administration route. Eur J Contracept Reprod Health Care. 2020;25(6):417–426. https://doi.org/10.1080/13625187.2020.1815008.

13. Apter D, Gemzell-Danielsson K, Hauck B, Rosen K, Zurth C. Pharmacokinetics of two low-dose levonorgestrel-releasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies. Fertil Steril. 2014;101(6):1656–1662. https://doi.org/10.1016/j.fertnstert.2014.03.004.

14. Nelson A, Apter D, Hauck B, Schmelter T, Rybowski S, Rosen K, Gemzell-Danielsson K. Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial. Obstet Gynecol. 2013;122(6):1205–1213. https://doi.org/10.1097/aog.0000000000000019.

15. Gemzell-Danielsson K, Apter D, Dermout S, Faustmann T, Rosen K, Schmelter T, Merz M, Nelson A. Evaluation of a new, low-dose levonorgestrel intrauterine contraceptive system over 5 years of use. Eur J Obstet Gynecol Reprod Biol. 2017;210:22–28. https://doi.org/10.1016/j.ejogrb.2016.11.022.

16. Beckert V, Aqua K, Bechtel C, Cornago S, Kallner KH, Schulze A et al. Insertion experience of women and health care professionals in the Kyleena® Satisfaction Study. Eur J Contracept Reprod Health Care. 2020;25(3):182–189. https://doi.org/10.1080/13625187.2020.1736547.

17. Stovall WD, Aqua K, Römer T, Donders G, Sørdal T, Hauck B et al. Satisfaction and continuation with LNG-IUS 12: findings from the realworld kyleena® satisfaction study. Eur J Contracept Reprod Health Care. 2021;26(6):462–472. https://doi.org/10.1080/13625187.2021.1975268.

18. Чернуха ГЕ, Пронина ВА. Низкодозированная внутриматочная контрацепция – инновационный подход к профилактике нежелательной беременности. Медицинский совет. 2022;16(5):40–45. https://doi.org/10.21518/2079-701X-2022-16-5-40-45.

19. Todhunter L, Hogan-Roy M, Pressman EK. Complications of pregnancy in adolescents. Semin Reprod Med. 2022;40(01/02):98–106. https://doi.org/10.1055/s-0041-1734020.

20. Anjos FCQS, Marcelino AC, Espejo-Arce X, Pereira PC, Barbosa PF, Juliato CT, Bahamondes L. Clinical Assessment of 3 Intrauterine Devices in Adolescent Girls: A Randomized Clinical Trial. J Pediatr Adolesc Gynecol. 2024;37(2):165–170. https://doi.org/10.1016/j.jpag.2023.12.002.

21. Tulandi T. Ectopic pregnancy: clinical manifestations and diagnosis. Philadelphia, PA: Wolters Kluwer; 2024. Availаble at: https://www.uptodate.com/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis.

22. Hendriks E, Rosenberg R, Prine L. Ectopic Pregnancy: Diagnosis and Management. Am Fam Physician. 2020;101(10):599–606. Available at: https://pubmed.ncbi.nlm.nih.gov/32412215/.

23. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996;65(6):1093–1099. Available at: https://pubmed.ncbi.nlm.nih.gov/8641479/.

24. Singer SR, MelchorJ, Ripps SJ, Burgess J. Ectopic Pregnancy Observed With Kyleena Intrauterine Device Use: A Case Report. Cureus. 2023;15(3):e35637. https://doi.org/10.7759/cureus.35637.

25. Nelson A, Apter D, Hauck B, Schmelter T, Rybowski S, Rosen K, GemzellDanielsson K. Two low-dose levonorgestrel intrauterine contraceptive systems: a randomized controlled trial. Obstet Gynecol. 2013;122(6): 1205–1213. https://doi.org/10.1097/aog.0000000000000019.

26. Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril. 2012;97(3):616–622. https://doi.org/10.1016/j.fertnstert.2011.12.003.

27. Gemzell-Danielsson K, Apter D, Hauck B, Schmelter T, Rybowski S, Rosen K, Nelson A. The Effect of Age, Parity and Body Mass Index on the Efficacy, Safety, Placement and User Satisfaction Associated With Two Low-Dose Levonorgestrel Intrauterine Contraceptive Systems: Subgroup Analyses of Data From a Phase III Trial. PLoS ONE. 2015;10(9):e0135309. https://doi.org/10.1371/journal.pone.0135309.

28. Прилепская ВН (ред.). Руководство по контрацепции. М.: МЕДпрессинформ; 2017. 464 с. Режим доступа: https://www.med-press.ru/catalog/akusherstvo_i_ginekologiya/58741/#desc.