Insertion of an intrauterine device (Levosert) (device included)
What Is Contraception and How Is It Categorized?
Contraception refers to methods used to prevent unintended pregnancy. These methods may be surgical, medication-based (hormonal), or non-medication-based (non-hormonal). Based on their effectiveness, contraceptive methods are generally divided into three categories: highly effective, effective, and less effective methods.
Highly effective:
- Contraceptive implants
- Hormonal intrauterine systems (IUSs)
- Copper intrauterine devices (IUDs)
- Sterilization
Effective:
- Combined oral contraceptive pills
- Combined contraceptive patch
- Combined vaginal contraceptive ring
- Progestin-only pills
Less effective:
- Barrier methods (male and female condoms)
- Spermicides
- Withdrawal method
- Fertility awareness-based methods (abstaining from sexual intercourse during fertile days)
It is important to note that the effectiveness of contraception differs between perfect use and typical use. Perfect use reflects how well a method works when used exactly as instructed every time over the course of a year, usually under clinical study conditions. Typical use reflects how well the method prevents pregnancy in real-life situations, where users may occasionally make mistakes or not follow instructions consistently.
Hormonal Intrauterine Systems: How Long Do They Last and How Do They Work?
In this article, we will discuss the most commonly used long-acting reversible contraceptive method in Lithuania: the hormonal intrauterine system. Hormonal IUSs available in Lithuania may be prescribed for 3, 5, or 8 years of contraceptive use. The most appropriate hormonal IUS for each patient is chosen during a consultation with an obstetrician-gynaecologist, taking into account the woman's needs, future reproductive plans, and other relevant factors.
In addition to contraception, hormonal IUSs may also be used for the treatment of:
- Heavy menstrual bleeding
- Endometrial protection in women receiving hormone replacement therapy during menopause
A hormonal IUS is a small T-shaped plastic device measuring approximately 2.8-3.2 cm in width and 3.0-3.2 cm in height.
The device contains a small reservoir filled with the hormone levonorgestrel. This hormone is released slowly and continuously in very small amounts. Depending on the type of device, the hormone provides contraceptive protection for 3, 5, or 8 years, while the therapeutic effect is maintained for up to 5 years. Only minimal amounts of levonorgestrel enter the bloodstream, meaning that the primary effect of the hormonal IUS is local, within the uterus.
How Does a Hormonal IUS Work?
A hormonal IUS prevents pregnancy through several mechanisms:
- Levonorgestrel thickens the cervical mucus, making it more difficult for sperm to enter the uterus.
- Sperm motility in the uterus and fallopian tubes is reduced.
- Sperm viability and their ability to fertilize an egg are diminished.
- Ovulation is suppressed in some women (approximately 15%).
- Cyclical thickening of the endometrium is reduced, making implantation of a fertilized egg less likely.
Who Is a Hormonal IUS Suitable For?
A hormonal IUS is a long-acting reversible contraceptive (LARC) method. This means it provides contraception for an extended period, while normal fertility returns after the device is removed. Most women (approximately 80%) become pregnant within the first year after IUS removal. Therefore, if you are not planning a pregnancy within the next 3, 5, or 8 years and have no contraindications to its use, a hormonal IUS may be an appropriate contraceptive option.
The device is inserted only once. Approximately one month after insertion, a follow-up visit with an obstetrician-gynaecologist is recommended to confirm correct placement. After this check-up, annual gynaecological examinations are recommended, just as for women who do not use an IUS.
Unlike combined oral contraceptive pills, a hormonal IUS does not require daily attention. For women who occasionally forget to take a pill, a contraceptive IUS offers a reliable and convenient solution with long-term protection against unintended pregnancy.
It is important to note that in Lithuania, the only contraceptive method currently reimbursed by the National Health Insurance Fund is a 3-year levonorgestrel-releasing hormonal IUS. It may be prescribed to girls and young women aged 15 to 20 years (until they reach 21 years of age). For girls aged 15-17 years, prescription is subject to the procedures established by the Ministry of Health of the Republic of Lithuania. For women aged 18-20 years, the device may be prescribed following a consultation with an obstetrician-gynaecologist regarding contraception.
What Side Effects May Occur?
Like all medicinal products, hormonal intrauterine systems may cause side effects, although not everyone experiences them. The frequency of adverse reactions varies depending on the amount of hormone contained in the device. The adverse reactions listed below refer to a hormonal intrauterine system containing 52 mg of levonorgestrel, approved for contraceptive use for up to 8 years. Very common side effects include headache, abdominal or pelvic pain, changes in bleeding patterns (including heavier or lighter menstrual bleeding, spotting, oligomenorrhea, and amenorrhea), vulvovaginitis, and vaginal discharge. Common side effects include low mood, depression, decreased libido, migraine, dizziness, nausea, acne, hirsutism, back pain, upper genital tract infection, ovarian cysts, dysmenorrhea, breast pain, complete or partial expulsion of the intrauterine system, and weight gain. Uncommon side effects include alopecia, chloasma, skin hyperpigmentation, and uterine perforation. Side effects with an unknown frequency include hypersensitivity reactions such as rash, urticaria, and angioedema, as well as increased blood pressure.
How Can Adverse Reactions Be Reported?
If you experience any side effects, including those not listed in the patient information leaflet, inform your doctor or pharmacist.
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