Intrauterine spiral insertion

What Is Contraception and How Is It Classified?

Contraception refers to methods used to prevent unintended pregnancy. Contraceptive methods may be surgical, hormonal (medication-based), or non-hormonal. Based on their effectiveness, they are generally divided into three categories:

Highly Effective Methods:

Contraceptive implants
Hormonal intrauterine systems (IUSs)
Copper intrauterine devices (IUDs)
Sterilization

Effective Methods:

Combined oral contraceptive pills
Combined contraceptive patch
Combined contraceptive vaginal ring
Progestin-only pills

Less Effective Methods:

Barrier contraception (male and female condoms)
Spermicides
Withdrawal method (coitus interruptus)
Natural family planning (abstinence 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 consistently and exactly as instructed throughout a clinical study. Typical use reflects real-life conditions, where people may occasionally make mistakes or fail to use the method exactly as directed. As a result, the effectiveness of most contraceptive methods is lower with typical use than with perfect use.

Hormonal IUSs: How Long Do They Last and How Do They Work?

In this article, we will discuss one of the most commonly used long-acting reversible contraception (LARC) methods in Lithuania: the hormonal intrauterine system (IUS). Hormonal IUSs available in Lithuania for contraception may be approved for use for 3, 5, or 8 years. The most suitable hormonal IUS for each patient is determined during a consultation with an obstetrician-gynaecologist, taking into account the woman’s individual needs, future reproductive plans, and other relevant factors. In addition to contraception, hormonal IUSs can also be used for medical treatment, including the management of heavy menstrual bleeding and endometrial protection during hormone replacement therapy (HRT) in menopausal women.

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 that releases the hormone levonorgestrel slowly and continuously in very small amounts. Depending on the product, the hormone provides contraceptive protection for 3, 5, or 8 years, while a therapeutically effective dose for treatment purposes is released for up to 5 years. Only very small amounts of the hormone 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 cervical mucus, making it more difficult for sperm to enter the uterus.
It reduces sperm motility within the uterus and fallopian tubes.
It decreases sperm viability and their ability to fertilize an egg.
In some women, ovulation is suppressed (approximately 15%).
It reduces cyclic thickening of the endometrium and prevents implantation of a fertilized egg.

Who Are Hormonal IUSs Suitable For?

A hormonal intrauterine system (IUS) is a long-acting reversible contraceptive (LARC). This means it provides effective contraception for an extended period, and normal fertility returns once it 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 a suitable contraceptive option.

In addition, the IUS is inserted only once. A follow-up appointment with an obstetrician-gynaecologist is recommended approximately one month after insertion to confirm that the device remains correctly positioned. Thereafter, routine annual gynaecological check-ups are recommended, just as for women who do not use an IUS.

Unlike combined oral contraceptive pills, a hormonal IUS does not require daily action or reminders. For girls and women who occasionally forget to take their contraceptive pill, a hormonal IUS can be an excellent option, providing reliable protection against unintended pregnancy and greater peace of mind.

Although it is commonly believed that IUSs are suitable only for women who have given birth, this is a myth. Hormonal IUSs are appropriate for women who have given birth, women who have never given birth, and adolescents. They may also be a suitable contraceptive option for women who cannot safely use estrogen-containing contraceptives. In addition, hormonal IUSs can be used after miscarriage, following childbirth, and during breastfeeding.

It is important to note that in Lithuania, the only contraceptive method reimbursed by the Compulsory Health Insurance Fund (PSDF) is a levonorgestrel-releasing hormonal IUS approved for up to 3 years of use. It may be prescribed to girls and young women aged 15 to 20 years (until their 21st birthday). For girls aged 15 to 17 years, the IUS may be prescribed in accordance with procedures established by the Minister of Health of the Republic of Lithuania, while for women aged 18 to 20 years, it may be prescribed following a consultation with an obstetrician-gynaecologist regarding contraception.

Who Should Not Use a Hormonal IUS?

Hormonal IUSs are not suitable for women with confirmed or suspected pregnancy; progestogen-dependent tumours such as breast cancer; current or recurrent pelvic inflammatory disease; cervicitis; lower genital tract infections; postpartum endometritis; infection following an abortion within the previous three months; conditions associated with an increased susceptibility to infection; cervical dysplasia; malignant disease of the uterus or cervix; unexplained abnormal uterine bleeding; congenital or acquired uterine abnormalities, including fibroids that distort the uterine cavity; acute liver disease or liver tumours; or hypersensitivity to levonorgestrel or any of the excipients contained in the IUS.

What Side Effects May Occur?

Like all medicines, hormonal IUSs may cause side effects, although not everybody experiences them.

The frequency and type of side effects may vary depending on the amount of hormone contained in the device. The adverse reactions listed below relate to a hormonal IUS containing 52 mg of levonorgestrel and approved for contraceptive use for up to 8 years.

Very common: headache, abdominal or pelvic pain, changes in bleeding patterns (including heavier or lighter menstrual bleeding), spotting, oligomenorrhoea, amenorrhoea, vulvovaginitis, and vaginal discharge.
Common: low mood, depression, decreased libido, migraine, dizziness, nausea, acne, hirsutism, back pain, upper genital tract infection, ovarian cysts, dysmenorrhoea, breast pain, complete or partial expulsion of the IUS, and weight gain.
Uncommon: alopecia, chloasma, skin hyperpigmentation, and uterine perforation.
Frequency not known: hypersensitivity reactions, including rash, urticaria, and angioedema, as well as increased blood pressure.

How Can Adverse Effects Be Reported?

If you experience any side effects, including those not listed in the package leaflet, inform your doctor or pharmacist.

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