Research continues to show that the 52 mg levonorgestrel IUD is safe and effective for up to eight years of use. It also can decrease bleeding and spotting, and half of the women using the device experienced amenorrhea or infrequent bleeding.1
Investigators also found that nearly 99% of women using the IUD for eight years and who completed the study were satisfied with continued use. Of the 31 women who discontinued because of a desire to become pregnant, 24 reported a pregnancy within one year — a 77.4% return-to-fertility rate.1
The FDA has already approved the 52 mg levonorgestrel IUDs — including Mirena and Liletta — for eight years of use.2 Any 52 mg levonorgestrel IUD will provide the same benefits.
“Most practitioners recognize that the difference in hormonal IUDs rests upon their loading dose,” says Jeffrey T. Jensen, MD, MPH, lead study author and professor and vice chair of research in the department of obstetrics and gynecology at Oregon Health & Science University. “We should consider the data for 52 mg devices, regardless of manufacturer, basically support the same thing.”
Clinicians may prefer recommending one IUD over another based on the insertion device, but once the IUD is placed, patients’ experiences will be the same. “This study confirms the data from women who entered the Liletta study, where they followed continuously the same cohort that obtained a device and used it continuously for eight years,” Jensen explains. “Some dropped out for a variety of reasons.”
But data from the people who remained in the study for eight years showed the IUD demonstrated contraceptive efficacy. “In this study, a group of users were enrolled during their fifth year of use, and then entered the study and were followed for three additional years,” Jensen says. “They were healthy, successful users at the end of year five, and they had a Mirena device.”
If patients using the IUD are doing well and wish to continue, then all data support them continuing for several more years. “There’s no reason to have the device changed out at five years if you’re doing well,” Jensen notes. “If they’re not doing well, then it may be an indication to change earlier.”
OB/GYNs and reproductive health providers may continue to ask patients to return to their offices, thinking they need to have their IUD replaced because they are in the sixth year of use. Now, with plenty of evidence backing up longer use of the devices, providers can tell them they can put off replacing it for another couple of years, if they like, Jensen adds.
It would be difficult to obtain research data on using the IUD for 10 years because of the expense, study fatigue, and other issues, he notes. But, if a woman is in her mid-40s, and her fertility is already reduced, then it is feasible to see if she would like to keep the same device for another couple of years.
“You’re extending beyond the data,” Jensen says. “This is individualized care.”
REFERENCES
- Jensen JT, Lukkari-Lax E, Schulze A, et al. Contraceptive efficacy and safety of the 52-mg levonorgestrel intrauterine system for up to 8 years. Am J Obstet Gynecol 2022;227: 873.el-873.e12.
- Young M. Levonorgestrel IUDs are safe and effective for eight years of use. Contraceptive Technology Update. October 2022.
Research continues to show that the 52 mg levonorgestrel IUD is safe and effective for up to eight years of use. It also can decrease bleeding and spotting, and half of the women using the device experienced amenorrhea or infrequent bleeding.
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