Poster presented in Endocrinology Congress, 2006 - Dr Ayman Ewies

1. Continuation rate, reasons of early removal and patient satisfaction with
the levonorgestrel-releasing intrauterine system (Mirena)
Suzanna Daud, MBChB, DFFP, SpR in Gynaecology & Ayman Ewies, MBChB, MSc, MRCOG, MD, Consultant Gynaecologist
Background
• The levonorgestrel-releasing intrauterine system (Mirena) is
commonly used by gynaecologists and general practitioners
as a contraceptive and to treat menorrhagia.
• The continuation rate of Mirena in Finnish population was
reported to be 93% and 87% in the first and second year,
respectively.1
• Despite its popularity in the UK, patient satisfaction has not
been adequately assessed.
Objectives
• To identify the continuation rate and symptoms associated
with early removal of Mirena before the 5 years effective life-
time recommended by the manufacturer.
• To document the patient satisfaction level with Mirena.
Sample
160 women who had a LNG-IUS inserted from 1st January
2000 till 31st December 2003.
Setting
Ipswich Hospital NHS Trust, Suffolk ,UK.
Design
• Retrospective case-notes review, and a questionnaire was
sent to all women as regard the bleeding pattern, the side
effects experienced, the length of use and level of satisfaction.
• The level of satisfaction was assessed using Visual Analog
Scale (VAS) of 0-10 cm.
• The number of questionnaires returned was 102 (response
rate 64%); 6 of them were incomplete.
Results
• In the 160 women, Mirena was inserted for menstrual
problem, contraception and hormone replacement therapy in
129(80%), 30(19%) and 1(1%) women, respectively.
• The analysis of the data was only done for 104 women. Fifty-
six women were excluded because incomplete data, Mirena
spontaneous expulsion or wanting pregnancy.
.
• 56/104 (54%) women were having Mirena in situ, and 48/104
(46%) had it already removed at the time of data collection.
1.The continuation rate of Mirena use (n=104):
• The median duration of use of the LNG-IUS in women who
had it removed early was 260.5 (range from 4 to 1460 days).
2. Main reasons of early removal of Mirena (n=104):
• Some patients had more than one reason of early removal.
• Progestogenic side effect includes bloatedness, headache,
weight gain, depression, breast tenderness, excessive hairiness,
greasiness of skin and sexual disinterest.
3. Level of satisfaction among Mirena users (n=96):
Conclusion
• The continuation rate of Mirena use in the studied population is
less than that in Finnish women.
• The satisfaction rate was only 60%.
• The progestogenic side effects could be attributed to the high
systemic absorption of the progestogen since serum levels of
levonorgestrel has been recorded around 511pmon/L.2
Therefore, the idea that Mirena works entirely as a local source
of progestogen should be revised.3
• Adequate counselling before insertion is essential, and women
should be informed about the rates of adverse effects and
removal reported so far.
• A large study is required to quantify the continuation rate and
patient satisfaction in The UK population.
References
1.Backman T, Huhtala S, Blom T, Luoto R, Rauramo I, Kosenvuo
M. Length of use and symptoms associated with premature
removal of levonorgestrel intrauterine system: a nation-wide
study of 17,360user. BJOG 2000; 107(3): 335-9.
2.Xia B,Wu SC, Chong J, Zeng T, Han LH,Luukkainen T.
Therapeutic effects of levonorgestrel-releasing intrauterine
system in treatment of idiopathic menorrhagia. Fertil Steril 2003;
79(4): 963-969.
3.Wahab M, Al-Azzawi F. The use of levonorgestrel-releasing
intrauterine system for treatment of menorrhagia in women with
inherited bleeding disorders. BJOG 2006; 113(2): 248-9.
84
72
63
54
0
10
20
30
40
50
60
70
80
90
6 months 12 months 24 months more than 24
months
Duration
Percentageofwomen
16
33
14
16
0
5
10
15
20
25
30
35
Abdominal pain Unscheduled
bleeding
Progestogenic
side effect
others
Reasonsofearlyremoval
29
9
58
0
10
20
30
40
50
60
70
unsatisfied fair satisfied
level of satisfaction
numberofwomen