Therapy of heavy menstrual bleeding in Korea: Subanalysis and results from a multinational clinical trial in the Asian region investigating the levonorgestrel-releasing intrauterine system versus conventional therapy.

Objective: To compare real-life clinical outcomes with the levonorgestrel-releasing intrauterine system (LNG-IUS) and conventional medical therapies (CMTs), including combined oral contraceptives and oral progestins in the treatment of idiopathic heavy menstrual bleeding (HMB) in South Korea.

Methods: This prospective, observational cohort study recruited a total of 647 women aged 18 to 45 years, diagnosed with HMB from 8 countries in Asia, including 209 women from South Korea (LNG-IUS, 169; CMTs, 40), who were followed up to one year. The primary outcome was cumulative continuation rate (still treated with LNG-IUS and CMTs) at 12 months.

The levonorgestrel-releasing intrauterine system for endometrial protection during estrogen replacement therapy: a clinical review.

Estrogen replacement therapy (ERT) is a well-established method of managing climacteric symptoms in women approaching the menopause, but it is associated with a significant risk of endometrial hyperplasia if unopposed by concomitant progestogen administration. The levonorgestrel-releasing intrauterine system (LNG-IUS) offers a highly effective method of minimizing this risk and has additional benefits beyond endometrial protection. The LNG-IUS provides excellent contraception, which may still be necessary in perimenopausal women, and is suitable for women with underlying conditions that may preclude their use of estrogen-containing contraceptive methods.

Satisfaction and health-related quality of life in women with heavy menstrual bleeding; results from a non-interventional trial of the levonorgestrel-releasing intrauterine system or conventional medical therapy.

Purpose: To evaluate the patient satisfaction and health related quality of life (HRQoL) for levonorgestrel-releasing intrauterine system (LNG-IUS) versus conventional medical treatments ([CMTs] combined oral contraceptives, oral progestins, and antifibrinolytics, alone or in combination) in Asian women with heavy menstrual bleeding (HMB).

Patients And Methods: A total of 647 patients diagnosed with HMB were recruited to this non-interventional study from the eight participating countries in Asia. Patient satisfaction was recorded at the last visit (at 12 months or premature discontinuation).

Bleeding pattern and user satisfaction in second consecutive levonorgestrel-releasing intrauterine system users: results of a prospective 5-year study.

Study Question: What is the bleeding pattern during second consecutive levonorgestrel-releasing intrauterine system (LNG-IUS) use?

Summary Answer: Consecutive use of LNG-IUS is associated with a predictable bleeding pattern, characterized by the absence of the initial period of irregular bleeding seen after interval insertion of an LNG-IUS and a non-bleeding pattern in the vast majority of women.

What Is Known Already: With increased popularity of the LNG-IUS for long-term birth control and treatment of heavy menstrual bleeding (HMB), consecutive use of the system is becoming more frequent. One previous study showed 60% amenorrhea rate in consecutive IUS users; however, the sample size was small.

Acceptability of long-acting, progestin-only contraception in Europe: a two-year prospective, non-interventional study.

OBJECTIVES To compare two-year continuation rates and user satisfaction with the levonorgestrel releasing-intrauterine system (LNG-IUS) and the etonogestrel releasing-subdermal implant (ENG implant) in women in Europe. METHODS This prospective, non-interventional study was undertaken at 72 sites in France (n = 61), Great Britain (n = 2), Ireland (n = 3) and Slovakia (n = 6). Women opting to switch their method of contraception to the LNG-IUS or the ENG implant were followed-up over 24 months to document continuation and satisfaction with their chosen contraceptive method.

Management of initial bleeding or spotting after levonorgestrel-releasing intrauterine system placement: a randomized controlled trial.

Objective: To assess the efficacy of tranexamic acid or mefenamic acid in the management of the initial "nuisance" bleeding or spotting in the period immediately after placement of the levonorgestrel-releasing intrauterine system.

Methods: Women were randomized after levonorgestrel-releasing intrauterine system placement to oral tranexamic acid (500 mg), mefenamic acid (500 mg), or placebo three times daily during bleeding or spotting episodes over a 90-day treatment period. Treatment was initiated from onset of a bleeding or spotting episode and continued until the first day after bleeding or spotting stopped and restarted with a new bleeding or spotting episode.

Levonorgestrel-releasing intrauterine system versus conventional medical therapy for heavy menstrual bleeding in the Asia-Pacific region.

Objective: To compare clinical outcomes, including cumulative continuation rate (CCR), in the treatment of idiopathic heavy menstrual bleeding (HMB) with the levonorgestrel-releasing intrauterine system (LNG-IUS) and with conventional medical therapies (CMTs), including combined oral contraceptives, oral progestins, and antifibrinolytics, either alone or in combination, in the Asia-Pacific region.

Methods: In a prospective observational cohort study conducted between September 2008 and December 2010, 647 women (LNG-IUS, n=483; CMTs, n=164), aged 18-45 years and diagnosed with HMB, were recruited from 8 countries and followed for up to 1 year. The primary outcome was the CCR at 12 months.

Bleeding patterns with the levonorgestrel-releasing intrauterine system when used for heavy menstrual bleeding in women without structural pelvic pathology: a pooled analysis of randomized controlled studies.

Background: The study was conducted to characterize the changes in bleeding pattern over time in women receiving the levonorgestrel-releasing intrauterine system (LNG-IUS) for heavy menstrual bleeding (HMB). The reduction in menstrual blood loss volume has been well documented elsewhere.

Study Design: Post hoc pooled analysis of the impact of the LNG-IUS on bleeding patterns in four comparator studies of medical and surgical treatment options for HMB.

Use of contraceptive methods and contraceptive recommendations among health care providers actively involved in contraceptive counseling -- results of an international survey in 10 countries.

Background: This study was conducted to determine the personal choices of contraceptive methods among an international sample of contraception health care professionals (HCPs) and to determine if these choices are concordant with their recommendations to women.

Study Design: In an anonymous online survey, 1001 HCPs actively involved in contraceptive counseling [obstetrician/gynecologists (OB/GYNs), general practitioners (GPs) and midwives (only in Sweden)] from 10 countries (Australia, Brazil, Canada, France, Germany, Korea, Mexico, Spain, Sweden and the United Kingdom) were asked about their personal use of contraceptive methods and their recommendations to women in two different clinical scenarios: for spacing between children (Group A) and after completion of the family (Group B).

Results: The largest HCP group was OB/GYNs (67.

The levonorgestrel-releasing intrauterine system in heavy menstrual bleeding: a benefit-risk review.

Heavy menstrual bleeding (HMB) is a common problem in women of reproductive age and can cause irritation, inconvenience, self-consciousness and fear of social embarrassment. Our objective was to review and appraise literature identified from the MEDLINE and EMBASE databases to evaluate the clinical evidence and provide an update on the risks and benefits of using the levonorgestrel-releasing intrauterine system (LNG-IUS) in the treatment of HMB. The LNG-IUS consistently reduces menstrual blood loss (MBL) in women with HMB, including those with underlying uterine pathology or bleeding disorders.

Acceptability of the levonorgestrel releasing-intrauterine system and etonogestrel implant: one-year results of an observational study.

Objectives: To analyse the acceptability and patterns of use of the levonorgestrel releasing-intrauterine system (LNG-IUS) and the etonogestrel releasing-subdermal implant (ENG implant) among young European women.

Methods: A total of 454 women aged 20-35 years opting to switch their method of contraception from oral contraception to the LNG-IUS or ENG implant, were recruited in an observational study in four different European countries (France, Ireland, Slovakia and the United Kingdom). The present paper reports the interim results of the study at 12 months of observation.

Fertility after discontinuation of contraception: a comprehensive review of the literature.

Background: Fear of adverse effects on subsequent fertility following reversible contraceptive use is an important concern for some women.

Study Design: We undertook a comprehensive and objective review of the literature for prospective studies reporting pregnancy rates in women following contraceptive cessation. One-year pregnancy rates and pregnancy outcomes are summarized.

Recent developments in the clinical use of the levonorgestrel-releasing intrauterine system.

This overview focuses on recent developments in the clinical use of the levonorgestrel- releasing intrauterine system (LNG-IUS) on established indications. Recent studies confirm that the LNG-IUS is safe and equally effective for all age groups of women. All available studies showed that intrauterine contraception is more effective when compared to non-intrauterine contraceptive methods to prevent repeat abortions.

Efficacy of contraceptive methods: a review of the literature.

Objectives: To provide a comprehensive and objective summary of contraceptive failure rates for a variety of methods based on a systematic review of the literature.

Methods: Medline and Embase were searched using the Ovid interface from January 1990 to February 2008, as well as the reference lists of published articles, to identify studies reporting contraceptive efficacy as a Pearl Index or life-table estimate. Reports that recruited less than 400 subjects per study group and those covering less than six cycles/six months were excluded.

Double-blind, randomized, placebo-controlled study on the effect of misoprostol on ease of consecutive insertion of the levonorgestrel-releasing intrauterine system.

Background: Misoprostol has been studied intensively to produce cervical dilatation. To date, no studies have evaluated the effectiveness, safety or acceptability of this treatment for repeat intrauterine device insertions.

Study Design: This study was a randomized, double-blind, placebo-controlled trial on the consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS).

Predictors of bleeding and user satisfaction during consecutive use of the levonorgestrel-releasing intrauterine system.

Background: Consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS) is increasing. However, little is known about factors that predict the bleeding during consecutive use. The objective of this study was to analyse the possible factors which may predict the bleeding pattern during the first year of use of a second LNG-IUS.

Efficacy of contraceptive methods: A review of the literature.

Objectives: To provide a comprehensive and objective summary of contraceptive failure rates for a variety of methods based on a systematic review of the literature.

Methods: Medline and Embase were searched using the Ovid interface from January 1990 to February 2008, as well as the reference lists of published articles, to identify studies reporting contraceptive efficacy as a Pearl Index or life-table estimate. Reports that recruited less than 400 subjects per study group and those covering less than six cycles/six months were excluded.

Bleeding pattern and safety of consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS)--a multicentre prospective study.

Background: The LNG-IUS has increasingly been used for contraception, treatment of menorrhagia and endometrial protection during hormone replacement therapy since mid-1990s. Thus, many women use the LNG-IUS consecutively. However, published data on the bleeding pattern regarding consecutive use of the LNG-IUS is scarce.

Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis.

Objective: To compare the effects of the levonorgestrel intrauterine system and endometrial ablation in reducing heavy menstrual bleeding.

Data Sources: Medline and EMBASE were searched online using Ovid up to January 2009, as well as the reference lists of published articles, to identify randomized controlled trials comparing the levonorgestrel intrauterine system with endometrial ablation in the treatment of heavy menstrual bleeding.

Methods Of Study Selection: This systematic review and meta-analysis was restricted to randomized controlled trials in which menstrual blood loss was reported using pictorial blood loss assessment chart scores.

Long-term use of the levonorgestrel-releasing intrauterine system.

Since its launch in Finland in 1990, the levonorgestrel-releasing intrauterine system (LNG IUS) has become available in more than 100 countries throughout the world, with most countries also having the approval for the treatment of idiopathic menorrhagia and protection from endometrial hyperplasia during estrogen replacement therapy. After its introduction in Finland and Scandinavian countries, the LNG IUS has been available in most European countries since the mid to late 1990s and in the United States since 2001. Studies on the repeat use of the LNG IUS with second and third consecutive IUSs have shown high continuation rates and low rates of adverse effects.

Use of the levonorgestrel-releasing intrauterine system and breast cancer.

Objective: The effect of exogenous hormones on the incidence of breast cancer has been extensively studied. Most studies regarding hormonal contraception have focused on combined oral contraceptives, and there is paucity of literature regarding nonoral and progestin-only contraceptives. The present study analyzed the relationship between breast cancer and use of the levonorgestrel-releasing intrauterine system.

The levonorgestrel intrauterine system: long-term contraception and therapeutic effects.

The levonorgestrel intrauterine system (Mirena((R))) has been developed as a long-acting method of contraception. This medicated device, inserted into the uterus, delivers a small daily dose of a progestin, levonorgestrel, into the uterine cavity. It is one of the most effective methods of contraception and is approved in more than 100 countries for 5 years of use.