This device, marketed as the Mirena, is T-shaped and contains a barrel with 52mg of Levonorgestrel. It is inserted inside the uterine cavity, through the cervix using a speculum and indicated instruments. This is a simple office procedure in most instances. Levonorgestrel is released at an initial rate of 20mcg/day that decreases to 10-14 mcg per day over its currently approved five year duration of use. (8) The main risks are uterine perforation (1/1000) (23), IUD expulsion (6%) (19), and slight increase in PID in the 20 days following insertion (1%). (24) It is important to clarify that overall, IUD use in teenagers is encouraged and that it does not increase risk of PID, STI and infertility. Cervical screening for Chlamydia and Gonorrhea should be done on all women at high risk for STIs, therefore all adolescents. Side effects are minimal but include limited irregular vaginal bleeding, acne, headaches and mood disturbance. Other benefits include menstrual lightening (up to 90% of flow) or suppression (in 50% at 24 months of use), alleviation of dysmenorrhea and pelvic pain, and reduction of risk of endometrial cancer. There is limited evidence for or against IUD use in cancer related immunocompromised women, however the CDC and WHO both support its use and are reassuring about its safety based on other types of immunocompromised patient data. (10)
A lower dose levonorgestrel IUD became available on the market in the United States in 2013, marketed as Skyla. This IUD contains 13.5 mg of levonorgestrel, that is initial released at a rate of 14 mcg/day that decreases to 5 mcg/day overs its approved three year duration of use. It has a slightly smaller size and diameter, which theoretically may make it more suitable for placement in certain populations with a small uterine cavity or cervical stenosis. The low dose levonorgestrel IUD is not currently approved for the treatment of menorrhagia and has a lower likelihood of amenorrhea (13% vs 24%) compared with the higher dose IUD. (25)
Overall, the levonorgestrel IUDs have been proven to be a highly effective birth control method that is both beneficial and safe. Non-sexually active teenagers and young adults usually tolerate insertion very well. In patients who are unable to tolerate in-office placement, such as those with special needs, the IUD can be placed under general anesthesia. It is best to attempt to combined placement with a previously scheduled procedure, such as a line placement or biopsy, however they can also be scheduled independently.
For Menstrual Suppression:
IUD-Levonorgestrel can be used for menstrual lightening and suppression however these desired side effects develop over time in a subset of users. There is an initial risk of light irregular menstrual bleeding for the first 3 to 6 months after insertion.
If a patient has established menstrual lightening or suppression with an IUD-Levonorgestrel in place at the time of her diagnosis of malignancy, it is recommended to leave it in place. (34)