Intrauterine Levonorgestrel System Effective in Menopausal Women on Estrogen

July 18, 2011

NEW YORK (Reuters Health) Jul 15 - The levonorgestrel-releasing intrauterine system (LNG-IUS) is as effective as systemic progestogen regimens for endometrial protection in menopausal women taking estrogen replacement therapy.

That finding comes from a meta-analysis conducted by a Thai team, reported online June 24 in Menopause.

Dr. Woraluk Somboonporn and colleagues at Khon Kaen University note that while progestogen supplementation lowers endometrial cancer risk in perimenopausal and postmenopausal women taking estrogen, it's become apparent that systemic progestogen may be linked to adverse effects, "particularly an increased risk of cardiovascular diseases and breast cancer."

The LNG-IUS addresses the problem by providing high intrauterine but low systemic levels of levonorgestrel.

In a review of the literature, the team identified six trials with a follow-up of at least 12 months, in which 518 menopausal women received estrogen therapy with either the LNG-IUS (20 mcg/day) or a systemically delivered progestogen.

Four of the five trials reporting endometrial histology found no endometrial proliferation with any type of progestational opposition; the other reported a higher rate with sequential oral medroxyprogesterone acetate. The meta-analysis therefore showed the incidence of proliferative endometrium to be significantly lower with the LNG-IUS than with other systemic progestogens (odds ratio 0.07).

The one trial reporting data on vaginal bleeding showed no difference between the two groups, the investigators found.

Furthermore, the discontinuation rate trended lower (odds ratio 0.62) in the LNG-IUS group than in the systemic progestogen group, according to the report.

However, the longest study was for 24 months, so no conclusions can be drawn about long-term endometrial safety, and none of the studies provided data on breast cancer or cardiovascular disease.

Nonetheless, Dr. Somboonporn and colleagues conclude, "In light of the review, LNG-IUS should be considered as an option for endometrial protection in perimenopausal and postmenopausal women receiving estrogen therapy."


Menopause 2011.


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