Safety and Efficacy of the Levonorgestrel-releasing Intrauterine System

Recent Insights

Kristina Gemzell-Danielsson; Pirjo Inki; Oskari Heikinheimo


Expert Rev of Obstet Gynecol. 2013;8(3):235-247. 

In This Article

Abstract and Introduction


This overview focuses on the recent developments in the safety and efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) on established indications, namely contraception, treatment of heavy menstrual bleeding as well as endometrial protection during estrogen therapy for menopausal symptoms. The LNG-IUS is one of the most efficacious reversible contraceptive methods available. It can be used by various patient groups, including nulliparous women, during breast-feeding, after elective pregnancy termination, in women suffering from various pre-existing medical conditions and menopausal women. This review provides an overview of the published literature on the LNG-IUS from the last 5 years, focusing on cost–effectiveness, safety-related outcomes, the use of LNG-IUS by young and/or nulliparous women as well as by various different patient groups. After decades of dominance by the 'the Pill', it is likely that in the future, long-acting reversible contraceptives, such as the LNG-IUS, will become the first-line contraceptive options, owing to their superior contraceptive effectiveness in real-life use, cost–effectiveness as well as their established safety profile.


The levonorgestrel-releasing intrauterine system (LNG-IUS) was first introduced in Finland in 1990, followed by more than 120 countries worldwide. The main indications of the LNG-IUS include contraception, treatment of heavy menstrual bleeding (HMB) and endometrial protection during estrogen replacement (last indication not approved in all countries). Since its launch, numerous publications and reviews have demonstrated the high efficacy and acceptability of the LNG-IUS in these indications.[1] Until recently, 'the Pill' has been the standard for contraception among young women. However, today the advantages of long-acting reversible contraceptives (LARCs), such as subdermal implants and intrauterine contraceptive devices (IUCDs), including copper-releasing IUDs (Cu-IUDs) and the LNG-IUS, are being increasingly recognized. An increasing number of women in Europe and in the USA use LARCs, and the LNG-IUS and Cu-IUDs are the most popular contraceptives in this class.[2–4] The same is true for women with intercurrent health problems, for whom combined contraceptives containing estrogen and progestin may potentially increase health risks.[5]

The present review provides an overview of published data from the last 5 years and is an update of a previous review on the established indications of the LNG-IUS.[6] A review of emerging indications for LNG-IUS use has previously been published.[7]