IUS

what is the full name for IUS?

levonorgestrel intrauterine system (LNG-IUS)

what does the IUS contain?

progestogen which is slowly released into the uterus

how soon after removal does fertility return?

immediately

what are the contraindications of the IUS?

- PID

- immunosuppression

- pregnancy

- unexplained bleeding

- pelvic cancer

- breast cancer

- uterine cavity distortion (e.g. fibroids)

which people need extra screening before insertion of IUS?

high risk of STIs (e.g. <25s) - screen for chlamydia and gonorrhoea

what is very common after insertion?

cramps - use NSAIDs

what are the other potential symptoms after insertion?

- bleeding

- vasovagal reactions (dizziness, bradycardia, arrhythmias)

- uterine perforation

- PID

- expulsion rate high in first 3 months

before the coil is removed what does the pt need to do to avoid pregnancy?

abstain from sex/ use condom for 7 days

what needs to be ruled out if threads are not visible or palpable?

- expulsion

- pregnancy

- uterine perforation

what are the different brand names for IUS and what do the all contain?

- mirena

- levosert

- kyleena

- jaydess

all contain levonorgestrel

how long can the mirena be left in for?

5 years

what is mirena also licensed for?

menorrhagia and HRT

how long is the mirena coil licensed for when being used for HRT in menopausal women?

4 years

how long can levosert be left in for?

5 years

what is levosert also licensed for?

menorrhagia

how does levonorgestrel work?

- thickening cervical mucous

- altering endometrium - less implantation

- inhibits ovulation in small number of women

what day can the IUS be inserted up to without the need for extra contraception?

7th day of period

what is needed if it is inserted after 7 days?

- extra contraception for 7 days

- rule out pregnancy

what are the benefits of the iUS?

- make periods lighter or stop

- protective for endometrial cancer

- improve dysmenorrhoea or pelvic pain from endometriosis

- no effect of bone mineral density

- no increase in thrombosis risk

- no restrictions for obese pts

- mirena = hrt and menorrhagia uses

what are the drawbacks of the IUS?

- can cause irregular spotting or bleeding

- some women experience pelvic pain

- increased risk of ectopic

- increased incidence of ovarian cysts

- acne, headaches, breast tenderness

- occasionally fall out

what is recommended for problematic bleeding?

COCP for first 3 months

what is the advice on bleeding in IUS?

generally will cause irregular bleeding for the first few months - but then most women will either have very light periods or no periods