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Intrauterine progestogen system

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VOL: 102, ISSUE: 15, PAGE NO: 36

GENERIC AND PROPRIETARY NAMES

GENERIC AND PROPRIETARY NAMES
- Intra-uterine progestogen system.

- Mirena.

ACTION
- Levonorgestrel is released directly into the uterine cavity preventing endometrial proliferation, thickening cervical mucus and for some women suppressing ovulation.

- Some contraceptive protection may be a result of the device alone.

CLASSIFICATION
- Intra-uterine progestogen-only device.

INDICATIONS
- Contraception.

- Primary menorrhagia.

- Prevention of endometrial hyperplasia during oestrogen replacement therapy.

CONTRAINDICATIONS
- Endometrial disorders should be ruled out before insertion of the device.

- Not suitable as emergency contraception.

CAUTIONS
- Pregnancy: remove due to risk of teratogenic effects.

SIDE-EFFECTS
- Abdominal pain.

- Peripheral oedema.

- Nervousness.

- Salpingitis and pelvic inflammatory disease.

- Pelvic pain.

- Back pain.

- Ectopic pregnancy but the risk is smaller than with other intra-uterine devices.

- Initial changes in menstrual bleeding - spotting or prolonged bleeding.

INTERACTIONS
- Other progestogens.

ADMINISTRATION
- For contraception and menorrhagia, insert into uterine cavity within seven days of onset of menstruation (any time if replacement) or immediately after first-trimester termination by curettage.

- Postpartum insertion should be left until six weeks after delivery.

NURSING CONSIDERATIONS
- This may be the contraceptive method of choice for women who have excessively heavy menses, as there may be an improvement in any dysmenorrhoea and a reduction in blood loss. There is also evidence that the frequency of pelvic inflammatory disease may be reduced.

- In primary menorrhagia, menstrual bleeding is reduced significantly within 3-6 months of inserting the levonorgestrel intra-uterine system (IUS), probably because it prevents endometrial proliferation. Another treatment should be considered if menorrhagia does not improve within this period.

- Women should be examined 4-6 weeks following insertion and then annually.

- Patients should be fully counselled and provided with a patient information leaflet.

PATIENT TEACHING
- Women should be encouraged to return if they experience any unusual bleeding or pain.

- Progestogenic side-effects such as mastalgia and mood changes normally improve within a few months.

- A few months after insertion bleeding often becomes very light or absent.

- Women should be taught to check for threads to confirm that the IUS is in place at the end of each period.

- Fertility return after removal is rapid and appears complete.

Nurses should refer to manufacturer's summary of product characteristics and to appropriate local guidelines

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