VOL: 102, ISSUE: 15, PAGE NO: 36GENERIC AND PROPRIETARY NAMES
GENERIC AND PROPRIETARY NAMES
- Intra-uterine progestogen system.
- 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.
- Intra-uterine progestogen-only device.
- Primary menorrhagia.
- Prevention of endometrial hyperplasia during oestrogen replacement therapy.
- Endometrial disorders should be ruled out before insertion of the device.
- Not suitable as emergency contraception.
- Pregnancy: remove due to risk of teratogenic effects.
- Abdominal pain.
- Peripheral oedema.
- 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.
- Other progestogens.
- 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.
- 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.
- 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