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The LNG-IUD does not appear to have an adverse effect on bone mineral density or to increase the risk of fracture 29 30. Acne is rarely reported with use of the LNG-IUD 28. Users of the LNG-IUD report weight gain that is comparable to those using the copper IUD 26 27. Compared with the LNG-20 IUD, the LNG-13.5 IUD has a narrower inserter, smaller “T” frame, and releases less hormone daily 25.Īlthough only a small amount of steroid is released from the LNG-IUD, some women may experience hormone-related effects, such as headaches, nausea, breast tenderness, mood changes, and ovarian cyst formation. The cumulative pregnancy rate is 0.33 per 100 women-years of use 24. The LNG-13.5 IUD is FDA approved for up to 3 years of use 20. The LNG-19.5 IUD is FDA approved for up to 5 years of use with a cumulative pregnancy rate of 0.31 per 100 women-years 19 24. The LNG-18.6 IUD is FDA approved for up to 4 years of use 18. The LNG-20 IUD is FDA approved for up to 5 years of use 17. The available evidence supports that LNG-IUDs do not disrupt pregnancy 15 and are not abortifacients. The LNG-19.5 IUD (Kyleena) contains a total of 19.5 mg of levonorgestrel, releasing 17.5 micrograms/day of levonorgestrel, and the LNG-13.5 IUD (Skyla) contains a total of 13.5 mg of levonorgestrel, releasing 14 micrograms/day of levonorgestrel 19 20 21.Īll LNG-IUDs have a similar primary mechanism of action: they prevent fertilization by causing a profound change in the amount and viscosity of cervical mucus, making it impenetrable to sperm 15 22 23. Two types of LNG-IUDs contain a total of 52 mg of levonorgestrel: the LNG-20 IUD (Mirena) releases 20 micrograms/day, and the LNG-18.6 IUD (Liletta) releases 18.6 micrograms/day 17 18. Several types of LNG-IUDs are currently available in the United States all are T-shaped and include a polydimethylsiloxane sleeve that contains levonorgestrel on the stem. Levonorgestrel-Releasing Intrauterine Devices A recent cost-effectiveness analysis from the public payer perspective determined that LARC use becomes cost neutral within 3 years of initiation when compared with use of short-acting methods 13. Typical-use pregnancy rates for LARC are lower when compared with those for oral contraceptives Table 2 12. Reducing barriers to LARC access for appropriate candidates may continue to help lower unintended pregnancy rates in the United States, given that gaps in use and discontinuation of shorter acting methods are associated with higher unintended pregnancy rates 11.
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Birth and abortion rates also fell among young women enrolled in the study, with decreases of 14% and 18%, respectively 9. The increase in LARC use was accompanied by a 29% decrease in birth rates and a 34% decrease in abortion rates among teenagers.
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Similar to findings in the CHOICE study 10, during the Colorado Family Planning Initiative, LARC use increased from 5% to 19% among low-income teenagers (aged 15–19 years) and young women (aged 20–24 years). The CHOICE project identified a significant reduction in unintended pregnancies and in the abortion rate of study participants compared with a similar population from the same geographic area 6.īuilding on outcomes from the CHOICE Project, the Colorado Family Planning Initiative provided access to LARC methods at no cost to clients through Title X-funded clinics in 37 of Colorado’s 64 counties, which comprised 95% of the state’s total population 9. Continuation rates for participants who chose LARC were higher than for those who chose short-acting methods Table 1 8. Seventy-five percent of the cohort chose LARC: 46% chose the LNG-IUD, 12% chose the copper IUD, and 17% chose the subdermal implant. In the Contraceptive CHOICE research project, a prospective cohort of 9,256 women aged 14–45 years were offered their choice of contraceptive method without charge 6. Although the reduction in unintended pregnancy is multifactorial, increased use of LARC likely has contributed 6 7. An historic 18% decrease in unintended pregnancy occurred in the United States between 2008, when 51% of pregnancies were unintended, and 2011, when only 45% of pregnancies were unintended 5. women who rely on LARC, 10.3% use IUDs and 1.3% use the implant. Use of LARC has increased during the past decade, from 2.4% in 2002 to 8.5% in 2009 to 11.6% in 2012, the most recent year for which data are available from the National Survey of Family Growth 4.
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Five IUDs are currently marketed in the United States: the copper-containing IUD and four levonorgestrel-releasing intrauterine devices (LNG-IUDs). Two types of LARC are available in the United States: 1) intrauterine devices (IUDs) and 2) the etonogestrel single-rod contraceptive implant.