What is the effect of using an Intrauterine Device (IUD) with progesterone?

From the Guidelines

The use of an Intrauterine Device (IUD) with progesterone is highly effective in reducing heavy menstrual bleeding, with a reduction in menstrual blood loss of 71% to 95% [ 1 ].

Key Benefits of IUD with Progesterone

• Reduces menstrual blood loss: The levonorgestrel 20 μg/d–releasing device is the most effective approach, resulting in a significant reduction in menstrual blood loss [ 1 ].
• Protects against pregnancy: The IUD with progesterone also provides protection against pregnancy, making it a suitable option for women who experience heavy menstrual bleeding [ 1 ].
• Minimally increases systemic progesterone levels: The main effect of the IUD with progesterone is at the endometrial level, with minimal increase in systemic progesterone levels [ 1 ].

Important Considerations

• Counseling before insertion: It is essential to provide counseling about potential changes in bleeding patterns during IUD use, including unscheduled spotting or light bleeding, which is expected during the first 3–6 months of use [ 1 ].
• Monitoring and follow-up: Regular monitoring and follow-up are necessary to assess the effectiveness of the IUD with progesterone and to address any concerns or side effects [ 1 ].

From the FDA Drug Label

ADVERSE REACTIONS See BOXED WARNINGS, WARNINGS, and PRECAUTIONS. Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice The following adverse reactions have been reported in women taking progestins, including medroxyprogesterone acetate tablets, without concomitant estrogens treatment:

1. Genitourinary System Abnormal uterine bleeding (irregular, increase, decrease), change in menstrual flow, breakthrough bleeding, spotting, amenorrhea, changes in cervical erosion and cervical secretions.

The effect of using an Intrauterine Device (IUD) with progesterone is not directly addressed in the provided drug label.

• Key points:
  • The label discusses adverse reactions to medroxyprogesterone acetate tablets.
  • It does not mention the use of an IUD with progesterone.
  • The label only discusses oral progesterone therapy, not intrauterine devices. The FDA drug label does not answer the question.

From the Research

Effect of Using an Intrauterine Device (IUD) with Progesterone

The use of an Intrauterine Device (IUD) with progesterone has been studied in various research papers. Here are the key findings:

• The levonorgestrel-releasing intrauterine system (LNG-IUS) is more effective than oral medication as a treatment for heavy menstrual bleeding (HMB) 2, 3, 4.
• The LNG-IUS reduces menstrual blood loss by up to 90% and improves quality of life 2, 3, 4.
• The LNG-IUS is associated with more minor adverse effects, such as pelvic pain, breast tenderness, and ovarian cysts, compared to oral therapy 2, 3, 4.
• The LNG-IUS is more cost-effective than hysterectomy and endometrial ablation techniques 2, 3, 4.
• The LNG-IUS prevents endometrial hyperplasia at least as effectively as oral or vaginal forms of progesterone 5.
• Progesterone and progestogens are used to regulate intermenstrual bleeding and decrease heavy menstrual bleeding (HMB) in women of reproductive age or who are perimenopausal 6.

Comparison with Other Treatments

The LNG-IUS has been compared to other treatments, including:

• Oral medical therapy: The LNG-IUS is more effective in reducing HMB and improving quality of life 2, 3, 4.
• Endometrial destruction techniques: The LNG-IUS is probably similar to endometrial destruction techniques in reducing HMB, but may have more adverse events 4.
• Hysterectomy: The LNG-IUS is less effective than hysterectomy in reducing HMB, but is more cost-effective and has fewer serious adverse events 2, 4.

Benefits and Risks

The benefits of using an IUD with progesterone include:

• Reduction in menstrual blood loss
• Improvement in quality of life
• Cost-effectiveness
• Prevention of endometrial hyperplasia The risks and side effects include:
• Minor adverse effects, such as pelvic pain, breast tenderness, and ovarian cysts
• Intermenstrual bleeding and spotting
• Progestogenic side effects, such as mood changes and weight gain 2, 3, 5, 4, 6.