What are the side effects of Visanne (levonorgestrel-releasing intrauterine device)?

Side Effects of Visanne (Dienogest)

The most common side effects of Visanne (dienogest) include irregular bleeding patterns such as spotting, light bleeding, or amenorrhea, which are generally not harmful but may be bothersome for some patients. These bleeding changes may or may not decrease with continued use 1.

Common Side Effects

• Bleeding irregularities:

  • Unscheduled spotting or light bleeding
  • Amenorrhea (22% of users)
  • Infrequent spotting (34% of users)
  • Frequent bleeding (7% of users)
  • Prolonged bleeding (18% of users) 1

• Other potential side effects:

  • Headaches
  • Nausea
  • Hair loss
  • Breast tenderness
  • Depression
  • Decreased libido
  • Ovarian cysts 2

Management of Bleeding Irregularities

For Irregular Bleeding:

1. Rule out underlying gynecological problems:

   • Interactions with other medications
   • STDs
   • Pregnancy
   • Pathologic uterine conditions (polyps, fibroids) 1

2. If no underlying problem is found and treatment is desired:

   • NSAIDs for short-term treatment (5-7 days)
   • Hormonal treatment with low-dose COCs or estrogen for short-term treatment (10-20 days) if medically eligible 1

3. If irregular bleeding persists and is unacceptable:

   • Consider alternative contraceptive methods 1

For Amenorrhea:

• No medical treatment required; provide reassurance
• If amenorrhea represents a sudden change from regular bleeding, consider ruling out pregnancy
• If amenorrhea persists and is unacceptable, discuss alternative methods 1

Special Considerations

For Women with Endometriosis:

Dienogest has been shown to decrease dysmenorrhea, pelvic pain, and dyspareunia in women with endometriosis 1.

For Women with Heavy Menstrual Bleeding:

Levonorgestrel-releasing intrauterine systems have been found to be beneficial in treating menorrhagia 1, 3, 4.

For Women with HIV:

Intrauterine devices may be used in HIV-infected women with low risk for other STDs, though there are some controversies. The benefits of a levonorgestrel-releasing intrauterine device may outweigh the risks, particularly in terms of reducing menstrual blood loss 1.

Important Caveats

• Enhanced counseling about expected bleeding patterns and reassurance that bleeding irregularities are generally not harmful has been shown to reduce discontinuation in clinical trials 1.

• If pregnancy occurs while using Visanne, the device should be removed if feasible 2.

• Visanne should not be inserted for at least three months after resolution of a sexually transmitted infection 2.

• Neither antibiotic prophylaxis nor misoprostol use before insertion is beneficial 2.

• Visanne is not recommended as an ongoing emergency contraceptive method 5.

By understanding these potential side effects and management strategies, patients can make informed decisions about using Visanne and better manage any adverse effects that may occur.