LNG-IUD for Patients with Stable Angina Requiring Contraception
The LNG-IUD is an excellent contraceptive option for patients with stable angina, as it has minimal cardiovascular risk and provides highly effective contraception without the thrombotic concerns associated with estrogen-containing methods. 1
Cardiovascular Safety Profile
The LNG-IUD carries minimal cardiovascular risk in patients with stable angina:
The U.S. Medical Eligibility Criteria classifies LNG-IUD use as Category 1 (no restrictions) for patients with adequately controlled hypertension and most cardiovascular conditions. 1
For patients with multiple risk factors for arterial cardiovascular disease (including older age, smoking, diabetes, and hypertension), the LNG-IUD is classified as Category 2, meaning the benefits generally outweigh the risks. 1
Even in patients with elevated blood pressure (systolic 140-159 mm Hg or diastolic 90-99 mm Hg), the LNG-IUD remains Category 1. 1
For more severe hypertension (systolic ≥160 mm Hg or diastolic ≥100 mm Hg) or vascular disease, the LNG-IUD is Category 2 due to theoretical concerns about levonorgestrel's effect on lipids, but this is still considered acceptable use. 1
Key Advantages Over Estrogen-Containing Methods
Combined hormonal contraceptives (pills, patches, rings) are contraindicated or carry significant risks in patients with cardiovascular disease, making the LNG-IUD a superior choice:
Estrogen-containing methods increase thrombotic risk and are generally Category 3-4 (risks outweigh benefits or unacceptable health risk) in patients with cardiovascular disease. 1
The LNG-IUD provides local hormone delivery with minimal systemic absorption, avoiding the cardiovascular risks associated with systemic estrogen. 2, 3
Levonorgestrel levels in systemic circulation are low with the LNG-IUD, leading to strong endometrial suppression without significant cardiovascular effects. 3
Contraceptive Efficacy
The LNG-IUD provides exceptional contraceptive protection:
Failure rates are less than 1%, with Pearl pregnancy rates of 0.0-0.2 per 100 woman-years, comparable to surgical sterilization. 2, 4
The device is approved for 5 years of use, with evidence supporting effectiveness up to 7 years. 2
Rapid return to fertility occurs after removal, with 1-year pregnancy rates of 89% for women under 30. 2
Additional Health Benefits
Beyond contraception, the LNG-IUD offers therapeutic advantages:
Dramatic reduction in menstrual bleeding occurs in most users, with 15-20% experiencing amenorrhea by 1 year. 2
Menstrual blood loss decreases by approximately 90% from pretreatment levels during the first year. 4
Dysmenorrhea typically disappears with LNG-IUD use. 4
The device increases body iron stores by reducing menstrual blood loss. 4
Important Counseling Points
Proper counseling about bleeding patterns is essential for continuation:
Unscheduled spotting or light bleeding is expected during the first 3-6 months and is generally not harmful. 1
Bleeding generally decreases over time, with many women experiencing only light menstrual bleeding or amenorrhea. 1
Approximately half of users experience amenorrhea or oligomenorrhea by 2 years of use. 1
Enhanced counseling about expected bleeding patterns improves continuation rates. 1
Clinical Caveats
Key considerations for LNG-IUD placement:
If new-onset bleeding occurs after initial stabilization, evaluate for IUD displacement, sexually transmitted infections, pregnancy, or new pathologic uterine conditions (polyps, fibroids). 1
Women with anatomical abnormalities that distort the uterine cavity may not be good candidates for IUD placement. 5
Premedication with naproxen 500-550 mg or ketorolac 20 mg orally 1 hour before placement can reduce discomfort. 1