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Hormone-containing intrauterine contraceptives
Last reviewed: 04.07.2025

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Currently, the hormonal intrauterine device (IUD) Mirena is quite widely used.
Mirena is a levonorgestrel-releasing system made of polyethylene and has a T-shape. Mirena is 32 mm long. Around the vertical rod there is a cylindrical container filled with levonorgestrel (52 mg), which has a stronger effect on the endometrium than progesterone. The container is covered with a special membrane that ensures the continuous release of levonorgestrel in the amount of 20 mcg/day. Mirena combines high contraceptive efficacy and therapeutic properties of hormonal contraceptives (COCs and subcutaneous implants) with the convenience and long-term action of the IUD.
The duration of use of Mirena is 5 years, although the contraceptive effect lasts for 7 years.
The mechanism of action of Mirena is based on a combination of the mechanisms of action of the intrauterine contraceptive and levonorgestrel.
- The IUD suppresses the functional activity of the endometrium: it inhibits the proliferation of the endometrium, causes atrophy of the endometrial glands, pseudodecidual transformation of the stroma and vascular changes, which prevents implantation.
- The physical and chemical properties of cervical mucus change (viscosity increases), which makes it difficult for sperm to penetrate.
- The motility of sperm in the uterine cavity and fallopian tubes decreases.
Advantages of the method
- Reliable contraceptive effect.
- High safety (local action of the hormone minimizes its systemic action).
- Reversibility of the contraceptive effect (pregnancy is possible as early as the first month after removing Mirena, but fertility is usually restored 6–24 months after the end of the drug’s action).
- Lack of connection with sexual intercourse and the need for self-control.
- Reduction of menstrual blood loss in most patients.
- It can be used during breastfeeding, as Mirena does not affect the quality and quantity of breast milk, or the growth and development of the child.
- Therapeutic effect in idiopathic menorrhagia.
- Can be used for small uterine fibroids.
Indications for use of Mirena
Recommended primarily for women of different ages who have given birth, who have one sexual partner and who need long-term and reliable contraception. It is especially indicated for women with heavy and painful menstruation. In some cases, Mirena can be used by women who have not given birth, who have one partner and who need reliable long-term contraception, as well as for therapeutic purposes. It should be emphasized that for young women who have not given birth, Mirena is not a first-choice method.
Contraindications for the use of Mirena:
- acute thrombophlebitis or thromboembolic conditions;
- breast cancer;
- acute hepatitis;
- severe liver cirrhosis, liver tumors;
- ischemic heart disease;
- General contraindications to the use of IUDs.
It should be noted that there are a number of conditions when, in accordance with the acceptance criteria (i.e. the benefit from using the method in this case exceeds the theoretical and proven risk), Mirena can be used, but only under constant medical supervision. The list of such conditions includes hypertension with BP of 160/100 mm Hg and above, vascular diseases, diabetes, ischemic heart disease or stroke in the anamnesis, hyperlipidemia, migraine, mild liver cirrhosis, risk factors for cardiovascular diseases.
Side effects and complications when using Mirena
- During the first 3-4 months of IUD use, levonorgestrel may have minor systemic effects, which include mood changes, headache, mastalgia, nausea, and acne, which then resolve on their own.
- The development of functional ovarian cysts is possible (in 12% of patients), which, as a rule, regress on their own and do not require removal of the IUD.
- Menstrual cycle disorders are possible.
- Acyclic uterine bleeding is one of the most common side effects of progestogen-only contraception. It occurs in the first 3-4 months of IUD use and is predominantly spotting. In these cases, differential diagnostics should be performed with IUD expulsion, inflammatory diseases of the uterus and/or its appendages, spontaneous abortion, ectopic pregnancy, and organic pathology of the uterus. The woman should be explained that with increasing duration of use, bloody discharge usually stops, the menstrual cycle stabilizes, and menstruations become short, light, and less painful.
- Oligo- and amenorrhea develop in 20% of cases of Mirena use as a result of local action of levonorgestrel on the endometrium with the development of its atrophy. If menstruation is absent for 6 weeks after the onset of the last menstruation, pregnancy should be excluded. Repeated pregnancy tests for amenorrhea are not necessary (in the absence of other signs of pregnancy). After removal of the IUD, the condition of the endometrium normalizes within 1 month.
Limitations of the method
- Menstrual cycle disorders in the form of irregular uterine bleeding.
- The possibility of developing amenorrhea, which is caused by the local effect of levonorgestrel on the endometrium, and not by dysfunction of the hypothalamic-pituitary-ovarian axis. However, for women with heavy menstruation and iron deficiency anemia, the development of this condition may be an advantage.
Therapeutic (non-contraceptive) effects of Mirena
- Reduction in the intensity of menstrual bleeding and an increase in the level of hemoglobin and iron in the blood.
- Reducing pain in dysmenorrhea.
- Possibility of use as a component of hormone replacement therapy in perimenopause due to its pronounced suppressive effect on the endometrium.
- An alternative to surgical treatment for bleeding.
- Prevention of fibroids and internal endometriosis of the uterus.
- Prevention of hyperplastic processes and endometrial cancer. Mirena is recommended to be inserted from the 4th to the 6th day of the menstrual cycle. The technique of inserting Mirena has some peculiarities due to the need to use a special guide supplied with the product.
Basic principles for monitoring patients using Mirena
- During the first month after insertion of Mirena, it is necessary to check its threads several times to ensure that the IUD is inserted correctly.
- Follow-up examinations should be carried out at least once every 6 months.
- The patient should be taught self-examination, which should be carried out after each menstruation - palpation of the position of the IUD threads. If they cannot be found, transvaginal ultrasound scanning is necessary.
- It should be explained to the patient that if the temperature rises, there is pain in the lower abdomen, abnormal discharge from the genital tract, or the nature of menstruation changes or is delayed, she should consult a doctor as soon as possible.
Hormone-containing vaginal contraceptive ring "NuvaRing"
The NovaRing ring is a fundamentally new method of contraception based on the vaginal method of introducing hormones. Its diameter is 54 mm. It releases 15 mcg of EE and 120 mcg of etonogestrel, an active metabolite of desogestrel, per day, ensuring high contraceptive efficiency. The vaginal method of introduction has significant advantages: firstly, a stable hormonal background, i.e. a stable concentration of hormones in the blood; secondly, the absence of primary passage through the liver and gastrointestinal tract. This allows using smaller daily doses of hormones with the same efficiency compared to tablets, which are more easily tolerated by the body. Thus, the systemic effect on the woman's body is minimal. In addition, NovaRing does not affect body weight due to the minimal dose and stable level of hormones in the blood. The main mechanism of action of NovaRing, as well as COCs, is the suppression of ovulation. In addition, it increases the viscosity of cervical mucus.
Reception mode
One ring is required per menstrual cycle. The woman inserts and removes NuvaRing herself. It is inserted from day 1 to day 5 of the menstrual cycle, and the ring remains in the vagina for 3 weeks. Then it is removed, a 7-day break is taken, and the next ring is inserted. During the first 7 days of using the vaginal ring, a condom must be used. In subsequent cycles, there is no need to use any additional contraception.
Adverse reactions
- Nausea.
- Headache.
- Discomfort in the vagina.
- Vaginitis.
- Irregular bleeding.
- Feeling of engorgement of the mammary glands.
Contraindications
- Pregnancy or suspicion of pregnancy.
- Bleeding from the genital tract of unknown etiology.
- Diabetic angiopathy.
- Severe liver diseases and tumors.
- Hormone-dependent tumors of the reproductive system (including history).
- Migraine with focal neurological symptoms.
- Conditions that make it difficult to use the vaginal ring include cystocele, rectocele, uterine prolapse, cervical prolapse, bladder hernia, rectal hernia, and severe chronic constipation.