Contraceptives with levonorgestrel, types of drugs and their names. Mirena hormonal device: indications, consequences, reviews of women and doctors

Levonorgestrel

Latin name

Levonorgestrel

Chemical name

(17alpha)-13-Ethyl-17-hydroxy-18,19-dinopregn-4-en-20-yn-3-one

Gross formula

C21H28O2

Pharmacological group

Estrogens, gestagens; their homologues and antagonists

Nosological classification (ICD-10)

N92 Heavy, frequent and irregular menstruation
N95.1 Menopausal and menopausal conditions in women
Z30.0 General Tips and consultations on contraception
Z30.5 Monitoring the use of (intrauterine) contraceptives

CAS code

797-63-7

Characteristic

Contraceptive agent (gestagen).

Pharmacology

Pharmacological action: contraceptive, gestagenic.

Causes inhibition of ovulation and changes in the endometrium, prevents the implantation of a fertilized egg. Increases the viscosity of cervical mucus, which interferes with the advancement of sperm.

As part of the intrauterine therapeutic system(IUD) levonorgestrel has a direct local effect on the endometrium, the fallopian tubes and viscosity of cervical mucus.

After oral administration, it is quickly and completely absorbed from the gastrointestinal tract, bioavailability is about 100%. Cmax in plasma after taking a single dose of 0.75 mg is observed after (1.6±0.7) hours and is (14.1±7.7) ng/ml. Binds to serum albumin (approximately 50%) and sex hormone-binding globulin (47.5%). Metabolized in the liver, the metabolites are pharmacologically inactive. T1/2 - (24.4±5.3) hours. Excreted mainly in urine, a small amount - in feces.

When using an IUD, the rate of release of levonorgestrel into the uterine cavity is approximately 20 mcg/day at the beginning and decreases after five years to approximately 11 mcg/day. The average release rate of levonorgestrel is approximately 14 mcg/day for up to 5 years. IUDs may be used in women receiving hormone replacement therapy in combination with oral or transdermal estrogen preparations that do not contain progestogens.

Application

Inside. Emergency post-coital contraception in women (including after unprotected sexual intercourse and if the method of contraception used cannot be considered reliable).

For intrauterine therapeutic system. Contraception (long-term), idiopathic menorrhagia, prevention of endometrial hyperplasia during replacement therapy estrogens.

Contraindications

Hypersensitivity, pregnancy (or suspicion of it); for oral administration (optional) - serious illnesses liver or biliary tract, jaundice (including a history), puberty, breastfeeding; for IUDs (optional) – existing or recurrent inflammatory diseases pelvic organs, infections of the lower genitourinary tract, postpartum endometritis, septic abortion within the last 3 months, cervicitis, diseases accompanied by increased susceptibility to infections; cervical dysplasia, malignant neoplasms uterus or cervix, progestogen-dependent tumors, incl. mammary cancer; pathological uterine bleeding unknown etiology, congenital or acquired anomalies of the uterus, incl. fibroids leading to deformation of the uterine cavity; acute diseases or liver tumors.

Restrictions on use

For the Navy. After consultation with a specialist: migraine, focal migraine with asymmetric vision loss or other symptoms indicating transient cerebral ischemia; unusually strong headache; jaundice, severe arterial hypertension; severe circulatory disorders, incl. stroke and myocardial infarction.

The advisability of IUD removal should be discussed if any of the following conditions are present or first occur.

Use during pregnancy and breastfeeding

Contraindicated during pregnancy.

If pregnancy occurs while using an IUD, it is recommended to remove the system because... any intrauterine contraceptive device left in situ increases the risk of miscarriage and premature birth. Removing the IUD or probing the uterus can lead to spontaneous miscarriage. If it is not possible to carefully remove the intrauterine contraceptive device, the advisability of induced termination of pregnancy should be discussed. If a woman wants to continue her pregnancy and the IUD cannot be removed, the patient should be informed about the risks and possible consequences premature birth for the baby. In such cases, the course of pregnancy should be carefully monitored. Must be excluded ectopic pregnancy(if a woman with an IUD becomes pregnant, the relative risk of ectopic pregnancy increases). The woman should be advised that she should report any symptoms that suggest a pregnancy complication, particularly colicky abdominal pain accompanied by fever.

Passes into breast milk: during breastfeeding, about 0.1% of levonorgestrel along with breast milk enters the newborn's body. Breast-feeding after taking the drug orally for emergency postcoital contraception, it should be stopped for 36 hours.

For the Navy. The use of any progestin-only method of contraception 6 weeks after birth is considered to have no harmful effect on the growth and development of the child and is unlikely to pose a risk to the child at doses released by the IUD in the uterine cavity.

Side effects

When conducting clinical trials the most common symptoms observed in women taking levonorgestrel orally (0.75 mg) were nausea (23.1%), abdominal pain (17.6%), fatigue (16.9%), headache (16.8%), violation menstrual cycle, incl. copious menstrual bleeding(13.8%), scanty menstrual bleeding (12.5%), dizziness (11.2%), breast tension (10.7%), vomiting (5.6%), diarrhea (5.0%) .

When using an IUD

From the outside nervous system and sensory organs: ≥1%,<10% — пониженное настроение, нервозность, головная боль; ≥0,1%, <1% — лабильность настроения, мигрень.

From the gastrointestinal tract: ≥1%,<10% — боль в животе, тошнота; ≥0,1%, <1% — вздутие живота.

From the genitourinary system: ≥1% - uterine/vaginal bleeding, spotting, oligo- and amenorrhea, benign ovarian cysts; ≥1%,<10% — боль в области органов малого таза, дисменорея, вагинальные выделения, вульвовагинит, напряженность молочных желез, болезненность молочных желез, снижение либидо; ≥0,1%, <1% — воспалительные заболевания органов малого таза, эндометрит, цервицит; ≥0,01%, <0,1% — перфорация матки.

From the skin: ≥1%,<10% — угри; ≥0,1%, <1% — алопеция, сыпь, гирсутизм, зуд, экзема; ≥0,01%, <0,1% — сыпь, крапивница.

Other: ≥1%,<10% — боль в спине, повышение массы тела; ≥0,1%, <1% — отеки.

Interaction

When taking inducers of cytochrome P450 isoenzymes simultaneously, the metabolism of levonorgestrel may increase and the effect may decrease. The following drugs may reduce the effectiveness of levonorgestrel: amprenavir, lansoprazole, nevirapine, oxcarbazepine, tacrolimus, topiramate, tretinoin, barbiturates (including primidone), phenytoin and carbamazepine, drugs containing St. John's wort (Hypericum perforatum), as well as rifampicin, ritonavir, ampicillin, tetracycline , rifabutin, griseofulvin. Levonorgestrel reduces the effectiveness of hypoglycemic drugs and anticoagulants (coumarin derivatives, phenindione), increases plasma concentrations of glucocorticosteroids. Drugs containing levonorgestrel may increase the risk of cyclosporine toxicity due to inhibition of its metabolism.

Directions for use and doses

Inside, intrauterine. Orally, used in the first 96 hours after sexual intercourse at a dose of 0.75-1.5 mg. It is not recommended to use emergency contraception more than once every 4-6 months.

Intrauterine, the IUD is inserted into the uterine cavity.

Precautionary measures

Repeated use of the drug orally during the same menstrual cycle should be avoided due to the possibility of menstrual dysfunction. The use of the oral form as a means of regular and continuous contraception is not allowed, because this leads to a decrease in the effectiveness of the drug and an increase in adverse reactions. If menstruation is delayed by more than 5-7 days after emergency postcoital contraception, pregnancy must be excluded, and in the event of uterine bleeding, a gynecological examination is recommended.

In adolescents under 16 years of age, use for emergency postcoital contraception is possible only in exceptional cases (including rape) and only after consultation with a gynecologist.

Before installing an IUD, it is necessary to conduct a general medical and gynecological examination, including examination of the pelvic organs and mammary glands, as well as a smear examination from the cervix. A woman should be re-examined 4-12 weeks after IUD insertion, and then once a year or more often, if clinically indicated. The IUD remains effective for five years. Installation should only be performed by a physician who has experience with this IUD or is well trained in this procedure.

The results of some recent studies show that women taking progestin-only contraceptives may have an increased risk of venous thrombosis; however, these results are not well defined. However, if symptoms of venous thrombosis appear, appropriate diagnostic and treatment measures should be taken immediately.

After removal of the IUD, the ability to bear children is restored in 50% of women after 6 months, and in 96.4% after 12 months.

Year of last adjustment

2011

Interactions with other active ingredients

Acarbose*
Glipizide*	Against the background of levonorgestrel, the hypoglycemic effect is weakened; When administered in combination, constant monitoring of blood glucose concentration is necessary.
Soluble insulin [pork monocomponent]*	With levonorgestrel, the hypoglycemic effect is weakened (a dose increase may be required).
Carbamazepine*	Carbamazepine induces the activity of the CYP450 system in the liver, reduces plasma levels and reduces the reliability of the contraceptive effect of levonorgestrel.
Levothyroxine sodium*	With levonorgestrel, the level of thyroxine-binding globulin in plasma increases (a dose increase may be required).
Retinol*	With levonorgestrel, a significant increase in plasma levels is possible.
Rifampicin*	Rifampicin, as an inducer of liver enzymes, accelerates biotransformation and may weaken the effect of levonorgestrel and reduce the reliability of contraception.
Phenytoin*	Phenytoin induces the activity of cytochrome P450, accelerates biotransformation, and may weaken the contraceptive effect of levonorgestrel.

Only new delusions save us from despair after the loss of old ones.
Felix Hvalibug

Without struggle there would be no evolution or progress. We are alive because we struggle and work.

A clash of personalities, interests, and constant obstacles are the key to movement. And so it is in everything. When a technical innovation appears, its defenders and opponents immediately appear, considering everything absurd. A new drug appears - and we hear enthusiastic reviews from those who were healed and negative reviews from those who did not experience the effect. But it’s not for nothing that the sages advised turning everything negative into experience, and a useful one at that. Criticism is also one of the engines of progress. Although often disapproval from reasonable criticism develops into something more - into misconceptions and myths.

We are seeing this, for example, in connection with the growing popularity in Russia and throughout the world of intrauterine hormonal contraceptives. Let's look at the most common judgments. What useful things can you take away from them and how can you avoid getting lost yourself? We turned to obstetrician-gynecologist Yulia Zhigalova with this question.

“I want to install an intrauterine hormonal system, but I’m afraid that pimples will appear and the condition of the skin will change.”

This common misconception appears whenever hormones are discussed. Moreover, those who are mistaken do not even try to figure out what specific hormones we are talking about. Male sex hormones - androgens - most often have an adverse effect on the skin.

The intrauterine hormonal system contains a completely different hormone, in structure - an analogue of the female sex hormone progesterone (gestagen), which actually has no effect on the condition of the skin. In addition, the active substance is released directly into the uterine cavity. Thus, a minimal amount enters the bloodstream and is not capable of in any way affecting the general background of the body, including the condition of the skin. According to statistics, from 1 to 10% of women who had an intrauterine hormonal system installed complained of acne, but only during the first time of use. These phenomena refer to adaptation reactions, which usually disappear 3-6 months after installation of the system.

“I have a difficult relationship with my husband: there is almost no intimacy, we are always in some kind of tension. We have two small children. Of course, we are both tired. There is coldness in the relationship. I am trying to solve this problem, I am consulting with a psychologist. I understand what is needed build intimacy and at the same time resolve the issue in the most effective way contraception. It seems that my choice fell on the intrauterine hormonal system, but I heard from some friends that with it, on the contrary, the desire disappears. And it seems like you can have sex as much as you want, but you don’t want to.”

The intrauterine hormonal system cannot influence sexual desire, because the hormone acts locally. Insignificant concentrations enter the blood. But even if we theoretically assume its effect on libido, it will most likely turn out to be a plus, because levonorgestrel has minimal residual androgenic activity, which means it can only increase sexual desire.

If women note a lack of desire when an intrauterine hormonal system is installed, theoretically there may be another explanation. In the first months after installation, the body adapts to the new regime. He needs time to get used to it. Therefore, sometimes a slight fatigue occurs, slight cramps in the lower abdomen - everything that may appear in the first months - this simply does not allow a woman to relax and completely surrender to her feelings. But as soon as the discomfort of this period passes and the woman fully experiences all the benefits of the method, believe me, there will be no problems with desire.

“Why do some people notice a change in the menstrual cycle after the installation of an intrauterine hormonal system? I’m just being examined to have it installed, and now I’m thinking about it.”

Gestagen, which is in the system, protects the endometrium (the inner lining of the uterus) from proliferation (excessive growth). Under the influence of it, menstruation may change and acquire the character of spotting, become longer or shorter, occur with more or less bleeding than usual, or stop altogether. After 3-6 months, for most women, the adaptation period ends and the menstrual cycle is established. Moreover, menstruation in most women becomes scanty, short and painless. There is also no need to worry about suppression of ovarian function (after all, periods are very scanty) - the ovaries work as usual, and many studies have confirmed the presence of ovulation in a large number of women.

“I really want to find an effective method of contraception. I’m breastfeeding my second baby and definitely don’t plan on a third in the coming years. I’ve just gotten back into shape after giving birth, and it’s important for me that the contraceptive, in addition to its main effect, does not affect weight. "I spent a lot of effort trying to reduce it. Besides, my tendency to be overweight is hereditary. Will the intrauterine hormonal system affect my weight?"

The intrauterine hormonal system does not affect weight. This has been proven by many studies.

Often, the intrauterine hormonal system is used by women for therapeutic purposes, including those with metabolic syndrome, pathology of carbohydrate metabolism, and hidden diseases of the thyroid gland. It can be assumed that in such situations weight gain is possible. And one more nuance. The system lasts a long time - about 5 years. A woman becomes five years older - her metabolism changes, and muscle mass is gradually lost with age, which contributes to the breakdown of fat. Weight gain is much faster. And in order to stay fit at this age, you need to monitor your diet and give your body certain physical activities. And it’s not about the system at all, but about the way of life.

“I don’t have children yet. And I don’t even plan to. And I need reliable contraception. I wanted to install an intrauterine hormonal system, but I heard that it can fall out or grow into the uterus.”

This is truly a myth. It is most likely associated with conventional metal-containing IUDs, which, by their mechanism of action, cause increased contraction of the uterus and, as a result, the IUD may fall out.

Indeed, when using VMGS, expulsion (loss) of the spiral may occur, but this is most often associated with a technically incorrectly installed system. To a greater extent, spontaneous prolapse is associated with conventional metal-containing IUDs, which, by their mechanism of action, cause increased contractions of the uterus. And VMGS has a relaxing effect on the uterus, which prevents the system from being pushed out of the body. For the same reason, for many women, menstruation becomes less painful and flows easier.

As for ingrowth, this term is more common. And it again applies to a greater extent to metal-containing spirals. More precisely, to cases of their incorrect installation, when the spiral perforates the wall of the uterus, resulting in an inflammatory reaction and the endometrium begins to grow. The intrauterine system helps reduce proliferation (growth) of the endometrium, so the term “ingrowth” is not applicable to it.

“I used the system for 4 years, I feel great, menstruation lasts 1-2 days, it’s scanty. Now I’ve decided to get pregnant again, I’m going to remove the system, but I’m afraid that after removal there may be severe bleeding.”

Levonorgestrel, located in the system, affects the endometrium, causing its thinning. As a result, for most women, like you, menstruation becomes very scanty. But the action continues exactly as long as the system remains in the uterine cavity. After the system is removed, the endometrium begins to grow again. In this case, menstruation is restored to its original level.

“I need to remove the system because the expiration date has expired, but I heard that there is a risk of pregnancy immediately. How long does the contraceptive effect last after removal?”

Of course, the contraceptive effect is achieved only during the presence of the system in the uterine cavity. When pregnancy is not desired, other methods of contraception must be started after removal of the system. You can also install a new system immediately after removing the previous one; in this case, no additional measures to prevent pregnancy are required.

“Why bother and buy such an expensive product? It’s better to put in a regular IUD and take pills (COCs) at the same time - the effect will be the same.”

A fundamentally incorrect and dangerous misconception. A regular spiral has incomparably more side effects than the system. COCs taken orally act systemically and may have more side effects than levonorgestrel from the intrauterine system, which is released directly into the uterine cavity.

Moreover, the meaning of such a combination is not at all clear. COCs will independently provide a reliable contraceptive effect. Why combine them with a regular spiral? It can increase the pain and profuseness of menstruation, and it often causes inflammatory diseases of the pelvic organs. And the intrauterine system is precisely a unique combination of the advantages of both methods minus their disadvantages.

“I’m afraid to install an intrauterine system; will it provoke irritability?”

The intrauterine system acts locally, Levonorgestrel enters the uterine cavity and has virtually no systemic effect on the body. However, on the contrary, many studies have noted a decrease in premenstrual syndrome and associated irritability.

Even the most unpleasant side effect is a situation that requires careful analysis with your doctor. Often, it’s not so much about the drug, but about the accompanying circumstances, and before, as they say, cutting from the shoulder, you need to figure everything out.

The uniqueness of the intrauterine system method lies in the targeted delivery of the active substance directly to the uterus - the place where it should have an effect, therefore the risk of side effects with this system is significantly reduced.

And don’t forget, if myths are invented, it means someone needs it. To someone, but not to you! You need objective information.

Discussion

When I was wondering whether to use this very system, I asked on the manufacturer’s website whether one single “system” with the same dose of the hormone was suitable for everyone. My question was quickly erased. And this article also does not cover why COCs are selected, but they are ready to supply this “system” to any woman. It seems to me that they want to use us as guinea pigs.

06/19/2010 17:31:32, Marina27

Comment on the article "The History of Misconceptions, or Let's Figure It Out"

Mourning as fashion Dress in our usual idea of it is the merit of the famous trendsetter Gabrielle Chanel. It was she who at the beginning of the last century “freed” ladies from corsets, frills and uncomfortable long hemlines. Every woman knows about the little black dress, but few have heard about the history of its appearance. Oddly enough, the reason for its occurrence is not a social event, but mourning. In 1925, Chanel's lover crashed on the Cote d'Azur, but she wore official mourning...

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Girls (and boys:)), help, who knows. I’ll tell you my story, stage 1 thyroid cancer, but according to the resolution. And again, I’m afraid to mislead, but is this a matter for the court, and not specifically for the dispensary? exactly in the medical certificate 03/18/2014 23:35:27, mirania.

Discussion

I’ll tell you my story, stage 1 thyroid cancer, but according to the Decree of the Government of the Russian Federation No. 117 of February 14, 2013, now stages 1 and 2 are excluded, but there is no new medicine form yet. Our daughter was under the guardianship of her husband, we were adopted in December 2013, both of us. The guardianship told me that I would bring them a certificate (in which it was emphasized “revealed”, why it was revealed, well, this is a long history of butting heads with the oncology clinic) + a separate certificate from them that I had undergone radical treatment, and the guardianship gave me a conclusion, in fact, the court I accepted this set of documents, in general, since January I have been the official mother of my sweet daughter.
Actually, this is what I mean, I think everything should be fine with a benign tumor, the dispenser should give an opinion about your current health, and not about your prospects for the future and that’s all. Well, in general, who will give a guarantee that any adoptive guardian will never get sick, so that everyone is healthy)))

I was registered at the oncology dispensary. It's okay, I have a daughter. And from the oncology center they sent me to move on with my life. They said that the time needed for registration had passed and I just needed to get a mammogram every year. It was a benign tumor.

It’s true that I don’t understand cats at all, correct me if there’s anything wrong. Then at least someone could tell me if this is a misconception or not. A friend’s husband only reacts to a Neva cat. This I know. It’s just that the Neva Masquerade gives a better chance of breeding, at least in terms of phenotype.

Discussion

my friend has a terrible allergy to kys, he came to feed mine during my absence and every time it ended badly for him (((((his family really wanted to have a cat... he went to a Siberian nursery... talked to the kittens and their parents... ended up adopting a cat... 6 months... everything is fine!

I have a terrible allergy.
we got Donetsk girls!
really they are not for everyone)
see photo in reg)

Don't be misled. Unknown is when there are two dashes, and the child is a foundling. These are living children with their own stories, very tragic, but very different. in general it is possible, but each case is examined specifically, but in most cases it is possible to adopt.

Discussion

Can. We are like that. The most difficult thing here is to get to the R/D on time...

Rules for transferring children for adoption and monitoring the conditions of their life and upbringing in adoptive families on the territory of the Russian Federation

(as amended by Resolutions of the Government of the Russian Federation dated April 4, 2002 No. 217, dated March 10, 2005 No. 123, dated April 11, 2006 No. 210, dated April 25, 2012 No. 391, dated May 12, 2012 No. 474)

2. Adoption is permitted in relation to minor children whose only parent or both parents:

Unknown, declared missing by the court or declared dead;

Recognized by the court as incompetent;

Deprived of parental rights by a court;

Gave consent to adoption in accordance with the established procedure;

For reasons recognized by the court as disrespectful, they do not live with the child for more than 6 months and evade his upbringing and maintenance (except for cases of adoption by foreign citizens or stateless persons of children who are citizens of the Russian Federation).

The adoption of a found (abandoned) child, whose parents are unknown, can be carried out in the manner established by the legislation of the Russian Federation if there is an appropriate act issued by the internal affairs bodies or the guardianship and trusteeship authorities.
The adoption of a child abandoned in a maternity hospital (ward) or other medical organization can be carried out in accordance with the procedure established by the legislation of the Russian Federation if there is an appropriate act drawn up by the administration of the institution in which the child was abandoned.

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Discussion

ask the BM for a photo of your passport with Schengen (if you have one) and submit it as a joint trip

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Discussion

By the time the court decides the seizure case, it may already be too late.
Remember how many antisocial children burned and froze alive this winter.

Well, I don’t dislike that the participants of this congress are against YuYu, but support Dima Yakovlev’s law.
Somehow illogical.

I have one girl who studies with tutors (11th grade), the second goes to courses (10th grade), but the courses are only social studies and history. The only thing is that I would still ask you not to mislead mothers who are not very versed in benefits.

Discussion

Our path to admission to HSE: Physics and Mathematics Lyceum Moscow Region, from the 11th grade we additionally studied with a mathematics tutor in solving part C problems - 1.5 thousand rubles. per lesson once a week 2-2.5 hours + a very voluminous task for the week. Those. per month 6 thousand. English courses. 5 thousand. They refused to travel far from the FDP, although they had planned to. I prepared for the olympiads on my own, especially for the Physics and Technology Olympiad in mathematics, solved a huge number of variants of problems, the most difficult ones were sorted out with a tutor. I didn’t manage to enter the olympiads, I fell just a little short, it was especially disappointing for the Physics and Technology, 4 points were not enough for a diploma giving the right to a non-competitive receipts. But I passed the Unified State Exam perfectly - Math.82, English.95 and Russian. 90. She studies on a budget, Faculty of Business Informatics. Yes, for another six months she studied on Saturdays at Moscow State University in computer science courses (informatics) just to understand whether she needed to enroll in this profile or not. It’s inexpensive there - 2.5 thousand per month for 1 time a week for 3 hours.

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They need to allocate funding and they are trying to somehow mislead. If they don’t go, you’ll have to deal with the director or the education department. registered, attached a certificate. The director at the teachers' council gave the task to prepare...

Discussion

You know, I would have conveyed to my life partner, at the level of a dog’s eye, the full depth of his delusions - and quite unambiguously. So “she asked me not to do it”, “it was strange for me” - this is from the realm of fantasy.

IMHO your child is being beaten with your connivance. Some deuces, chess, purses... well, who is interested in these reasons? Are you a mother or what?

My father spanked me with a belt once, in first grade, and it also had something to do with the lessons.
I still remember this, and I still remember that my mother did not protect me.
You know, I also felt calmer when my father was not at home. After school I left them for another city.
Not only, of course, because of this incident.
Now we communicate and meet. But I still can’t understand why my mother didn’t divorce him then. He also drank terribly, on top of everything else (now he’s coded, a completely different person).
And remembering my childhood, I think that it would have been calmer if my parents had divorced.

08/04/2009 18:59:04, I’ll hide

About the so-called Inquisition There is also a lot written about witches both in history and in books, if you are interested in this topic, look for yourself. And you clearly didn’t understand it completely. Indeed, among occultists there are those who remain for the time being in sincere error.

Chemical name.
(17)-13-Ethyl-17-hydroxy-18,19-dinopregn-4-en-20-yn-3-one.

Pharmachologic effect.
Synthetic progestin with contraceptive effect. It affects the gonadotropic function of the pituitary gland, reducing the peak of FSH and LH. Causes temporary atrophic changes in the endometrium, which lead to disruption of the process of egg implantation. Increases the viscosity of cervical mucus, which interferes with the advancement of sperm. After subcutaneous implantation of 6 capsules, the contraceptive effect is achieved after 24 hours. Levonorgestrel in the intrauterine device has a direct local effect on the endometrium (reducing its implantation function), fallopian tubes, viscosity of cervical mucus, which increases the effectiveness and duration of IUD use, without suppression of ovulation.
Pharmacokinetics.
When taken orally, it is quickly absorbed into the gastrointestinal tract, the time to reach Cmax in the blood is 2 hours, and is metabolized in the liver. T1/2 2-7 hours. Excreted in urine (60%) and feces (40%). Passes into breast milk.
Indications.
Capsules for implantation: long-term hormonal contraception in cases where IUDs and estrogen-containing contraceptives cannot be used; if immediate contraception is necessary after an abortion. Pills: contraception for women who have infrequent sexual intercourse.
Contraindications.
Capsules and intrauterine device: pregnancy, acute and subacute inflammatory processes of the internal and external genital organs, malignant tumors of the body and cervix, metrorrhagia of unknown origin, congenital anomalies of the body and cervix, endometriosis, uterine fibroids, chronic salpingoophoritis and endometritis, cervical erosion , ectopic pregnancy (history), nulliparous women, hepatosis of pregnant women (history), acute liver diseases, Dubin-Johnson syndrome, Rotor syndrome, breast cancer, herpes, thrombosis of arteries and veins, thromboembolism (history), bleeding of unknown etiology (in history), disorders of fat metabolism. Tablets: diseases of the liver and biliary tract, jaundice (including a history).
Dosage regimen.
Orally, immediately after the first sexual intercourse, 1 tablet, with repeated intercourse, an additional 1 tablet 8 hours after taking the first one. You can take no more than 4 tablets per month. Capsules 6 pcs, implanted subcutaneously into the inner area of the shoulder using the original surgical method, for a period of 5 years. It is recommended to insert an intrauterine device on days 4-6 of the menstrual cycle, after an induced abortion, immediately or after the next menstruation. After uncomplicated spontaneous birth no earlier than 6 weeks.
Side effects.
Intermenstrual bleeding, dysmenorrhea, mastalgia, headache, migraine, dizziness, anxiety, depression, changes in libido, anorexia, nausea, acne, weight gain, fluid retention, hirsutism, dermatitis, hair loss, rarely thromboembolism.
Special instructions.
After 3 months After implantation of the capsules and then once a year, medical supervision is required. In patients who are overweight, the contraceptive effect of levonorgestrel is less effective. Indications for immediate removal of capsules are: acute visual impairment, planned surgery followed by immobilization for 6 months. (in this case, the capsules are removed 6 weeks before surgery), the first symptoms of thrombophlebitis or thromboembolism, symptoms of acute liver disease, migraine-like pain. In acute and severe forms of chronic liver diseases, monitoring of liver tests is necessary at intervals of 8-12 weeks. If the expected menstruation does not occur during treatment, pregnancy must be excluded. The design of the IUD ensures the release of levonorgestrel at a constant rate of 20 mcg/day. BMC validity period is 5 years. After removal of the IUD, reproductive function is restored quickly. In case of prolonged and persistent intermenstrual bleeding, additional examination is necessary to clarify the diagnosis.
Interaction.
Rifampicin, ampicillin, tetracycline reduce the effect of levonorgestrel.

Levonorgestrel is an active ingredient in a whole group of emergency and permanent contraception. Its effect on the female body is significant, has contraindications and frequent side effects. In order not to harm your health, it is important to study these issues in advance - before using the substance.

What is levonorgestrel used for?

The main scope of use of drugs with the specified active substance is the prevention of unwanted pregnancy and emergency contraception.

Funds are issued in three forms- each has its own purpose of use:

Pills. Most often, medications are intended for emergency contraception after unprotected or poorly protected sexual intercourse;
Intrauterine devices (IUD). Long-term contraception, valid for 5 years. In addition, IUDs can be used as a preventive measure for hyperplasia of the inner uterine lining during treatment with estrogens, as well as for heavy and painful menstruation;
Capsules for subcutaneous implantation. Just like IUDs, they are a means of contraception with an effective duration of 5 years.

How does levonorgestrel work?

When taking a drug containing levonorgestrel, influence on a woman's body happens according to the following mechanism:

Ovulation slows down, the intrauterine lining undergoes changes, as a result of which the fertilized egg cannot catch on and remain in the uterine cavity;
Under the influence of the active substance, the mucus contained in the cervix becomes denser, which prevents sperm from approaching the egg.

Levonorgestrel in intrauterine devices operates on a similar principle:

The structure of the endometrium changes;
The mucus becomes more viscous and thick;
The patency of the fallopian tubes decreases.

After the drug is stopped, the ability to become pregnant is restored.

For whom is levonorgestrel contraindicated?

Due to its significant influence, the substance has many contraindications.

You should stop taking medications with levonorgestrel in the following cases:

when a woman is allergic to a substance;
these contraceptives are prohibited during pregnancy and breastfeeding;
Contraindications include liver disease;
should not be taken by girls under 18 years of age;
The IUD is not used for cervical dysplasia, malignant tumors in the genitals or mammary glands, or if the woman has had a complicated abortion in the last 4 months.

Side effects from use

Based on which contraceptive contains levonorgestrel, the likelihood of side effects may vary from 5 to 15%.

Most often, they are barely noticeable and do not cause complications or particular inconvenience.

The most common side effects:

nausea, intestinal tract dysfunction;
aching pain in the abdominal area;
loss of strength, irritability;
disruptions in the menstrual cycle, changes in blood intensity, spotting in 2-3 weeks of the cycle;
frequent headaches;
tension and enlargement of the mammary glands;
skin rashes;
swelling of the lower extremities.

Medicines containing levonorgestrel

There is a large selection of contraceptives with the specified active ingredient.

The following products are available in different forms and differ in the nature of their effect on the female body.

When choosing a contraceptive, you should definitely pay attention to its bioavailability, or ability to be absorbed.

Name (release form)	Maximum concentration after use	Advantages	Flaws
Levonorgestrel (tablets)	1 to 2 hours	1. The most inexpensive among analogues; 2. Long half-life; 3. The dosage is divided into 2 tablets. Thanks to this, the effective concentration of the active substance is maintained longer.	1. Insignificant amount of absorption; 2. Side effects occur frequently - in 15% of cases.
Postinor (pills)		1. Low price; 2. The package contains 2 tablets; 3. Side effects are observed in 8% of cases; 4. High bioavailability; 5. Maximum half-life.	1. The time required to achieve maximum concentration is above average.
Escapelle (tablets)		1. Maximum bioavailability; 2. Maximum half-life; 3. Side effects were noticed in only 5% of cases.	1. Expensive drug; 2. It is produced in 1 tablet, so the high concentration in the body does not last long.
Eskinor-F (pills)		1. Available in 2 different dosages, which allows you to maintain effectiveness for a long time; 2. Inexpensive medicine; 3. Maximum digestibility.	1. Quite a high probability of side effects - about 11%.
Microlut (tablets, IUD)	From 1 to 1.5 weeks	1. Can be used for permanent contraception; 2. Has a therapeutic effect in some gynecological pathologies; 3. On average, only 6% of cases of using the product showed side effects.	1. Poorly absorbed; 2. Short half-life.
Norplant (capsules for implantation under the skin)		1. The convenient form of release allows the drug to be used for contraception for 5 years, without uterine intervention; 2. Staying under the skin, it is always distributed evenly.	1. The bioavailability of the drug is lower than that of its analogues; 2. The half-life is also shorter; 3. When initially administered under the skin, discomfort may be felt, but it goes away over time.
Mirena (IUD)		1. Long term validity – 5 years; 2. Few side effects.	1. Low volume of absorption; 2. It takes a long time for maximum concentration; 3. Half-life occurs faster than analogues; 4. The price of the product is quite high.

The most popular intrauterine hormonal contraceptive is the Mirena device (IUD). Intrauterine contraceptives (IUDs) have been used since the middle of the last century. They quickly fell in love with women due to many positive qualities: the absence of a systemic effect on the female body, high performance, ease of use.
The spiral does not affect the quality of sexual contact, is installed for a long period, and requires virtually no control. But the IUD has a very significant disadvantage: many patients develop a tendency to metrorrhagia, as a result of which they have to abandon this type of contraception.

In the 60s, intrauterine systems containing copper were created. Their contraceptive effect was even higher, but the problem of bleeding from the uterus was not solved. And as a result, in the 70s, the 3rd generation of VMK was developed. These medical systems combine the best qualities of oral contraceptives and IUDs.

Description of the Mirena intrauterine device

Mirena has a T-shape, which helps to securely fit into the uterus. One of the edges is equipped with a loop of threads designed to remove the system. In the center of the spiral is a whitish hormone. It slowly enters the uterus through a special membrane.

The hormonal component of the IUD is levonorgestrel (gestagen). One system contains 52 mg of this substance. An additional component is polydimethylsiloxane elastomer. The Mirena IUD is inside a tube. The spiral has individual vacuum plastic and paper packaging. It should be stored in a dark place, at a temperature of 15-30 C. Shelf life from the date of manufacture is 3 years.

Effect of Mirena on the body

The Mirena contraceptive system begins to “release” levonorgestrel into the uterus immediately after installation. The hormone enters the cavity at a rate of 20 mcg/day; after 5 years, this figure drops to 10 mcg per day. The spiral has a local effect, levonorgestrel is almost all concentrated in the endometrium. And already in the muscular layer of the uterus the concentration is no more than 1%. The hormone is contained in the blood in microdoses.

After inserting the spiral, the active ingredient enters the bloodstream in about an hour. There its highest concentration is reached after 2 weeks. This indicator can vary significantly depending on the woman’s body weight. With a weight of up to 54 kg, the level of levonorgestrel in the blood is approximately 1.5 times higher. The active substance is almost completely broken down in the liver and evacuated by the intestines and kidneys.

How Mirena works

The contraceptive effect of Mirena does not depend on a weak local foreign body reaction, but is mainly associated with the effect of levonorgestrel. The introduction of a fertilized egg is not carried out due to the suppression of the activity of the uterine epithelium. At the same time, the natural growth of the endometrium is suspended and the functioning of its glands is reduced.

Also, the Mirena coil impedes the motility of sperm in the uterus and its tubes. The contraceptive effect of the drug increases the high viscosity of the cervical mucus and thickening of the mucous layer of the cervical canal, which complicates the penetration of sperm into the uterine cavity.

After installation of the system, a restructuring of the endometrium is observed for several months, manifested by irregular spotting. But after some time, proliferation of the uterine mucosa provokes a significant decrease in the duration and volume of menstrual bleeding, up to its complete cessation.

Indications for use

An IUD is installed primarily to prevent unwanted pregnancy. In addition, the system is used for very heavy menstrual bleeding for an unknown reason. The possibility of malignant neoplasms of the female reproductive system is preliminarily excluded. As a local gestagenic agent, the intrauterine device is used to prevent endometrial hyperplasia, for example, during severe menopause or after bilateral oophorectomy.

Mirena is sometimes used in the treatment of menorrhagia, if there are no hyperplastic processes in the uterine mucosa or extragenital pathologies with severe hypocoagulation (thrombocytopenia, von Willebrand disease).

Contraindications for use

The Mirena spiral is an internal contraceptive; therefore, it cannot be used for inflammatory diseases of the genital organs:

endometritis after childbirth;
inflammation in the pelvis and cervix;
septic abortion performed 3 months before installation of the system;
an infection localized in the lower part of the genitourinary system.

The development of acute inflammatory pathology of the pelvic organs, which is practically untreatable, is an indication for removal of the coil. Therefore, internal contraceptives are not prescribed if there is a predisposition to infectious diseases (constant change of sexual partners, severely decreased immunity, AIDS, etc.). To protect against unwanted pregnancy, Mirena is not suitable for cancer, dysplasia, fibroids of the body and cervix, and changes in their anatomical structure.

Since levonorgestrel is broken down in the liver, the spiral is not installed in case of malignant neoplasm of this organ, as well as in case of cirrhosis and acute hepatitis.

Although the systemic effect of levonorgestrel on the body is insignificant, this progestin substance is still contraindicated in all gestagen-dependent cancers, for example, breast cancer and other conditions. This hormone is also contraindicated for stroke, migraine, severe forms of diabetes, thrombophlebitis, heart attack, and arterial hypertension. These diseases are a relative contraindication. In such a situation, the question of using Mirena is decided by the doctor after laboratory diagnostics. The spiral should not be installed if pregnancy is suspected and hypersensitivity to the components of the drug.

Side effects

Common side effects

There are several side effects of Mirena, which occur in almost every tenth woman who has the IUD installed. These include:

disorders of the central nervous system: short temper, headache, nervousness, bad mood, decreased sexual desire;
weight gain and acne;
gastrointestinal dysfunction: nausea, abdominal pain, vomiting;
vulvovaginitis, pelvic pain, spotting;
chest tension and tenderness;
back pain, as with osteochondrosis.

All of the above signs appear most clearly in the first months of using Mirena. Then their intensity decreases, and, as a rule, unpleasant symptoms disappear without a trace.

Rare side effects

Such side effects occur in one patient out of a thousand. They are also usually expressed only in the first months after the installation of the IUD. If the intensity of manifestations does not decrease over time, the necessary diagnostics are prescribed. Rare complications include bloating, frequent mood swings, itching, swelling, hirsutism, eczema, baldness and rash.

Allergic reactions are very rare side effects. If they develop, it is necessary to exclude another source of urticaria, rash, etc.

Instructions for use

Installation of the Mirena coil

The intrauterine system is packaged in a sterile vacuum bag, which is opened before inserting the IUD. If the system is opened in advance, it must be disposed of.

Only a qualified person can install the Mirena contraceptive. Before this, the doctor must conduct an examination and prescribe the necessary examination:

gynecological and breast examinations;
cervical smear analysis;
mammography;
colposcopy and pelvic examination.

You need to make sure there is no pregnancy, malignant neoplasms or STIs. If inflammatory diseases are detected, they are treated before placing Mirena. You should also determine the size, location and shape of the uterus. The correct position of the spiral ensures a contraceptive effect and protects against system expulsion.

For patients of fertile age, an IUD is inserted in the first days of menstruation. In the absence of contraindications, the system can be installed immediately after an abortion. If the uterus contracts normally after childbirth, Mirena can be used after 6 weeks. You can replace the IUD on any day, regardless of your cycle. To prevent excessive growth of the endometrium, the intrauterine system should be inserted at the end of the menstrual cycle.

Precautionary measures

After installation of the IUD, you need to see a gynecologist in 9-12 weeks. Then you can visit the doctor once a year, more often if complaints arise. So far, there are no clinical data proving a predisposition to the development of varicose veins and thrombosis of the leg veins when using the spiral. But if signs of these diseases appear, you need to consult a doctor.

The effect of levonorgestrel negatively affects glucose tolerance, as a result of which patients with diabetes need to systematically monitor blood glucose levels. If there is a threat of septic endocarditis in women with valvular heart defects, insertion and removal of the system should be performed with the use of antibacterial agents.

Possible side effects are minor

Ectopic pregnancy is extremely rare and requires emergency surgery. This complication can be suspected if symptoms of pregnancy occur (long delay of menstruation, dizziness, nausea, etc.) together with severe pain in the lower abdomen and signs of internal bleeding (severe weakness, pale skin, tachycardia). There is a higher likelihood of developing such a complication after severe inflammatory or infectious pathologies of the pelvis or a history of ectopic pregnancy.
Penetration (ingrowth into the wall) and perforation (perforation) of the uterus usually develop when the IUD is inserted. These complications may be accompanied by lactation, recent childbirth, or unnatural position of the uterus.
Expulsion of the system from the uterus occurs quite often. For its early detection, patients are recommended to check the presence of threads in the vagina after every menstruation. It’s just that, as a rule, it is during menstruation that the probability of the IUD falling out is high. This process goes unnoticed by the woman. Accordingly, when Mirena is expelled, the contraceptive effect ends. To avoid misunderstandings, it is recommended to inspect used tampons and pads for loss. The manifestation of the beginning of the IUD falling out in the middle of the cycle can be bleeding and pain. If incomplete expulsion of the intrauterine hormonal device occurs, the doctor must remove it and install a new one.
Inflammatory and infectious diseases of the pelvic organs usually develop in the first month of using the Mirena system. The risk of complications increases with frequent changes of sexual partners. The indication for removal of the coil in this case is recurrent or severe pathology and the lack of results from the treatment.
Amenorrhea develops in many women while using an IUD. The complication does not occur immediately, but about 6 months after Mirena installation. When you stop menstruating, you must first rule out pregnancy. After removing the IUD, the menstrual cycle is restored.
Approximately 12% of patients develop functional ovarian cysts. Most often, they do not manifest themselves in any way and only occasionally may pain during sex and a feeling of heaviness in the lower abdomen occur. Enlarged follicles usually return to normal within 2-3 months on their own.

Removal of the IUD

The spiral must be removed 5 years after installation. If the patient does not plan pregnancy further, then the manipulation is carried out at the beginning of menstruation. By removing the system in the middle of the cycle, there is a possibility of conception. If desired, you can immediately replace one intrauterine contraceptive with a new one. The day of the cycle does not matter. After removing the product, you need to carefully inspect the system, since if there are difficulties in removing Mirena, the substance may slip into the uterine cavity. Both insertion and removal of the system may be accompanied by bleeding and pain. Sometimes fainting or a seizure occurs in patients with epilepsy.

Pregnancy and Mirena

The IUD has a strong contraceptive effect, but not 100%. If pregnancy nevertheless develops, then first of all it is necessary to exclude its ectopic form. In a normal pregnancy, the IUD is carefully removed or a medical abortion is performed. Not in all cases, it is possible to remove the Mirena system from the uterus, then the likelihood of premature pregnancy increases. It is also necessary to take into account the likely adverse effects of the hormone on the formation of the fetus.

Use during lactation

Levonorgestrel IUD enters the bloodstream in small dosages and can be excreted in milk when breastfeeding. In this case, the hormone content is about 0.1%. Doctors say that at such a concentration it is impossible that such a dose could affect the general condition of the baby.

FAQ

The price of Mirena is quite high, and the use of a contraceptive can cause many side effects. Does the product have any positive effect on the female body?

Mirena is often used to restore the condition of the endometrium after bilateral ovarian removal or during pathological menopause. Also intrauterine device:

increases hemoglobin levels;
prevents endometrial cancer and hyperplasia;
reduces the duration and volume of idiopathic bleeding;
restores iron metabolism in the body;
reduces pain during algomenorrhea;
carries out the prevention of fibroids and endometriosis of the uterus;
has a general strengthening effect.

Is Mirena used to treat fibroids?

The spiral stops the growth of the myomatous node. But additional diagnostics and consultation with a gynecologist are needed. It is necessary to take into account the volume and localization of the nodes, for example, in case of submucosal formations of fibroids that change the shape of the uterus, installation of the Mirena system is contraindicated.

Is Mirena intrauterine drug used for endometriosis?

The IUD is used to prevent endometriosis because it stops the growth of the endometrium. Recently, the results of studies proving the effectiveness of treating the disease were presented. But the system provides only a temporary effect and each case must be considered individually.

Six months after the introduction of Mirena, I developed amenorrhea. Is this how it should be? Will I be able to get pregnant in the future?

The absence of menstruation is a natural reaction to the influence of the hormone. It gradually develops in every 5 patients. Just in case, take a pregnancy test. If it is negative, then there is no need to worry; after removal of the system, menstruation resumes and you can plan a pregnancy.

After installing the Mirena contraceptive, can you experience discharge, pain or uterine bleeding?

Usually these symptoms appear in a mild form, immediately after the introduction of Mirena. Severe bleeding and pain are often indications for IUD removal. The cause may be ectopic pregnancy, improper installation of the system, or expulsion. Contact your gynecologist immediately.

Can the Mirena IUD affect your weight?

Weight gain is one of the side effects of the drug. But you need to take into account that it occurs in 1 woman out of 10 and, as a rule, this effect is short-lived; after a few months it disappears. It all depends on the individual characteristics of the body.

I protected myself from unwanted pregnancy with hormonal pills, but often forgot to take them. How can I change the drug to the Mirena spiral?

Irregular oral hormone intake cannot completely protect against pregnancy, so it is better to switch to intrauterine contraception. Before this, you need to consult a doctor and undergo the necessary tests. It is better to install the system on days 4-6 of the menstrual cycle.

When can I get pregnant after taking off Mirena?

According to statistics, 80% of women become pregnant, if that is what they want, of course, in the first year after removing the IUD. Thanks to its hormonal action, it even slightly increases the level of fertility (fertility).

Where can I buy the Mirena spiral? And what is its price?

The IUD is available only with a prescription and is sold at pharmacies. Its price is determined by the manufacturer, and varies from 9 to 13 thousand rubles.