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Advances in Contraception

, Volume 11, Issue 2, pp 85–95 | Cite as

Ovarian function after seven years' use of a levonorgestrel IUD

  • I. Barbosa
  • S. -E. Olsson
  • V. Odlind
  • T. Goncalves
  • E. Coutinho
Article

Abstract

Fifteen women with regular menstrual periods and seven amenorrheic women who had been using a levonorgestrel-releasing (LNg) IUD for more than seven years were studied. For controls, eight women using TCu380Ag IUDs, for more than seven years were studied during two complete menstrual cycles. Ovarian function was assessed with hormonal determination and ultrasound examinations. The regularly menstruating women were studied for two complete menstrual cycles and the amenorrheic women for eight weeks.

In the regularly menstruating LNg-IUD users, according to progesterone levels, 93% of the cycles were ovulatory but just 58% of these ‘ovulatory’ cycles showed normal follicular growth and rupture. Follicular cysts and luteinization of regressing follicles were observed in 42% of the 26 ‘ovulatory’ cycles studied.

SHBG capacity was decreased in the LNg-IUD users compared with the TCu380Ag users. Progesterone levels were lower in the LNg-IUD users compared with the TCu380Ag users but this difference was not statistically significant. Preovulatory estradiol and LH levels were lower in the LNg-IUD users than in the TCu380Ag users. These differences were not statistically significant.

For the amenorrheic women, five had follicular cysts that disappeared spontaneously within 45 days. Two women showed follicular development and rupture.

The presence of good cervical mucus was observed in 69% of the ovulatory cycles studied in the LNg-IUD users. This indicates that effects on cervical mucus cannot be the main mechanism of action of the LNg-IUDs.

It is concluded that LNg-IUDs may exert a contraceptive effect in many different ways, such as inhibition of ovulation, endometrial changes preventing implantation, alteration of physical and chemical properties of cervical mucus affecting sperm transport and subtle disturbances in hypothalamic pituitary ovarian function, resulting in alterations of follicular development and rupture.

Keywords

Estradiol Ovarian Function Progesterone Level Levonorgestrel Follicular Development 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Resumé

Cette étude a porté sur 15 femmes présentant des cycles menstruels réguliers et 7 femmes aménorrhéiques qui utilisaient depuis plus de sept ans des DIU libérant du lévonorgestrel (DIU-LNg). Comme témoins, on a étudié pendant deux cycles menstruels complets 8 femmes qui portaient, un dispositif TCu380Ag depuis plus de sept ans. La fonction ovarienne a été relevée par évaluation hormonale et par des examens aux ultrasons. Celles dont les menstruations étaient régulières ont été étudiées pendant deux cycles complets et les femmes aménorrhéiques pendant 8 semaines.

D'après les niveaux de progestérone, chez les utilisatrices de DIU-LNg ayant des menstruations régulières, 93% des cycles étaient ovulatoires mais seulement 58% de ces cycles ‘ovulatoire’ présentaient une croissance folliculaire normale avec rupture. Des kystes folliculaires et la lutéinisation des follicules en régression ont été observés dans 42% des 26 cycles ‘ovulatoires’.

L'importance des SHBG était diminuée chez les utilisatrices du DIU-LNg comparée à celle des utilisatrices du TCu380Ag. les niveaux de progestérone étaient plus faibles chez les premières que chez les secondes mais la différence n'était pas statistiquement significative. Les niveaux préovulatoires d'oestradiol et d'hormone lutéinisante étaient inférieurs dans le groupe LNg, sans que la dífférence ne soit statistiquement significative.

En ce qui concerne les femmes aménorrhéiques, 5 présentaient des kystes folliculaires qui disparaissaient spontanément en 45 jours. Chez deux patientes, on a observé le développement et la rupture des follicules.

Dans 69% des cycles ovulatoires étudiés chez les utilisatrices du DIU-LNg, la présence de mucus cervical était bonne, ce qui laisse penser que les effets sur le mucus cervical ne peuvent être le principal mode d'action de ces dispositifs.

Il en est conclu que les DIU-LNg exercent sans doute un effet contraceptif de nombreuses manières, telles que l'inhibition de l'ovulation, des modifications de l'endomètre empêchant l'implantation, l'altération des propriétés physiques et chimiques du mucus cervical qui a une incidence sur le transport du sperme, et de légères perturbations de la fonction ovarienne hypothalamo-pituitaire, qui entraîne des modifications dans le développement et la rupture des follicules.

Resumen

Se estudiaron quince mujeres con períodos menstruales regulares y siete mujeres amenorreicas que habían estado utilizando un DIU de descarga de levonorgestrel durante más de siete años. Como controles, se estudiaron a 8 mujeres que utilizaban DIU TCu380Ag desde hacía más de siete años durante dos ciclos menstruales completos. Se evaluó la función ovárica mediante determinación hormonal y exámenes de ultrasonido. Las mujeres que menstruaban regularmente fueron estudiadas durante dos ciclos menstruales completos y las mujeres amenorreicas durante 8 semanas.

Según los niveles de progesterona, en las usuarias de DIU con LNg que menstruaban regularmente el 93% de los ciclos eran ovulatorios pero sólo el 58% de estos ciclos ‘ovulatorios’ señalaban un crecimiento y ruptura folicular normal. Se observaron quistes foliculares y luteinización de los folículos regresivos en el 42% de los 26 ciclos ‘ovulatorios’ estudiados.

La capacidad SHBG se había reducido en las usuarias de DIU con LNg en comparación con las usuarias de TCu380Ag. Los niveles de progesterona eran inferiores en las usuarias de DIU con LNg que en las usuarias de TCu380Ag pero esta diferencia no era estadísticamente significativa. Los niveles preovulatorios de estradiol y LH eran inferiores en las usuarias de DIU con LNg que en las usuarias de TCu380Ag. Estas diferencias no eran estadísticamente significativas. Entre las mujeres amenorreicas, 5, tenían quistes foliculares que desaparecieron espontáneamente, dentro de los 45 días. Dos mujeres señalaron desarrollo y ruptura folicular.

La presencia de buen moco cervical se observó en el 69% de los ciclos ovulatorios estudiados entre las usuarias de DIU con LNg. Esto indica que los efectos sobre el moco cervical no pueden ser el principal mecanismo de acción de los DIU con LNg.

Se llega a la conclusión de que los DIU con LNg pueden ejercer un efecto anticonceptivo de muchos modos diferentes, tales como la inhibición de la ovulación, cambios del endometrio que impiden la implantación, alteración de las propiedades fisicoquímicas del moco cervical que afectan el transporte de esperma y perturbaciones sutiles de la función ovárica pituitaria hipotalámica que originan alteraciones del desarrollo y la ruptura folicular.

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References

  1. 1.
    Nilsson CG, Allonen H, Diaz H, Luukkainen T. Two years experience with two levonorgestrel-releasing uterine devices and one copper-releasing intrauterine device. Fertil Steril. 1983;39:187.PubMedGoogle Scholar
  2. 2.
    Nilsson CG, Luukkainen T, Diaz H, Allonen H. Intrauterine contraception with levonorgestrel: a comparative randomized clinical performance study. Lancet. 1981;1:557.Google Scholar
  3. 3.
    Luukkainen T, Allonen H, Haukkamaa M, Lähteenmäki P, Nilsson CG, Toivonen J. Five years' experience with levonorgestrel releasing IUDs. Contraception. 1986;33:139–48.CrossRefPubMedGoogle Scholar
  4. 4.
    Nilsson CG. Comparative quantitation of menstrual blood loss with a d-norgestrel-releasing IUD and Nova T Copper device. Contraception. 1977;15:379.CrossRefPubMedGoogle Scholar
  5. 5.
    Nilsson CG, Lähteenmäki P, Robertson D, Luukkainen T. Plasma concentration of levonorgestrel as a function of the release rate of levonorgestrel from medicated intrauterine devices. Acta Endocrinol (Copenh.) 1980;93:380.Google Scholar
  6. 6.
    Nilsson CG, Lähteenmäki P, Luukkainen T. Ovarian function in amenorrhoeic and menstruating users of levonorgestrel-releasing intrauterine devices. Fertil Steril. 1984;41:52.PubMedGoogle Scholar
  7. 7.
    Kurumäki H, Toivonen J, Lähteenmäki PA, Luukkainen T. Pituitary and ovarian function and clinical performance during the use of a levonorgestrel-releasing intracervical contraceptive device. Contraception. 1984;29:31–43.CrossRefPubMedGoogle Scholar
  8. 8.
    Barbosa IC, Oddvar B, Olsson SE, Odling V, Johansson E. Ovarian function during use of levonorgestrel-releasing IUD. Contraception. 1990;42:51.PubMedGoogle Scholar
  9. 9.
    Weiner E, Johansson EDB. Plasma levels of d-norgestrel, estradiol and progesterone during treatment with silastic implants containing d-norgestrel. Contraception. 1976;14:81.PubMedGoogle Scholar
  10. 10.
    Hackelöer BJ, Fleming R, Robinson HP, Adam AH, Coutts JRT. Correlation of ultrasonic and, endocrinologic assessment of human follicular development. Am J Obstet Gynecol. 1979;135:122.PubMedGoogle Scholar
  11. 11.
    Belsey M. Laboratory manual for examination of human semen and semen-cervical mucus interaction. WHO, Geneva, Press Concern Singapore, 1980.Google Scholar
  12. 12.
    Landgren BM, Diczfaluzy E. Hormonal effects of the 300 mcg norethisterone (NET) minipill. 1. Daily steroid levels in 43 subjects during a pretreatment cycle and during the second month of NET administration. Contraception. 1980;21:87–113.PubMedGoogle Scholar
  13. 13.
    Olsson SE. Contraception with subdermal implant releasing levonorgestrel. A clinical and pharmacological study. Acta Obstet Gynecol Scand. 1987; (supplement 142).Google Scholar
  14. 14.
    Olsson SE, Bakos O, Lindgren PG, Odling V, Wide L. Ovarian function during use of subdermal implants releasing low doses of levonorgestrel. Br J Fam Plann. 1990;16:88–93.Google Scholar
  15. 15.
    Tayob Y, Adams J, Jacob HS, Guillebaud J. Ultrasound demonstration of increased frequency of functional ovarian cysts in women using progestogen-only oral contraception. Br J Obstet Gynaecol. 1985;92:1003.PubMedGoogle Scholar
  16. 16.
    Robinson GE, Bounds W, Kubba AA, Adams J, Guillebaud J. Functional ovarian cysts associated with levonorgestrel-releasing intrauterine device. Br J Fam Plann. 1989;14:131.Google Scholar
  17. 17.
    Liukkonen S, Koskimies AI, Tenhunen A, Ylostale P. Diagnosis of luteinized unruptured follicle (LUD) syndrome by ultrasound. Fertil Steril. 1984;41:26.PubMedGoogle Scholar
  18. 18.
    Daly DC, Soto-Albors C, Walters C, Ying Y, Ridding DH. Ultrasonographic assessment of luteinized unruptured follicle syndrome in unexplained infertility. Fertil Steril. 1985;43:62.PubMedGoogle Scholar
  19. 19.
    Daly DC. Treatment validation of ultrasound-defined abnormal follicular dynamics as a cause of infertility. Fertil Steril. 1979;51:51.Google Scholar
  20. 20.
    Ying Y, Daly DC, Randolph JF, Soto-Albors CE, Maier D, Schmidt CL, Ridding DH. Ultrasonographic monitoring of follicular growth for luteal phase defects. Fertil Steril. 1987;48:433.PubMedGoogle Scholar
  21. 21.
    Daly DC, Reuter S, Mastroianni J. Follicle size by ultrasound versus cervical mucus quality: normal and abnormal patterns in spontaneous cycles. Fertil Steril. 1989;51:598.PubMedGoogle Scholar
  22. 22.
    Geistövel F, Skubsch U, Zabel G, Schillinger H, Breckwoldt M. Ultrasonographic and hormonal studies in physiologic and insufficient menstrual cycles. Fertil Steril. 1983;39:277.PubMedGoogle Scholar
  23. 23.
    Brache V, Faundes A, Johansson EDB, Alvarez F. Anovulation inadequate luteal phase and poor sperm penetration in cervical mucus during prolonged use of Norplant implants. Contraception. 1985;31:261.PubMedGoogle Scholar
  24. 24.
    Alvarez F, Brache V, Tejada A, Faundes A. Abnormal endocrine profile among women with confirmed or presumed ovulation during longterm Norplant use. Contraception. 1986;33:114.CrossRefGoogle Scholar
  25. 25.
    Croxatto HD, Diaz S, Pavez M, Croxatto HB. Histopathology of the endometrium during continuous use of levonorgestrel. In: Zatuchni GI, Goldsmith A, Shelton JD, Sciarra JJ, eds. Long-acting contraceptive delivery systems. Philadelphia: Harper & Row. 1984:290.Google Scholar
  26. 26.
    Martinez-Manatou J, Azaur R. Endometrial morphology in women exposed to uterine systems releasing progesterone. Am J Obstet Gynecol. 1975;125:175.Google Scholar

Copyright information

© Kluwer Academic Publishers 1995

Authors and Affiliations

  • I. Barbosa
    • 1
    • 2
  • S. -E. Olsson
    • 1
    • 2
  • V. Odlind
    • 1
    • 2
  • T. Goncalves
    • 1
    • 2
  • E. Coutinho
    • 1
    • 2
  1. 1.Department of Human ReproductionFederal University of BahiaSalvador, BahiaBrazil
  2. 2.Department of Obstetrics and GynecologyUppsala UniversityUppsalaSweden

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