A Global Learning Agenda for the Levonorgestrel Intrauterine System (LNG IUS): Addressing Challenges and Opportunities to Increase Access

Kate H. Rademacher; Tabitha Sripipatana; Anne Pfitzer; Anna Mackay; Sarah Thurston; Ashley Jackson; Elaine Menotti; Hayley Traeger

doi:10.9745/GHSP-D-18-00383

The LNG IUS is one of the most effective forms of reversible contraception and has important noncontraceptive benefits but is currently not used at scale in any Family Planning 2020 focus country. A global working group developed a shared learning agenda to answer critical questions, harmonize approaches, avoid duplication, and facilitate introduction of the method within the context of informed choice.

BACKGROUND

The levonorgestrel intrauterine system (LNG IUS) is one of the most effective forms of reversible contraception with efficacy rates similar to subdermal implants and copper intrauterine devices (IUDs).¹ The LNG IUS is also associated with a number of important noncontraceptive health benefits, including treatment for menorrhagia (heavy menstrual bleeding) and uterine fibroids and potentially for anemia.²^–⁴ In addition, as a result of the localized release of hormones and relatively low systemic blood levels compared with other hormonal methods, the side effects for the LNG IUS may be less pronounced than side effects with other hormonal contraceptives.⁵^,⁶ (See Box 1 for a summary of the method's advantages.)

BOX 1

Summary of Advantages of the LNG IUS

Highly effective contraceptive method
Long-acting and reversible
Rapid return to fertility after removal
Can lead to reduced menstrual bleeding and cramping
Localized release of hormones and relatively low systemic blood levels compared with other hormonal methods (side effects for the LNG IUS may be less pronounced)
Removal can be easier than implant removals
Noncontraceptive health benefits including treatment of heavy menstrual bleeding and potential reduction in iron-deficiency anemia
May help protect against endometrial and cervical cancer
No further action or supplies required once the LNG IUS is inserted
Can be used immediately postpartum and post-abortion (Note: Manufacturers' labels for LNG IUS products do not currently include an indication for immediate postpartum insertions. However, the World Health Organization's Medical Eligibility Criteria for Contraceptive Use categorizes immediate postpartum …