Hormone Contraception I- Chapter 14 :

Q 14. 1 What types of hormone contraceptives are available?

   Hormones are used in the combined oral contraceptive pill (combination of oestrogens, estrogens, Q2.9 and progestogen  Q2.13), the progestogen-only pill, depot injection (progestogen) and in the relatively new levonorgestrel contraceptive system (Mirena).

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 2 How effective are hormonal contraceptives?

   Hormone contraceptives are highly effective in preventing unwanted pregnancy (Table 13.1).

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 3 How do hormone contraceptives work?

   Hormone contraceptives have three potential modes of action:

1. They cause the cervical mucus to be thick and therefore impenetrable to sperm.
2. The lining of the uterus (endometrium) remains thin and not capable of allowing succ the combined oral contraceptive pill, follicular development and ovulation (egg ressful implantation of an embryo.
3. With the combined oral contraceptive pill, follicular development and ovulation (egg release) are suppressed. The normal menstrual cycle involves a cycle of hormone stimulation and suppression (Q 2.14). The pituitary gonadotrophic hormones (FSH and LH) stimulate follicular development and ovulation and the oestrogen from the follicles prevents pituitary hormone levels from rising (negative feedback). The oestrogen in the combined oral contraceptive pill suppresses FSH and LH so that follicular development and oocyte release are infrequent at most. Progesterone and progestogens result in the cervical mucus being thick. In the normal menstrual cycle, progesterone levels rise only after ovulation. Progestogen is present in each of the hormone contraceptives and this keeps the mucus thick even at the time of ovulation. The endometrium in a normal cycle becomes thickened before ovulation (proliferative phase) in preparation for a possible embryo to become implanted. Progestogen, when present throughout the cycle, prevents adequate proliferation for implantation.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 4 What is a progestogen-only pill?

As the name implies, the progestogen-only pill (sometimes called the mini-pill) only contains progestogen – whereas the combined oral contraceptive pill contains oestrogen and a progestogen.

Table 14.1 Progestogen-only pills.

Preparation

Progestogen (mg)

Manufacturer

Femulen

Ethynodiol diacetate 500

Searle

Micronor

Norethisterone 350

Janssen-Cilag

Noriday

Norethisterone 350

Searle

Microval

Levonorgestrel 30

Wyeth

Norgeston

Levonorgestrel 30

Schering

Neogest

Neogestrel 37.5

Schering

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 5 How do progestogen-only pills provide contraception?

   Progestogen-only pills prevent the mucus changes around the time of ovulation so that sperm cannot get through to the egg thus preventing fertilisation. The lining of the womb (endometrium) is affected so that, even if an egg is fertilised, it is unlikely to be able to implant and develop.

   The combined oral contraceptive pill (COP), with occasional exceptions, prevents egg release (ovulation). It is now recognised that the progestogen-only pill also interferes with ovulation although not as effectively as COPs.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Table 14. 2. A comparison between progestogen-only pills and combined oral contraceptive pills.

Progestogen-only pills (POPs)

Combined pills (COPs)

Alternative when COPs have side-effects (Q15.7)

Alternative when COPs contraindicated (Q16.8)

New low dose pills have fewer side-effects.

Excellent contraception (Table 14.1).

More effective than POPs (Table 14.1).

Very effective when breast feeding.

Not recommended when breast feeding.

Very effective beyond the age of 40 years.

Acceptable up to the menopause (but see Q16.25).

No benefits to cycle control.

Excellent cycle control and reduced bleeds.

Timing of bleeds cannot be adjusted.

Timing of withdrawal bleeds can be adjusted.

Typical oestrogen side-effects less common.

Occasional oestrogen side-effects:- Headaches, nausea, weight changes, reduced libido.

Probably no additional risk of blood clots.

Very low risk of blood clots (Q15.13).

Previous blood clots not a contraindication.

Contraindicated if history of blood clots.

No effect on blood pressure.

Slight increase in blood pressure may occur.

Bleeding between periods not uncommon.

Bleeds between withdrawal bleeds uncommon.

Probably best avoided if history of ectopic pregnancy.

Ectopic pregnancy not a contraindication.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 7 When are POPs recommended in preference to COPs?

• For medical disorders where COPs are only prescribed with caution e.g. for diabetic patients (Q16.7).

• If COPs are contraindicated e.g. history of thromboembolism (Q16.8).

• If several combined pills are associated with side-effects (Q15.7)

• High blood pressure.

• Severe migraine.

• Obesity (see Q14.8)

• Breast feeding.

• Sickle cell disease.

• Cigarette smokers from age 35 years.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 8 How effective are progestogen-only pills?

   This depends on patient compliance and age. The quoted results vary from 0.3 to 4 per hundred women years (Q13.6). The progestogen-only pill is very effective during breast-feeding. Failure rates may be higher if you are overweight; if you are heavier than 11 stones (70KG) it is advisable to take two pills daily.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 9 When should POPs be started and how quickly are they are effective?

The progestogen-only pill can be commenced on the first day of a period and it will then provide immediate protection.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 10 When should progestogen-only pills be taken?

   Progestogen only pills should be taken daily – there are no pill-free intervals. Ideally, the POP should be taken within an hour of the elected time - there is only a three-hour maximum safety margin compared to the 12 hours with combined oral contraceptive pills. Many women find that early evening is the best time for the POP to be taken.

Q 14. 11 What should be done if a POP is missed?

   A pill should be regarded as missed if it is taken more than three hours late. The manufacturers indicate, that if the POP is taken late, additional precautions are required for seven days.

Emergency contraception (Q17.23) may be required

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

It is likely that they will continue as before but there is no consistent pattern. You may experience breakthrough bleeding between the periods initially and there is a chance that your periods may become lighter or occasionally stop.

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

   Provided the rules relating to taking the pill are obeyed pregnancy is unlikely. Pregnancy should be excluded by a pregnancy test. If you think you may be reaching yourmenopause, a hormone test may be helpful (Q26.14). Otherwise, there is no problem from the medical point of view. If you find it disconcerting not to see a period or you keep worrying about pregnancy you may need to consider a different form of contraception.

Q 14. 14 What should be done if vomiting occurs?

If this happens within two hours of taking the pill another should be taken. If another pill is not taken within this time additional precautions are required throughout the illness and for a further seven days.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 15 Should additional precautions be used during a course of antibiotics?

   The only antibiotics that definitely necessitate additional precautions are rifampicin and griseofulvin. If you need to take these drugs long-term, you will require a different method of contraception. No special action is required with other antibiotics.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 16 Can POPs cause ovarian cysts?

   Functional cysts (Q23.8), but not true ovarian cysts, occur more frequently amongst those taking progestogen-only pills. If a woman taking a POP develops pain and a period is late the question of an ectopic pregnancy has to be addressed. At one time laparoscopy (Q 23.20) was required to exclude the diagnosis. For nearly twenty years, we have had b HCG (pregnancy) tests, which are extremely sensitive; if the test is negative, an ectopic can be excluded. Unless there are severe symptoms, functional cysts can be left alone and they will regress over the course of a few weeks.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 17 Should the POP be discontinued before I have an operation?

   There is no reason for the progestogen-only pill to be discontinued. The advice with the progestogen-only pill differs from that with the combined pill (Q16.23).

Q 14. 18 What are long-acting hormonal contraceptives?

The concept of progestogen only oral contraception led on to the development of long-acting contraceptives involving progestogen alone. They have in common a thickening effect on the cervical mucus and the ability to render the endometrium less capable of allowing implantation of an embryo. Disturbance of the menstrual cycle and, in particular, irregular bleeding can be a problem. Long-acting hormonal contraception can be administered by injection, implants, vaginal rings and as part of a special intrauterine contraceptive device (Mirena-Schering).

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 19 What is Depo-Provera?

   This is an injection of the progestogen medroxyprogesterone acetate, which lasts for twelve weeks and can then be repeated. The first injection is usually given in the first four days of a period, or within seven days of a miscarriage or pregnancy termination. After childbirth, Depo-Provera is best delayed for five or six weeks as it could otherwise cause troublesome bleeding.

Q 14. 20 What are the advantages of Depo-Provera?

Depo-Provera provides a highly effective and convenient method of contraception. The failure rate is low (0.5 in 100 woman-years) and is equivalent to the combined oral contraceptive pill. Some women find that their periods are less heavy and less painful. Premenstrual tension may improve.

Depo-Provera does not increase blood pressure.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

There is no need to discontinue Depo-Provera before surgery.

Q 14. 22 What are the disadvantages of Depo-Provera?

• In common with other progestogen only contraception, there may be irregular bleeding.

• Occasionally periods may be absent.

• Weight gain of up to 2Kg (4lbs) can occur.

• It may take several months for the menstrual cycle to return to normal when injections are discontinued.

• It is possible that if used long term there may be reduced oestrogen levels perhaps leading to reduced bone density and less protection for the heart. If periods are absent and oestrogen levels are found to be low, it is acceptable to provide HRT thus providing contraception and adequate oestrogen levels.

When used for a year or so the benefits seem to outweigh the disadvantage of menstrual disturbance.

References:

Magnitude and variability of sequential estradiol and progesterone concentrations in women using depot medroxyprogesterone acetate for contraception (2001-3357)

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

   It can take up to a year for fertility to be restored following Depo-Provera and this should be kept in mind when planning a pregnancy. This does not mean that you can take a chance after three months: if you do not want a baby, contraception will be required.

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

   No. Depo-Provera reduces the risk of endometrial cancer and there is no increase in the risk of breast cancer.

Q 14. 25  What are contraceptive implants?

       There have been a variety of silicon implants that slowly release progestogen to provide contraception. Until recently, the most popular contained levonorgestrel (Norplant). Norplant was introduced as six rods, which were placed under the skin in the arm and could be left there for five years. Pregnancy rates are low (0.3 per 100 woman years – Table 13.1). When the implants are removed, their effects disappear rapidly. Norplant was discontinued in 1999.

Currently Implanon is the only available contraceptive implant available in the UK. It has the progestogenic effect of thickening the cervical mucus and keeping the endometrium thin but it also reduces ovulation. Implanon is a single 40mm  long and 2mm diameter rod that is easily introduced under the skin of the upper arm. It will function for three years and initial trials have shown no failures. It may stop periods in 20% of users and infrequent spotting may occur in 26%.

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

A levonorgestrel (LNG) IUS is similar in shape and size to some intra-uterine contraceptive devices (Figure 14.1; IUCDs – “Coils” – Q 17.1) that have been used in family planning for many years. A LNG-IUS slowly releases the hormone ‘levonorgestrel’ locally within the uterine cavity.

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IUS

Q 14. 27 How does the LNG-IUS work?

Although the LNG-IUS is physically similar to other IUCDs, its main mode of action is similar to progestogen-only pills. The mucus in the neck of the womb remains thick and hostile to sperm throughout the menstrual cycle; this thick mucus prevents sperm reaching the eggs and fertilisation is therefore unlikely to occur. Furthermore, the lining of the uterus remains thin so that even if an egg should be fertilised, a pregnancy cannot be supported. For some, the question of how the IUCD prevents pregnancy is critical. As IUCDs are effective partly after fertilisation, they may not be acceptable in some cultures. The Mirena functions almost entirely to prevent fertilisation.

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

The LNG-IUS is associated with only 0.2 pregnancies/100 woman years (Table 13.1). This is less than combined pills, progesterone only pills, other IUDs, and even female sterilisation (0.4).

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

When the LNG-IUS is removed from your uterus, fertility will be restored immediately.

Q 14. 30 How long has the LNG-IUS been in use?

It had been available for routine clinical use in Scandinavia for five years before it was licensed in the UK in May 1995.

Q 14. 31 How is the LNG-IUS introduced into the uterus?

Like other intrauterine devices, LNG-IUS is best introduced at the end of or just after a period. It has a slightly larger diameter (5mm) than most other devices so the neck of the womb may have to be stretched a little (dilated). This can usually be accomplished with a local anaesthetic injection. If there is an indication to perform a D & C operation (heavy periods, for example), the LNG-IUS can be introduced under the same anaesthetic.

Q 14. 32 How quickly will a LNG-IUS work?

Provided the LNG-IUS is introduced at the correct time, it is effective immediately. It can be introduced at any time if you are currently taking the pill. Generally, we recommend waiting until the first check, which is usually scheduled about six weeks after fitting.

Q 14. 33 What problems can occur with the LNG-IUS?

There may be initial spotting for the first two or three months after insertion. Pregnancy rates are very low. As with other intrauterine devices, a LNG-IUS could be expelled from the womb – it should be checked about six weeks after insertion. Very rarely, the device can go through the uterus (perforation).

Q 14. 34 How frequently should my LNG-IUS be changed?

The LNG-IUS is licensed for five years in the UK.

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Blood loss diminishes quite markedly with LNG-IUS and this will be a bonus for you if your periods are heavy and painful. You may, however, experience a tendency for spotting through the first two or three months after introduction. A panty liner will usually suffice. The spotting will almost always settle down. Some women stop seeing their periods altogether although the cycle will return once the device is removed. From a medical point of view there is no anxiety if your periods are absent if you have a LNG-IUS. It is a natural phenomenon before puberty, during pregnancy and breast-feeding and after the menopause. Periods are not required by the body to get rid of waste material.

Q 14. 36 What value is LNG-IUS in the management of period problems?

Although licensed for family planning, LNG-IUS has been demonstrated to significantly reduce menstrual blood loss. Dysmenorrhoea (pain with periods – Q23.3) generally improves. This can be used for treatment of period problems even if contraception is not required.

References:

The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: A systematic review (2001-3284)

Open randomised study of use of levonorgestrel releasing intrauterine system as alternative to hysterectomy (1998-3128)

The levonorgestrel intrauterine system in the management of menorrhagia (1997-1748)

Levonorgestrel intrauterine device in the treatment of menorrhagia in Chinese women: Efficacy versus acceptability (1995-927)

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Premenstrual syndrome is a common problem although for the majority of women the symptoms are only mild (Q25.1). Some women, however, have more major and sometimes debilitating difficulties. oestrogens, estrogens, often given as a small implant introduced under the skin with local anaesthetic, can alleviate symptoms but if the uterus is present progestogens must also be given to prevent the lining of the womb becoming too thick. Until recently, the progestogens had to be administered as tablets taken cyclically for about 12 days each month ( to produce a withdrawal bleed and this could reproduce PMS type problems. If a LNG-IUS is introduced, there will be no cyclical thickening of the lining of the womb and no cyclical progestogen tablets are required.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 38 What value is LNG-IUS with Hormone Replacement Therapy?

If the womb is present, oestrogen replacement therapy must be accompanied by progestogens. LNG-IUS can be used as the progestogen (Q27.19).

References:

Intrauterine release of levonorgestrel – A new way of adding progestogen in hormone replacement therapy (1992-600)

Q 14. 39 Where can I obtain further information about contraception?

Some your useful sources of further information can be found at Q13.27.

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page

Q 14. 40 Could I have some Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter:-

Q 14. 1 What types of hormone contraceptives are available?

Q 14. 2 How effective are hormonal contraceptives?

Q 14. 3 How do hormone contraceptives work?

Progestogen-only pills

Q 14. 4 What is a progestogen-only pill?

Q 14. 5 How do progestogen-only pills provide contraception?

Q 14. 6 How does the progestogen-only pill compare to the combined oral contraceptive pill?

Q 14. 7 When are POPs recommended in preference to COPs?

Q 14. 8 How effective are progestogen-only pills?

Q 14. 9 When should POPs be started and how quickly are they are effective?

Q 14. 10 When should progestogen-only pills be taken?

Q 14. 11 What should be done if a POP is missed?

Q 14. 12 What will happen to my periods whilst I am taking progestogen-only pills?

Q 14. 13 What should be done if my periods stop when I am taking the progestogen-only pill?

Q 14. 14 What should be done if vomiting occurs?

Q 14. 15 Should additional precautions be used during a course of antibiotics?

Q 14. 16 Can POPs cause ovarian cysts?

Q 14. 17 Should the POP be discontinued before I have an operation?

Long-acting hormonal contraception.

Q 14. 18 What are long-acting hormonal contraceptives?

Q 14. 19 What is Depo-Provera?

Q 14. 20 What are the advantages of Depo-Provera?

Q 14. 21 I have recently had a Depo-Provera injection and now I need to have an operation. Will the operation be delayed?

Q 14. 22 What are the disadvantages of Depo-Provera?

Q 14. 23 Will my fertility return three months after my last Depo-Provera injection?

Q 14. 24 Do long-acting hormonal contraceptives increase the risk of cancer?

Q 14. 25 What are contraceptive implants?

LEVONORGESTREL INTRAUTERINE SYSTEM – LNG-IUS – MIRENA

Q 14. 26 What is the Levonorgestrel Intrauterine System (LNG-IUS -Mirena)?

Q 14. 27 How does the LNG–IUS work?

Q 14. 28 How effective is the LNG-IUS as a method of family planning?

Q 14. 29 How would a LNG-IUS effect my long-term fertility?

Q 14. 30 How long has the LNG-IUS been in use?

Q 14. 31 How is the LNG-IUS introduced into the womb?

Q 14. 32 How quickly will a LNG-IUS work?

Q 14. 33 What problems can occur with the LNG-IUS?

Q 14. 34 How frequently should my LNG-IUS be changed?

Q 14. 35 What will happen to my periods after a LNG-IUS is introduced?

Q 14. 36 What value is LNG-IUS in the management of period problems?

Q 14. 37 What value is LNG-IUS for premenstrual syndrome?

Q 14. 38 What value is LNG-IUS in Hormone Replacement Therapy?

Q 14. 39 Where can I obtain further information about contraception?

Q 14. 40 Could I have some Web sites?

Women’s Health – Home Page