Use of the Levonorgestrel Intrauterine Device for Noncontraceptive Indications

Abstract

after copper was found to have spermicidal effects. The levonorgestrel IUD (LNG-IUD) was developed in the 1970s after research by Dr. Antonio Scommegna demonstrated intrauterine progesterone could induce endometrial atrophy. This concept was used by Dr. Jouni Valter Tapani Luukkainen to develop Progestasert, the first hormonecontaining IUD, marketed in 1976, which was effective for 1 year. Progestasert resembled modern-day IUDs; it was T-shaped and made with polydimethylsiloxane (PDMS) coated with progesterone to allow for slow/controlled release of hormone. The natural hormone progesterone was later replaced with levonorgestrel (LNG), a synthetic progestin with more potent progesterone receptor (PR) agonistic effects that lasted for 5 years. This device is now known as Mirena (LNG-20).1 At the time of writing, there are 4 types of LNG-IUDs currently available in the United States: Mirena (LNG-20) and Liletta (LNG-18.6) both containing 52 mg of LNG and releasing 20 and 18.6 μg of LNG per day, respectively, Kyleena (LNG-19.5) containing 19.5 mg of LNG and releasing 17.5 μg Before the 20th century, there were no clear data with regard to use of intrauterine devices (IUDs) for contraception or for other indications in humans. Dr. Richard Richter from Germany first documented the use of silk worm gut rings in the uterus to prevent pregnancy in 1909. After this, Dr. Ernst Grafenberg developed the “silver ring,” a spiral wound circular nonhormonal IUD made of silk suture and wrapped in silver wire in 1928. Development of the contraceptive copper IUD in the 1960s occurred Use of the Levonorgestrel Intrauterine Device for Noncontraceptive Indications