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Indications
Indications
Comprehensive information on the indications for treatment with Mirena.
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Placement & removal
Placement & removal
Reference guide to the placement and removal of Mirena, and follow up visits with patients.
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Counselling
Counselling
Addressing common topics when counseling patients with Mirena.
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Talk to your peers
Resources

Efficacy and safety of Mirena in preventing endometrial hyperplasia

The efficacy of Mirena in preventing estrogen-induced hyperplasia in peri- and post-menopausal women has been compared in numerous studies. No hyperplasia was detected in any of the trials, regardless of the dose or the method of administration of the estrogen component or the duration of therapy^{1,2,3,4,5,6,7}. Furthermore, amenorrhea rates with Mirena are comparable to those reported for oral continuous combined HRT^{8,9,10,11,12,13,14,15}.

Figure 13: Bleeding profile with Mirena-based HRT regimen compared with continuous combined HRT with oral medroxyprogesterone¹⁴.

The success of Mirena in providing endometrial protection is reflected in the fact that it has a continuation rate of 80% at 5 years^1,16.

Endometrial protection

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Endometrial protection

References

Varila E, Wahlstrom T, & Rauramo I. (2001). A 5-year follow-up study on the use of a levonorgestrel intrauterine system in women receiving hormone replacement therapy. Fertil Steril 76, 969-973.
Suvanto-Luukkonen E, Malinen H, Sundström H, et al. Endometrial morphology during hormone replacement therapy with estradiol gel combined to levonorgestrel-releasing intrauterine device or natural progesterone. Acta Obstet Gynecol Scand 1998;77:758–63
Suvanto-Luukkonen E, Sundström H, Penttinen J, et al. Insulin-like growth factor-binding protein-1: a biochemical marker of endometrial response to progestin during hormone replacement therapy. Maturitas 1995;22:255–62
Suhonen SP, Holmström T, Allonen HO, et al. Intrauterine and subdermal progestin administration in postmenopausal hormone replacement therapy. Fertil Steril 1995;63:336–42
Suhonen S, Haukkamaa M, Holmström T, et al. Endometrial response to hormone replacement therapy as assessed by expression of insulin-like growth factor-binding protein-1 in the endometrium. Fertil Steril 1996;65:776–82
Raudaskoski T, Tapanainen J, Tomas E, et al. Intrauterine 10 microg and 20 microg levonorgestrel systems in postmenopausal women receiving oral oestrogen replacement therapy: clinical, endometrial and metabolic response. BJOG 2002;109:136–44
Kalogirou D, Antoniou G, Karakitsos P, et al. A comparative study of the effects of an estradiol-releasing vaginal ring combined with an oral gestagen versus transdermal estrogen combined with a levonorgestrel-releasing IUD: clinical findings and endometrial response. Int J Fertil Menopausal Stud 1996;41:522–7
Staland B. (1981). Continuous treatment with natural oestrogens and progestogens. A method to avoid endometrial stimulation. Maturitas 3, 145-156.
Mattsson LA, Cullberg G, & Samsioe G. (1982). Evaluation of a continuous oestrogen-progestogen regimen for climacteric complaints. Maturitas 4, 95-102.
Magos AL, Brincat M, Studd JW et al (1985). Amenorrhea and endometrial atrophy with continuous oral estrogen and progestogen therapy in postmenopausal women. Obstet Gynecol 65, 496-499.
Sporrong T, Hellgren M, Samsioe G et al (1988). Comparison of four continuously administered progestogen plus oestradiol combinations for climacteric complaints. Br J Obstet Gynaecol 95, 1042-1048.
Weinstein L, Bewtra C, & Gallagher JC. (1990). Evaluation of a continuous combined low-dose regimen of estrogen-progestin for treatment of the menopausal patient. Am J Obstet Gynecol 162, 1534-1539; discussion 1539-1542.
Udoff L, Langenberg P, & Adashi EY. (1995). Combined continuous hormone replacement therapy: a critical review. Obstet Gynecol 86, 306-316.
Raudaskoski TH, Lahti EI, Kauppila AJ et al (1995). Transdermal estrogen with a levonorgestrel-releasing intrauterine device for climacteric complaints: clinical and endometrial responses. Am J Obstet Gynecol 172, 114-119.
Ettinger B, Li DK, & Klein R. (1998). Unexpected vaginal bleeding and associated gynecologic care in postmenopausal women using hormone replacement therapy: comparison of cyclic versus continuous combined schedules. Fertil Steril 69, 865-869.
Hampton NR, Rees MC, Lowe DG et al (2005). Levonorgestrel intrauterine system (LNG-IUS) with conjugated oral equine estrogen: a successful regimen for HRT in perimenopausal women. Hum Reprod 20, 2653-2660.

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Mirena® placement

Efficacy and safety of Mirena in preventing endometrial hyperplasia