IUD with progestogen

The IUS is a progestin -releasing intrauterine device (IUD ), which is inserted into the woman's uterus to prevent conception. Add delimitation of the hormone-free intrauterine contraceptive devices ( coils), the hormone-containing spiral is also called intrauterine system ( IUS ).

Areas of application

The first IUS is approved in Germany since 1996 for contraception and for the treatment of heavy menstrual bleeding. Since 2013 Europe is another smaller system approved with slightly lower progestin tax, which is however only permitted for contraception. An IUD can also serve to protect against excessive structure of the endometrium during estrogen replacement therapy in menopause.

Also known are a reduction of menstrual cramps and a potential benefit in the treatment of endometriosis.

Operation

The IUS consists of a 3 cm long T-shaped plastic body of the uterus releases the progestin levonorgestrel after the insert.

The T-shape of the plastic body allows adaptation to the shape of the uterus. The active substance is contained in a cylindrical reservoir at the vertical part of the plastic body and is in constant, very small amount (20 or 14 micrograms in 24 h ) delivered to the body. At the lower end of the IUD is an eyelet on the control strings are attached, which can sense the patient herself. Both of the plastic body with its specific T-shape and the hormone levonorgestrel prevent pregnancy, and in the following manner:

• The cervical mucus is thickened by levonorgestrel and thus impermeable to sperm.
• The motility of sperm that pass through the cervix but is inhibited.
• Through local action of the IUD on the endometrium, the conditions for the implantation of the fertilized ovum difficult.
• Egg maturation and ovulation can be influenced and suppressed in a portion of women.
• The structure of the endometrium is reduced, consequently, the menstrual blood flow.

The IUD is inserted by a doctor, the cost is about 280 to 350 euros. The costs are covered by the relevant welfare agency for statutory health insured women in Germany according to § 24a SGB V until the age of 20 by the health insurance and social assistance for eligible women according to § 49 SGB XII. If the IUD exclusively prescribed to treat heavy menstrual bleeding, the costs in Switzerland, where appropriate, covered by health insurance in Germany not.

Adverse effects

Possible complications of IUD are ejections ( expulsions ) in the first two months of application (6-7 %), slippage of the spiral ( whereby the contraceptive protection may be reduced ) and a violation of the uterus, especially during insertion of the IUD. The risk of injury may be increased in the spiral insert after birth in breast-feeding women and in malpositions of the uterus. Furthermore, it can cause side effects such as headaches, increased menstrual pain, decreased libido, tingling sensation in the breasts, acne, irregular menstrual cycles, weight gain, water retention in the tissues, upsets and depression.

Commercial preparations

Mirena (D, A, CH), Jaydess (Europe), Skyla ( USA); FibroPlant (variant without a T -shaped plastic frame )

In Germany, revenues of the first IUS in 2009 at 101 million euros.