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Ovarian function during use of a levonorgestrel-releasing IUD

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      Abstract

      Ovarian function was studied for two complete menstrual cycles in 9 regularly menstruating women and for 8 weeks in three amenorrhoeic women who had used levonorgestrel-releasing IUDs (LNG-IUD) for more than four years. Nine patients using copper IUDs (Nova-T) were studied for two complete menstrual cycles as controls. According to progesterone levels, Math Eq cycles in women using LNG-IUDs were ovulatory, whereas only Math Eq cycles showed normal follicular growth and rupture as judged by ultrasound. In ovulatory cycles, the peak progesterone levels were lower than in the controls. The preovulatory estradiol and LH peak levels were also lower than in control subjects. SHBG levels were lower in LNG-IUD users than in copper IUD users.
      It is concluded that, although the dose of levonorgestrel released from the IUD is very low, it probably exerts an effect on the gonadotrophin secretion, which disturbs follicular development in many of the women studied, which in addition to the local effect on the endometrium, contributes to its high contraceptive efficacy.
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      References

        • Nilsson C-G.
        • Allonen H.
        • Diaz H.
        • Luukkainen T.
        Two years experience with two levonorgestrel-releasing uterine devices and one copper-releasing intrauterine device.
        Fertil. Steril. 1983; 39: 187
        • Nilsson C-G.
        • Luukkainen T.
        • Diaz H.
        • Allonen H.
        Intrauterine contraception with levonorgestrel: A comparative randomized clinical performance study.
        Lancet. 1981; 1: 557
        • Sivin I.
        • Alvarez F.
        • Diaz J.
        • Diaz S.
        • Mahgoub S.
        • Coutinho E.M.
        • Brache V
        • Diaz M.
        • Faundes A.
        • Pavez M.
        • Mattos C.
        • Stern J.
        Intrauterine contraception with copper and with levonorgestrel. A randomized study of the TCu 380 Ag and levonorgestrel 20 mcg/day devices.
        Contraception. 1984; 30: 443
        • Nilsson C-G.
        • Lähteenmaki P.
        • Luukkainen T.
        Ovarian function in amenorrhoeic and menstruating users of a levonorgestrel-releasing intrauterine device.
        Fertil. Steril. 1984; 41: 52
        • Ratsula K.
        • Toivonen J.
        • Lähteenmaki P.
        • Luukkainen T.
        Plasma levonorgestrel levels and ovarian function during use of a levonorgestrel-releasing intracervical contraceptive device.
        Contraception. 1989; 39: 195
        • Nilsson C-G.
        Comparative quantitation of menstrual blood loss with a d-norgestrel-releasing IUD and Nova T copper device.
        Contraception. 1977; 15: 379
        • Nilsson C-G.
        • Lähteenmäki P.
        • Robertson D.
        • Luukkainen T.
        Plasma concentration of levonorgestrel as a function of the release rate of levonorgestrel from medicated intrauterine devices.
        Acta Endocrinol. (Copenh.). 1980; 93: 380
        • Weiner E.
        • Johansson E.D.B.
        Plasma levels of d-norgestrel, estradiol and progesterone during treatment with Silastic implants containing d-norgestrel.
        Contraception. 1976; 14: 81
        • Rosner W.
        A simplified method for the quantitative determination of testosterone-oestradiol binding globulin activity in human plasma.
        J. Clin. Endocrinol. Metab. 1972; 34: 983
        • Odlind V.
        • Elamsson K.
        • Englund D.
        • Victor A
        • Johansson E.D.B.
        Effects of estradiol on sex hormone binding globulin.
        Acta Endocrinol. 1982; 101: 248
        • Edqvist L-E.
        • Johansson E.D.B.
        Radioimmunoassay of oestrone and oestradiol in human and bovine peripheral plasma.
        Acta Endocrinol. (Copenh). 1972; 71: 716
        • Lindberg B-S.
        • Lindberg P.
        • Martinsson K.
        • Johansson E.D.B.
        Radioimmunological methods for the estimation of oestrone, oestradiol 17-beta and oestriol in pregnancy plasma.
        Acta Obstet. Gynecol. Scan. Suppl. 1974; 32: 5
        • Thorneycroft I.H.
        • Stone S.C.
        Radioimmunoassay of serum progesterone on women receiving oral contraceptive steroids.
        Contraception. 1972; 5: 129
        • Bosu W.T.K.
        • Edqvist L-R
        • Lindberg P.
        • Martinsson F.
        • Johansson E.D.B.
        The effects of various doses of lynestrenol on the plasma levels of oestrogens and progesterone during the menstrual cycle in the rhesus monkey.
        Contraception. 1976; 13: 677
        • Hackelöer B-J.
        • Fleming R.
        • Robinson H-P.
        • Adam A.H.
        • Coutts J.R.T.
        Correlation of ultrasonic and endocrinologic assessment of human follicular development.
        Am. J. Obstet. Gynecol. 1979; 135: 122
        • Belsey M.
        2nd ed. Laboratory Manual for Examination of Human Semen and Semen-Cervical Mucus Interaction. WHO, Geneva, Press Concern, Singapore1980
        • Landgren B.M.
        • Diczfalusy E.
        Hormonal effects of the 300 mcg norethisterone (NET) minipill. 1. Daily steroid levels in 43 subjects during a pretreatment cycle and during the second month of NET administration.
        Contraception. 1980; 21: 87
        • Tayob Y.
        • Adams J.
        • Jacob H.S.
        • Guillebaud J.
        Ultrasound demonstration of increased frequency of functional ovarian cysts in women using progestogen-only oral contraception.
        Br. J. Obstet. Gynecol. 1985; 92: 1003
        • Liukkonen S.
        • Koskimies A-I.
        • Tenhunen A
        • Ylostalo P.
        Diagnosis of luteinized unruptured follicle (LUF) syndrome by ultrasound.
        Fertil. Steril. 1984; 41: 26
        • Daly D.C.
        • Soto-Albors C.
        • Walters C.
        • Ying Y.
        • Riddick D.H.
        Ultrasonographic assessment of luteinized unruptured follicle syndrome in unexplained infertility.
        Fertil. Steril. 1985; 43: 62
        • Daly D.C.
        Treatment validation of ultrasound-defined abnormal follicular dynamics as a cause of infertility.
        Fertil. Steril. 1979; 51: 51
        • Ying Y.
        • Daly D.C.
        • Randolph J.F.
        • Soto-Albors C.E.
        • Maier D.B.
        • Schmidt C.L.
        • Riddick D.H.
        Ultrasonographic monitoring of follicular growth for luteal phase defects.
        Fertil. Steril. 1987; 48: 433
        • Daly D.C.
        • Reuter S.
        • Mastroianni J.
        Follicle size by ultrasound versus cervical mucus quality: normal and abnormal patterns in spontaneous cycles.
        Fertil. Steril. 1989; 51: 598
        • Olsson S-E.
        Contraception with subdermal implant releasing levonorgestrel. A clinical and pharmacological study.
        Acta Obst. Gynecol. Scand. Supplement 124. 1987;
      1. Olsson, S-E., Bakos, O., Lindgren, P-G., Odlind, V., Wide, L.: Ovarian function during use of subdermal implants releasing low doses of levonorgestrel. Submitted for publication in Contraception.

        • Robinson G.E.
        • Bounds W.
        • Kubba A.A.
        • Adams J.
        • Guillebaud J.
        Functional ovarian cysts associated with levonorgestrel- releasing intrauterine device.
        Brit. J. Family Planning. 1989; 14: 131
        • Geisthövel F.
        • Skubsch U.
        • Zabel G.
        • Schillinger H.
        • Breckwoldt M.
        Ultrasonographic and hormonal studies in physiologic and insufficient menstrual cycles.
        Fertil. Steril. 1983; 39: 277
        • Brache V.
        • Faundes A.
        • Johansson E.D.B.
        • Alvarez F.
        Anovulation, inadequate luteal phase and poor sperm penetration in cervical mucus during prolonged use of Norplant implants.
        Contraception. 1985; 31: 261
        • Alvarez F.
        • Brache V.
        • Tejada A.
        • Faundes A.
        Abnormal endocrine profile among women with confirmed or presumed ovulation during long-term Norplant use.
        Contraception. 1986; 33: 114
        • Eisser M.K.
        • Sawers R.S.
        • Docker M.F.
        • Lynch S.S.
        • Newton R.J.
        Characters and incidence of dysfunctional ovulation patterns detected by ultrasound.
        Fertil. Steril. 1987; 47: 603
        • Polan M.L.
        • Totore M.
        • Caldwell B.V.
        • Dellaney A.H.
        • Hesseltine F.I.P.
        • Rose N.
        Abnormal ovarian cycles as diagnosed by ultrasound and serum estradiol levels.
        Fertil Steril. 1982; 37: 342
        • Croxatto H.D.
        • Diaz S.
        • Pavez M.
        • Croxatto H.B.
        Histopathology of the endometrium during continuous use of levonorgestrel.
        in: Zatuchni G.L. Goldsmith A. Shelton J.D. Sciarra J.J. Long-acting Contraceptive Delivery Systems. Harper & Row, Philadelphia1984: 290
        • Martinez-Manatou J.
        • Azuar R.
        Endometrial morphology in women exposed to uterine systems releasing progesterone.
        Am. J. Obstet. Gynecol. 1975; 125: 175