Summary

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• Mirena (levonorgestrel-releasing intrauterine system) is indicated for prevention of pregnancy for up to 8 years and for treatment of heavy menstrual bleeding for women who choose to use intrauterine contraception as their method of contraception for up to 5 years.
• This summary is based on the review of 12 systematic reviews/meta-analyses. ^[1-12]
• Six out of ten studies found a positive association between LNG-IUS use and breast cancer, particularly in older women and with longer duration of use. One study specifically indicated an increased risk for invasive breast cancer in women aged 40-45.
• LNG-IUS use was associated with increased depressive symptoms in 10 studies, while two studies reported reduced symptoms. Additionally, one study found increased anxiety, and another identified a higher risk of suicide.
• LNG-IUS significantly reduced menstrual blood loss and was more effective than other medical treatments such as tranexamic acid, danazol, and NSAIDs for heavy menstrual bleeding.
• Hysterectomy and endometrial ablation were more effective than LNG-IUS in reducing menstrual blood loss in second-line treatments for heavy menstrual bleeding.
• Breast Cancer Risk: LNG-IUS users, particularly older women, may have an increased risk of breast cancer. Hormone-free alternatives may be considered for women with a history of breast cancer.
• Psychiatric Safety: LNG-IUS is associated with psychiatric symptoms, including depressive symptoms and suicidality. Counseling on these risks is recommended for users.
• Adverse Effects in Heavy Menstrual Bleeding: LNG-IUS had an acceptable frequency of adverse events, with common effects including weight gain, mood changes, and headaches.
• There is no population types or subgroups information available in the reviewed documents.