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Role of the levonorgestrel intrauterine system in effective contraception

机译：左炔诺孕酮子宫内系统在有效避孕中的作用

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Abstract: Norgestrel, a synthetic progestin chemically derived from 19-nortestosterone, is six times more potent than progesterone, with variable binding affinity to various steroid receptors. The levonorgestrel-releasing intrauterine system (LNG IUS) provides a long-acting, highly effective, and reversible form of contraception, with a pearl index of 0.18 per 100 women-years. The locally released hormone leads to endometrial concentrations that are 200–800 times those found after daily oral use and a plasma level that is lower than that with other forms of levonorgestrel-containing contraception. The contraceptive effect of the LNG IUS is achieved mainly through its local suppressive effect on the endometrium, leading to endometrial thinning, glandular atrophy, and stromal decidualization without affecting ovulation. The LNG IUS is generally well tolerated. The main side effects are related to its androgenic activity, which is usually mild and transient, resolving after the first few months. Menstrual abnormalities are also common but well tolerated, and even become desirable (eg, amenorrhea, hypomenorrhea, and oligomenorrhea) with proper counseling of the patient during the choice of the method of contraception. The satisfaction rates after 3 years of insertion are high, reaching between 77% and 94%. The local effect of the LNG IUS on the endometrium and low rates of systemic adverse effects have led to its use in other conditions rather than contraception, as for the treatment of endometrial hyperplasia, benign menorrhagia, endometriosis, adenomyosis, and uterine fibroids.
机译：摘要：Norgestrel是一种化学衍生自19-nortestosterone的合成孕激素，效力是孕酮的六倍，对各种类固醇受体的结合亲和力不同。左炔诺孕酮宫内节育系统（LNG IUS）提供长效，高效和可逆的避孕形式，珍珠指数为每100妇女年0.18。局部释放的激素导致子宫内膜浓度为每日口服后发现的子宫内膜浓度的200-800倍，血浆水平低于其他形式的含左炔诺孕酮避孕的血浆水平。 LNG IUS的避孕作用主要是通过对子宫内膜的局部抑制作用实现的，从而导致子宫内膜变薄，腺体萎缩和间质蜕膜化而不影响排卵。 LNG IUS通常具有良好的耐受性。主要的副作用与它的雄激素活性有关，通常是温和的和短暂的，在最初几个月后就消失了。月经异常也很常见，但可以很好地耐受，甚至在选择避孕方法的过程中对患者进行适当的咨询，甚至变得可取（例如闭经，月经减少和少月经）。插入3年后的满意率很高，达到77％至94％。 LNG IUS对子宫内膜的局部作用和较低的全身性不良反应已导致将其用于其他条件而非避孕，如用于治疗子宫内膜增生，良性月经过多，子宫内膜异位，子宫腺肌病和子宫肌瘤。

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