Noncontraceptive applications of the levonorgestrel intrauterine system.

The introduction of an intrauterine system that releases 20 mg of levonorgestrel (LNG-IUS) directly to the uterine lining has ushered in a new era for the intrauterine device. The LNG-IUS reduces menstrual bleeding and dysmenorrhea, and is an effective nonsurgical treatment for idiopathic menorrhagia in premenopausal women. Women using the device experience significant reductions in menstrual flow and increases in hemoglobin. Abnormal uterine bleeding has become a primary indication for the use of this intrauterine device in Europe, and it is an emerging off-label indication in the United States. Women randomized to the use of the device experience a reduction in bleeding similar to that obtained by hysteroscopic procedures, and satisfaction with the results is high. The device also provides endometrial protection in combination with estrogen as postmenopausal hormone replacement therapy. In this paper, the growing literature on the emerging noncontraceptive indications for the LNG-IUS is reviewed.