Zeiss René, Schönfeldt-Lecuona Carlos, Gahr Maximilian, Graf Heiko
Department of Psychiatry and Psychotherapy III, Ulm University Hospital, Ulm, Germany.
Front Psychiatry. 2020 Aug 28;11:561685. doi: 10.3389/fpsyt.2020.561685. eCollection 2020.
The levonorgestrel-releasing intrauterine system (LNG-IUS) is used as hormonal contraception by millions of women worldwide. It is considered as a safe device with low rates of systemic adverse drug reactions (ADRs). However, an emerging evidence suggest mood changes as ADRs. Whereas most of these studies report psychiatric ADRs after the first implantation of the LNG-IUS, it has to be considered that these may also occur after replacement, even when psychiatric symptoms were not evident at the time of the initial insertion. A potential explanation for the development of psychiatric ADRs in subsequent LNG-IUS may rely on fluctuations of sex hormones throughout the female life cycle with changing windows of vulnerabilities for developing mood disorders. Thus, the reliable contraception for women remains a continual challenge. We present the case of a 41-year-old woman that used the LNG-IUS (Mirena) for contraception over 5 years without any complaints. Within the first weeks after insertion of the second LNG-IUS, she developed a depressive syndrome and anxieties. An extensive somatic, including gynecological examination revealed no pathological findings and a mental disorder was suggested. Due to the patient´s request and the recommendation of her psychiatrist, the device was removed and led to a remission of her mental complaints up to a 6- and 12-months follow-up. Beyond the mood changes considerably affecting her quality of life, the patient raised the concerns that she has never been informed about potential ADRs on mental health and her remarks regarding the potential association between psychiatric symptoms and the LNG-IUS were considered as groundless. With this case, we strengthen previous observations regarding mood changes under LNG-IUS. Moreover, we illustrate that psychiatric symptoms may also occur as ADRs during the subsequent insertion. Thus, we emphasize that psychiatric symptoms have to be clearly communicated as ADRs to patients with LNG-IUS within a written informed consent and should be routinely examined by gynecologists.
左炔诺孕酮宫内节育系统（LNG-IUS）被全球数百万女性用作激素避孕方法。它被认为是一种安全的装置，全身药物不良反应（ADR）发生率较低。然而，新出现的证据表明情绪变化也是ADR。虽然大多数这些研究报告了首次植入LNG-IUS后出现的精神科ADR，但必须考虑到这些情况在更换后也可能发生，即使在初次插入时没有明显的精神症状。后续LNG-IUS中精神科ADR发生的一个潜在解释可能依赖于女性生命周期中随着情绪障碍易患窗口变化而出现的性激素波动。因此，为女性提供可靠的避孕方法仍然是一个持续的挑战。我们报告一例41岁女性的病例，她使用LNG-IUS（曼月乐）避孕超过5年，没有任何不适。在第二次植入LNG-IUS后的头几周内，她出现了抑郁综合征和焦虑情绪。广泛的躯体检查，包括妇科检查，未发现病理结果，并提示存在精神障碍。由于患者的要求和她的精神科医生的建议，取出了该装置，在6个月和12个月的随访中，她的精神症状得到缓解。除了情绪变化严重影响她的生活质量外，患者还提出了她从未被告知有关心理健康潜在ADR的担忧，并且她关于精神症状与LNG-IUS之间潜在关联的言论被认为是毫无根据的。通过这个病例，我们强化了先前关于LNG-IUS下情绪变化的观察结果。此外，我们还表明，在后续植入过程中，精神症状也可能作为ADR出现。因此，我们强调，在书面知情同意书中，必须将精神症状作为ADR明确告知使用LNG-IUS的患者，并且妇科医生应常规进行检查。
