Body weight and composition in users of levonorgestrel-releasing intrauterine system

doi:10.1016/j.contraception.2012.01.017

Contraception

Volume 86, Issue 4, October 2012, Pages 350-353

https://doi.org/10.1016/j.contraception.2012.01.017 Get rights and content

Abstract

Background

There is little information about body weight and body composition (BC) among users of the levonorgestrel-releasing intrauterine system (LNG-IUS). The aim of this study was to evaluate body weight and BC in LNG-IUS users compared to users of the TCu380A intrauterine device (IUD).

Study Design

A prospective study was done with 76 new users of both contraceptive methods. Women were paired by age (±2 years) and body mass index (BMI, kg/m², ±2). Body weight and BC (% lean mass and % fat mass) were evaluated by a trained professional at baseline and at 1 year of contraceptive use. The BC measurements were obtained using Lunar DXA equipment. Weight and BC were evaluated in each woman at baseline and at 12 months and analyzed as the mean change within each woman. Then, the changes in weight and BC for each woman were calculated and then compared between LNG-IUS and TCu380A IUD users (paired data for each woman). The central-to-peripheral fat ratio was calculated by dividing trunk fat by the upper and lower limb fat.

Results

There were no significant differences at time of IUD insertion between LNG-IUS and TCu380A IUD users regarding age (mean±SD) (34.4±7.5 vs. 33.9±8.0 years), BMI (25.3±4.1 vs. 25.9±4.1) and number of pregnancies (1.9±0.2 vs. 1.7±0.2), respectively. Mean body weight gain of 2.9 kg was observed among LNG-IUS users at 12 months (p=.0012), whereas the body weight of TCu380A IUD users only increased by 1.4 kg (p=.067). There was no significant difference in body weight change between the two groups of users at 12 months. The variation in the central-to-peripheral fat ratio was the same between the two groups (−1.6% vs. −0.2%; p=.364). LNG-IUS users showed a 2.5% gain in fat mass (p=.0009) and a 1.4% loss of lean mass, whereas TCu380A IUD users showed a loss of 1.3% of fat mass (p=.159) and gain of 1.0% of lean mass (p=.120). TCu380A IUD users gained more lean mass than LNG-IUS users (p=.0270), although there was no significant difference between the two groups after 12 months of use.

Conclusions

Although an increase in mean fat mass among LNG-IUS users at 12 months of use was observed, it should be noted that an increase of body weight was also observed in both groups after 1 year of insertion of the device. However, a study with a larger number of women and long-term evaluation is necessary to evaluate these body changes.

Introduction

The levonorgestrel-releasing intrauterine system (LNG-IUS) is used by more than 10 million women in more than 120 countries [1], [2], is approved for 5-year use and is highly effective, with few side effects [2], [3], [4], albeit changes in body weight could influence early discontinuation [5], [6]. LNG is derived from 19-nortestosterone and can have anabolic effects on lean mass [7]. Changes in body weight are one of the reasons for discontinuing contraceptive methods, including the LNG-IUS [8], [9], [10]. In a study of 94 women with adenomyosis who used the LNG-IUS for up to 3 years, 28.7% reported a weight gain of more than 2.0 kg [11]. Other authors have observed an average weight increase of 3.1 kg after 5 years of LNG-IUS use, whereas users of the TCu380A intrauterine device (IUD) showed an average increase of 4.9 kg [12].

Although estradiol levels of LNG-IUS users are similar to those observed in the follicular phase of the menstrual cycle [6], one of the concerns with the long-term use of progestin contraceptives is the possible effect on body mass density (BMD) [7] and body composition (BC). As far as we know, there is no prospective study that evaluated BC (lean mass and fat mass) among LNG-IUS users, and there is still insufficient information about changes in weight during use. The aim of this study was therefore to evaluate BC in LNG-IUS users and compare it with that of TCu380A IUD users at 1 year of use.

Section snippets

Materials and methods

This prospective study was carried out at the Human Reproduction Unit, Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, Brazil. The study was approved by the Institutional Review Board, and all of the participants signed an informed consent form before entering the study. Women between 18 and 45 years of age who had initiated contraceptive use with either the LNG-IUS (Mirena^®, Bayer Oy, Turku, Finland) or a TCu380A IUD (Optima,

Results

The mean (±SD) age at the beginning of the treatment was 34.4±7.5 and 33.9±8.0 years for LNG-IUS and TCu380A IUD users, BMI was 25.3±4.1 and 25.9±4.1, and number of pregnancies was 1.9±0.2 vs. 1.7±0.2, respectively, without significant differences between the two groups. Additionally, there were no significant differences in number of children (1.7 vs. 1.6) and physical activity (10% vs. 13%) between the two groups. Physical activities were reported by 30.2% of the women in both groups. White

Discussion

Our study showed changes in mean weight and mean BC in both LNG-IUS and TCu380A IUD users after 1 year of use. There was also variation in the peripheral deposition of fat and lean mass in both groups, although a significant gain in fat mass was observed only among LNG-IUS users. Both groups were similar in age and the number of pregnancies, and none of the volunteers were overweight or obese at baseline, with 30.2% of the women participating in some physical activity.

The LNG-IUS users gained

Acknowledgments

This study was partially financed by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, award #2009/15595-4) and by the Brazilian National Research Council (CNPq, award #573747/2008-3).

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Cited by (25)

Metabolomics profile of 5649 users and nonusers of hormonal intrauterine devices in Finland
2022, American Journal of Obstetrics and Gynecology
Citation Excerpt :
The 52-mg LNG IUDs have also been compared with copper 380 mm2 IUDs among fertile-aged individuals in need of contraception.10 According to these studies, the use of hormonal IUDs is not associated with increased risk of cardiovascular accidents.7–9,11–15 However, the possible metabolic changes and large-scale biomarker profiles associated with the use of hormonal IUDs have not been studied in detail to date.
Use of hormonal intrauterine devices has grown during the last decades. Although hormonal intrauterine devices act mostly via local effects on the uterus, measurable concentrations of levonorgestrel are absorbed into the systemic circulation. The possible metabolic changes and large-scale biomarker profiles associated with hormonal intrauterine devices have not yet been studied in detail.
To examine through the metabolomics approach the metabolic profile of patients using hormonal intrauterine devices and how this metabolic profile is affected by duration and discontinuation of use.
The study consisted of cross-sectional analyses of 5 population-based surveys (FINRISK and FinHealth studies), spanning from 1997 to 2017. All fertile-aged participants (18–49 years) in the surveys with available information on hormonal contraceptive use and metabolomics data (n=5649) were included in the study. Altogether, 211 metabolic measures of users of hormonal intrauterine devices (n=1006) were compared with those of nonusers of hormonal contraception (n=4643) via multivariable linear regression models. To allow comparison across multiple measures, association magnitudes were reported in standard deviation units of difference in biomarker concentration compared with the reference group.
After adjustment for covariates, levels of 141 metabolites differed in current users of hormonal intrauterine devices compared with nonusers of hormonal contraception (median difference in biomarker concentration, 0.09 standard deviation): lower levels of particle concentration of larger lipoprotein subclasses, triglycerides, cholesterol and derivatives, apolipoproteins A and B, fatty acids, glycoprotein acetyls, and aromatic amino acids. The metabolic pattern of hormonal intrauterine device use did not change according to duration of use. When comparing previous users and never-users of hormonal intrauterine devices, no significant metabolic differences were observed.
The use of hormonal intrauterine devices was associated with several moderate metabolic changes previously associated with reduced arterial cardiometabolic risk. The metabolic effects were independent of duration of use of the hormonal intrauterine devices. Moreover, the metabolic profiles were similar after discontinuation of hormonal intrauterine device use and in never-users.
Weight change among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: Findings from a randomised, multicentre, open-label trial
2021, EClinicalMedicine
Citation Excerpt :
This concern can additionally deter women from initiation of POCs [7], despite their safety and reliability. Although many studies report weight gain in users of a range of POCs [2–4,6,8–20], the literature has focused primarily on depot medroxyprogesterone acetate (DMPA) delivered as an intramuscular injection 150 mg/ml (IM) with studies reporting weight gain of up to 2–3 kg in the first year of use [8–10,16,20,21], followed by gains of between 4 and 10 kg with longer term use of 3–5 years [2,15,17–19]. In a non-randomised trial, the second generation two rod LNG implant Jadelle® was found to have induced similar weight increases to the single rod etonogestrel (ENG) implant Implanon®, with weight gains of approximately 3 vs 1 kg for the Copper IUD users over a 3 year period [22].
There is limited evidence on the impact of the use of progestin-only hormonal contraception (POC) on weight change. We conducted a secondary analysis of prospective weight change among women enrolled in the Evidence for Contraceptive options and HIV Outcomes (ECHO) trial.
The ECHO trial was conducted at 12 sites in eSwatini, Kenya, South Africa and Zambia between December 2015 and October 2018. HIV negative, women aged 16–35 years, desiring contraception, were randomised (1:1:1) to either 3-monthly intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel (LNG) implant or copper intrauterine device (IUD). Follow-up was up to 18 months. Weight (kg) was measured at baseline and study exit. Analysis was performed as intention to treat (ITT) and time on continuous contraceptive use. The primary outcome of this secondary analysis is weight change from study enrolment to the final visit at study month 12–18. The ECHO trial is registered with ClinicalTrials.gov, NCT02550067.
7829 women were randomly assigned to DMPA-IM (n = 2609), copper IUD (n = 2607) or LNG implant (n = 2613). The ITT population included 7014 women 2293 DMPA-IM group, 2372 copper IUD group and 2349 LNG group) who were not lost to follow-up, pregnant on study, or missing weight data. The mean weight increased in all groups but was significantly different in magnitude: 3.5 kg (SD = 6.3), 2.4 kg (SD = 5.9) and 1.5 kg (SD = 5.7) in the DMPA-IM, LNG implant and copper IUD groups, respectively. Comparative differences between groups were (2.02 kg (95% CI, 1.68, 2.36, p < 0.001) for DMPA-IM versus copper IUD, 0.87 kg (0.53,1.20 p < 0.001) for LNG implant compared to copper IUD and 1.16 kg (0.82, 1.50, p < 0.001) for DMPA-IM compared with LNG implant. Results for continuous contraceptive use were similar.
We found differences in weight gain between POC users compared to the non-hormonal copper IUD group over 12–18 months of use. Women using POCs should be counselled about this potential side effect when choosing a contraceptive method.
Assessing Weight Status in Adolescent and Young Adult Users of the Etonogestrel Contraceptive Implant
2019, Journal of Pediatric and Adolescent Gynecology
There are inconsistent data regarding hormonal contraception and weight. Weight concerns might deter teens from using highly effective contraception such as the etonogestrel subdermal implant (ENG). There is little literature about weight gain and adolescent ENG use; most studies involve adult women. The purpose of this study was to evaluate weight/body mass index (BMI) change in adolescent and young adult ENG users compared with nonusers.
Retrospective chart review of 197 ENG users and age, race, BMI, and follow-up time-matched controls.
Adolescent medicine clinic.
Individuals who had been using ENG for 6 months or more were eligible. A control group of non-ENG users who had been seen during the same period was identified to compare weight/BMI over time. Cases were matched to controls on age, BMI, and race.
Electronic medical records were reviewed for weight/BMI change and ENG side effects. The study was designed to have 80% power to detect a 2-kg weight difference between cases and controls.
Participant mean age was 17 (±2) years. Mean follow-up was 24.5 (±9.3) months. Forty-three of 197 ENG users removed the implant early; 3/43 (6.3%) patients cited weight gain as the primary reason for removal. Mean weight change for ENG users was +3.6 (±7.8) kg vs +3.1 (±5.9) kg for controls (P = .43); mean BMI change was +1.3 (±2.9) in cases vs +1.0 (±2.3) in controls (P = .204). Overall regression analyses showed no group differences among cases and controls.
Long-term ENG use did not lead to significant weight gain in this sample of adolescent and young adult women. This study supports the statement that ENGs are an effective and weight-neutral option.
Comparison of body weight among hormonal and non-hormonal users in a Malaysian cohort
2019, Journal of Taibah University Medical Sciences
Weight gain remains an issue for contraceptive users due to the high prevalence of obesity. This retrospective study compares the weight gain between hormonal and non-hormonal contraceptive users in government health clinics in Kota Bharu, Kelantan, Malaysia.
A total of 380 women who had used the same contraceptive method for at least twelve months were recruited in this study. Covariance analysis was done to compare the weight gain between hormonal and non-hormonal contraceptive users, while studying the same confounders [age, household income, number of pregnancies, and baseline body mass index (BMI)].
Hormonal methods were more commonly used. The mean weight gain among hormonal users (adjusted mean 2.85, 95% CI 2.45, 3.24) was significantly higher than non-hormonal users (adjusted mean 0.46, 95% CI -0.73, 1.65; p-value <0.001), after controlling for age, household income, number of pregnancies, and baseline BMI.
The possibility of weight gain following the use of hormonal methods should be investigated and non-hormonal methods should be considered to prevent weight gain.
Intrauterine contraception: CNGOF Contraception Guidelines
2018, Gynecologie Obstetrique Fertilite et Senologie
L’objectif de ce travail est de fournir des recommandations pour la pratique clinique concernant la contraception intra-utérine.
Une revue exhaustive de la littérature a été effectuée à l’aide des moteurs de recherche Pubmed et Cochrane database. Les recommandations récentes sur le sujet, en langue française et anglaise, ont également été considérées.
La contraception intra-utérine peut être proposée dans de nombreuses situations, y compris chez les nullipares, les adolescentes, les patientes vivant avec le VIH avant le stade SIDA (Grade B) et les femmes présentant un antécédent de grossesse extra-utérine (GEU) (Grade C). Il est recommandé de ne pas modifier le schéma de dépistage du cancer du col chez les utilisatrices de dispositif intra-utérin (DIU) (Grade B). Seuls le toucher vaginal avec examen bimanuel et l’inspection cervicale sont formellement recommandés avant la pose d’un DIU (Grade B). Un dépistage systématique des infections sexuellement transmises n’est pas recommandé (Grade B). Ce dépistage est effectué idéalement le jour de la prescription du DIU mais peut être réalisé le jour de la pose si la patiente est asymptomatique (Grade B). Le DIU peut être posé à n’importe quel moment du cycle (Grade B). Il n’est pas recommandé de réaliser une antibioprophylaxie ou une prémédication systématique lors de l’insertion (Grade A). Une visite de suivi peut être proposée dans les semaines suivant la pose (AP). Il n’est pas recommandé de réaliser une échographie de contrôle systématique si la patiente est asymptomatique, que l’insertion du dispositif s’est déroulée sans difficulté et qu’à l’examen les fils sont vus et de longueur attendue (Grade B). Quel que soit le type de DIU, les métrorragies persistantes ou associées à des douleurs pelviennes doivent motiver des explorations complémentaires à la recherche d’une complication (AP). Devant une suspicion de perforation utérine, des examens complémentaires doivent être réalisés pour localiser le DIU (AP). L’abord laparoscopique est la voie à privilégier pour le retrait des DIU en situation abdominale (AP). En cas de grossesse sur DIU, il convient en premier lieu d’éliminer une GEU (Grade B). En présence d’une grossesse intra-utérine évolutive et désirée, il est recommandé de retirer le DIU si les fils sont accessibles (Grade C). La présence d’organismes Actinomyces-like au frottis cervico-vaginal chez une patiente asymptomatique ne doit pas motiver d’exploration complémentaire, de retrait anticipé ou de traitement anibiotique (Grade B). Il n’est pas recommandé de retirer d’emblée le DIU en cas de survenue d’une infection sexuellement transmise ou d’une infection génitale haute (Grade B). En l’absence d’évolution favorable à 48–72 h de l’institution du traitement, le retrait du dispositif doit être discuté (Grade B).
La contraception intra-utérine constitue un moyen contraceptif de longue durée d’action efficace avec un taux de continuation élevée qui s’accompagne d’un risque faible de complications. Elle peut donc être proposée à un très grand nombre de patientes, indépendamment de la parité.
To provide national clinical guidelines focusing on intrauterine contraception.
A systematic review of available literature was performed using Pubmed and Cochrane libraries. American, British and Canadian guidelines were considered as well.
Intrauterine contraception (IUC) displays a wide panel of indications, including adolescents, nulliparous, patients living with HIV before AIDS (Grade B) and women with history of ectopic pregnancy (Grade C). Cervical cancer screening should not be modified in women with IUC (Grade B). Bimanual examination and cervix inspection are mandatory before device insertion (Grade B). Patients should not systematically undergo screening for sexually transmitted infections (STI) before device insertion (Grade B). Screening for STI should be preferably done before insertion but it can be performed at the time of device insertion in asymptomatic women (Grade B). Routine antibiotic prophylaxis and premedication are not recommended before insertion (Grade A). A follow-up visit may be offered several weeks after insertion (Professional consensus). Routine pelvic ultrasound examination in not recommended after device insertion (Grade B). In patients with IUC, unscheduled bleeding, when persistent or associated with pelvic pain, requires further investigation to rule out complication (Professional agreement). Suspected uterine perforation warrants radiological workup to locate the device (Professional consensus). Laparoscopic approach should be preferred for elective removal of intrauterine device from abdominal cavity (Professional consensus). In case of accidental pregnancy with intrauterine device in situ, ectopic pregnancy should be excluded (Grade B). In case of viable and desired intrauterine pregnancy, intrauterine device removal is recommended if the strings are reachable (Grade C). Detection of Actinomyces-like organisms on pap smear in asymptomatic patients with intrauterine contraception does not require further intervention (Grade B). Immediate removal of intrauterine device is not recommended in case of STI or pelvic inflammatory disease (Grade B). Device removal should be considered in the absence of clinical improvement after 48 to 72 hours of appropriate treatment (Grade B).
Intrauterine contraception is a long-acting and reversible contraception method displaying great efficacy and high continuation rate. In contrast, complication rate is low. It should thus be offered to both nulliparous and multiparous women.
Practical Use of Pharmacotherapy for Obesity
2017, Gastroenterology
Citation Excerpt :
There are, however, weight-neutral contraceptive options that minimize hormonal exposure, including barrier methods, copper intrauterine devices, and surgical sterilization (including hysteroscopic sterilization and tubal ligation) that can be utilized when appropriate. Whether hormonal intrauterine devices are truly weight-neutral requires additional investigation.49 Oral glucocorticoids are often cited as the medication most likely to cause weight gain and impair glucose metabolism, but although this side effect is well known, the actual incidence is poorly defined.50
Obesity management requires a multidisciplinary approach, as there are many factors that contribute to the development of obesity, as well as the preservation of excess weight once it has been gained. Diet, exercise, and behavior modification are key components of treatment. In addition to lifestyle changes, weight gain secondary to medications is an important modifiable risk factor. Even after appropriate lifestyle modification, and medication adjustments (where possible) to avoid agents that can contribute to weight gain, many patients are still unable to achieve clinically meaningful weight loss. Pharmacotherapy for obesity management can fill an important role for these patients. This article will review medications that can lead to weight gain and potential alternatives, currently approved anti-obesity medications and best practices to individualize the selection process, and the use of testosterone in men with hypogonadism and obesity.

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Original research articleBody weight and composition in users of levonorgestrel-releasing intrauterine system☆

Abstract

Background

Study Design

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Acknowledgments

Contraception

Contraception

Contraception

Am J Obstet Gynecol

Contraception

Maturitas

Contraception

Contraception

A cross-sectional study of the forearm bone density of long-term users of levonorgestrel-releasing intrauterine system

Hum Reprod

Original research article
Body weight and composition in users of levonorgestrel-releasing intrauterine system☆