FSRH CEU Statement: Extended use of all 52mg LNG-IUDs for up to eight years for contraception

Posted 9 May 2024

Date: 09 May 2024

Type: FSRH Clinical Guidance and Clinical Statements

Following the change in licence of Mirena® to eight years, the CEU have reconvened the Intrauterine Contraception (IUC) Guideline Development Group (GDG) to consider the extended use of all 52mg LNG-IUDs to eight years for contraception. Overall, whilst the evidence is limited, the GDG felt there was sufficient evidence to make the following recommendations.

Recommendations

The FSRH IUC GDG support extended use of any 52mg LNG-IUD for up to eight years for contraception if the user is under 45 years old at the time of insertion.

There is insufficient evidence to support use of any 52mg LNG-IUD beyond eight years for contraception. If an individual presents for replacement of the device after eight years, criteria for reasonably excluding pregnancy must be met, as per FSRH guidance.

Key points

  • The available evidence has shown a low pregnancy rate (Pearl Index <0.4) in individuals using a 52mg LNG-IUD between years six and eight for contraception.
  • The limited evidence does not show an increase in bleeding in women who continue to use the 52mg LNG-IUD beyond six years.
  • There is no change to existing guidelines regarding use of the 52mg LNG-IUD for heavy menstrual bleeding or endometrial protection. 
  • As per existing guidelines, if a 52mg LNG-IUD is inserted over the age of 45, it can be used for contraception until the age of 55.
  • It must be noted that use of Benilexa® and Levosert® for eight years is off-label and prescribers should follow recommendations as set out in MHRA/GMC guidance and the recently updated FSRH Service Standards for Medicines Management.  

Read the full FSRH statement here