New low dose IUS offers additional contraceptive option

General practice nurses providing contraception advice or services can now offer a new, very low dose intrauterine system that promises to be as effective as existing IUS but with a much-reduced dose of levonorgestrel.

Like Mirena, Levosert and Jaydess, Kyleena® acts locally by thickening cervical mucus and thinning the endometrium, creating an environment that inhibits sperm function and motility.

Kyleena is licensed for contraceptive use for 5 years. It contains 19.5mg levonorgestrel (LNG), lower than Mirena and Levosert (52mg) but higher than Jaydess (13.5mg), which can be used for only 3 years. It has a small T-shaped frame, the same dimensions as Jaydess, and like Jaydess, also has a silver ring for improved visibility on ultrasound.

Kyleena has a Pearl Index (measure of contraceptive efficacy) of 0.29, and according to the Faculty of Sexual & Reproductive Healthcare (FSRH) Clinical Effectiveness Unit, it appears to have comparable efficacy to other LNG-IUS devices at 1 and 3 years of use. Reported pregnancy rates are low throughout 5 years of use.

Bleeding and spotting is lower with Mirena than Kyleena, and higher than Jaydess, but reduces over time. It appears that higher doses of LNG in the LNG-IUS are associated with fewer bleeding/spotting days. The rate of amenorrhoea is higher with Kyleena than Jaydess.

The FSRH says more evidence is needed to clarify the ectopic pregnancy rate of the new IUS, but it appears to be greater than with 52mg LNG devices.

It has been suggested that the narrow introducer and smaller device could make it more suitable for women with a narrower cervical canal and/or smaller uterine cavity, such as young women or women who have never been pregnant, and it is reported to be easier to insert and less painful than Mirena.

At £76 over 5 years, Kyleena has the lowest contraceptive cost per year over the full duration of licensed use of the LNG-IUS devices currently available.

NICE recommends increasing uptake of long-acting reversible contraception (LARC) as a cost-effective means of reducing unplanned pregnancies. Up to 48% of women using the oral contraceptive pill report having missed a pill in the past 3 months, and about a third of women in the UK will have a termination of pregnancy before they are 45. Unplanned pregnancies are highest among younger women. LARCs are highly effective as they do not rely on user compliance, but awareness and uptake remain low.

Dr Paula Briggs, Consultant in Sexual and Reproductive Health, said: ‘It’s essential we are aware of all options available in order to enable women to find the right contraceptive for them. This is particularly important for younger women, who may be less familiar with LARCs but struggle to remember to take a pill every day. The launch of Kyleena, means [there is] another viable option for younger women to consider when looking for long term, reversible contraception.’

FSRH Clinical Effectiveness Unit. New Product review: Kyleena 19.5mg intrauterine delivery system. January 2018.