Высокая частота незапланированных беременностей остается значимой проблемой во многих странах мира, включая Россию. Этот показатель мог бы быть существенно снижен благодаря применению обратимых контрацептивных методов длительного действия (Long-Acting Reversible Contraception – LARC), к которым относятся внутриматочные системы. Они признаны высокоэффективными, характеризуются малым числом противопоказаний и побочных эффектов, экономически рентабельны при длительном применении. Особое внимание уделено преимуществам левоноргестрел-рилизинг-системы, которая при рациональном консультировании может быть хорошим выбором для большинства женщин. Ключевые слова: контрацепция, обратимые контрацептивные методы длительного действия, левоноргестрел-рилизинг-система, Мирена.
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High frequency of unplanned pregnancies remains a significant problem in many countries, including Russia. This figure can be significantly reduced when the reversible contraceptive long-acting methods are used (Long-Acting Reversible Contraception – LARC), including intrauterine system (IUS). LARC-methods are highly effective, and are mainly characterized by small number of contraindications and side effects, thus being economically profitable along the application. Particular attention is paid to the benefits of levonorgestrel-releasing system, which, if timely advised can be a good choice for most women. Key words: contraception, reversible contraceptive methods of long-acting, levonorgestrel-releasing system, Mirena.
1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;
38 (2): 90–6.
2. Kaye K, Suellentrop K, Sloup C. The Fog Zone: how misperceptions, magical thinking, and ambivalence put young adults at risk for unplanned pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy 2009.
3. United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2009; http://www.un.org/esa/population/publications/WCU2009/Main.html 2010
4. Mosher WD, Martinez GM, Chandra A et al. Use of contraception and use of family planning services in the United States: 1982–2002. Adv Data 2004; 350: 1–36.
5. Nelson AL, Westhoff C, Schnare SM. Real-world patterns of prescription refills for branded hormonal contraceptives: a reflection of contraceptive discontinuation. Obstet Gynecol 2008; 112 (4): 782–7.
6. Winner B, Peipert JF, Zhao Q et al. Effectiveness of Long-Acting Reversible Contraception. N Engl J Med 2012; 366: 1998–2007.
7. NICE. Implementation uptake report: Long-acting reversible contraception. CG30 2010; guidance.nice.org.uk/cg30
8. Bajos N, Leridon H, Goulard H et al. Contraception: from accessibility to efficiency. Hum Reprod 2003; 18: 994–9.
9. Allen RH, Goldberg AB, Grimes DA. Expanding access to intrauterine contraception. Am J Obstet Gynecol 2009; 201 (5): 456–61.
10. Leeman L. Medical barriers to effective contraception. Obstet Gynecol Clin North Am 2007; 34 (1): 19–29.
11. Jones R, Darroch JE, Henshaw SK. Contraceptive use among US women having abortions in 2000–2001. Perspect Sex Reprod Health 2002; 34: 294–303.
12. Smith JD, Oakley D. Why do women miss oral contraceptive pills? An analysis of women's self-described reasons for missed pills. J Midwifery Womens Health 2005; 50: 380–5.
13. Grimes DA. Forgettable contraception. Contraception 2009; 80: 497–9.
14. Trussell J. Contraceptive efficacy. In: Hatcher RA, Nelson TJ, Guest F et al. Contraceptive technology. 19th ed. NY: Ardent Media 2007; 747–826.
15. Peipert JF, Zhao Q, Allsworth JE et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117: 1105–13.
16. Moreau C, Trussell J, Desfreres J, Bajos N. Patterns of contraceptive use before and after an abortion: results from a nationally representative survey of women undergoing an abortion in France. Contraception 2010; 82: 337–44.
17. Mavranezouli I. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod 2008; 23: 1338–45.
18. Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception 2008; 77: 1–5.
19. ACOG Committee on Gynecologic Practice; Long-Acting Reversible Contraception Working Group. ACOG Committee Opinion No. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2009; 114 (6): 1434–8
20. Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update 2010; 17 (1): 121–37.
21. ACOG Practice Bulletin No. 121: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol 2011; 118: 184–96.
22. Cleland K, Peipert JF, Westhoff C et al. Family planning as a cost-saving preventive health service. N Engl J Med 2011; 364 (18): e37.
23. Mansour D, Rosales C, Cox M. Women’s awareness of long-acting, reversible contraceptive methods (LARCs) in community family planning clinics and general practice. Eur J Contracept Reprod Health Care 2008; 13: 396–9.
24. Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75 (Suppl. 6): S16–S30.
25. Hidalgo MM, Hidalgo-Regina C, Bahamondes MV et al. Serum levonorgestrel levels and endometrial thick ness during extended use of the levonorgestrel-releasing intrauterine system. Contraception 2009; 80 (1): 84–9.
26. Lewis RA, Taylor D, Natavio MF et al. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception 2010; 82: 491–6.
27. Wilcox AJ, Weinberg CR, Armstrong EG, Canfield RE. Urinary human chorionic gonadotropin among intrauterine device users: detection with a highly specific and sensitive assay. Fertil Steril 1987; 47 (2): 265–9.
28. SPF Clinical guideline Use of the MirenaR LNG–IUS and Paragard™. CuT380A intrauterine devices in nulliparous women. Contraception 2010; 81: 367–71.
29. ACOG Committee opinion no. 392. December 2007: intrauterine device and adolescents. Obstet Gynecol 2007; 110: 1493–5.
30. Yen S, Saah T, Hillard PJ. IUDs and adolescents – an under-utilized opportunity for pregnancy prevention. J Pediatr Adolesc Gynecol 2010; 23 (3): 123–8.
31. Deans EI, Grimes DA. Intrauterine devices for adolescents: a systematic review. Contraception 2009; 79 (6): 418–23.
32. Stanwood NL, Bradley KA. Young pregnant women’s knowledge of modern intrauterine devices. Obstet Gynecol 2006; 108 (6): 1417–22.
33. Whitaker AK, Johnson LM, Harwood B et al. Adolescent and young adult women’s knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78 (3): 211–7.
34. Marions L, Lovkvist L, Taube A et al. Use of the levonorgestrel releasing intrauterine system in nulliparous women – a non-interventional study in Sweden. Eur J Contraception Reprod Health Care 2011; 16: 126–34.
35. Suhonen S, Haukkamaa M, Jakobsson T, Rauramo I. Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study. Contraception 2004; 69 (5): 407–12.
36. Godfrey EM, Memmel LM, Neustadt A et al. Intrauterine contraception for adolescents aged 14–18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the Copper T 380A. Contraception 2010; 81 (2): 123–7.
37. Heikinheimo O, Inki P, Schmelter T, Gemzell-Danielsson K. Bleeding pattern and user satisfaction in second consecutive levonorgestrel releasing intrauterine system users: results of a prospective 5-year study. Hum Reprod 2014; 29 (6): 1182–8.
38. Margolis MB, Zieman M, Cohen J et al. The Myths and Facts of Intrauterine Contraception Bleeding Profiles. OBG Management. The Female Patient 2011 (Suppl. 1): 1–8.
39. Heliövaara-Peippo S, Hurskainen R, Teperi J et al. Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial. Am J Obstet Gynecol 2013; 209 (6): 535–14.
40. Stoegerer-Hecher E, Kirchengast S, Huber JC, Hartmann B. Amenorrhea and BMI as independent determinants of patient satisfaction in LNG-IUD users: Cross-sectional study in a Central European district. Gynecol Endocrinol 2012; 28 (2): 119–24.
41. Farley TM, Rosenberg MJ, Rowe PJ et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet 1992; 339 (8796): 785–8.
42. World Health Organization, Department of Reproductive Health. Medical Eligibility Criteria for Contraceptive Use. 4th ed. Geneva: WHO; 2009. (http://www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/index.html) 2010.
43. Trussell J, Lalla AM, Doan QV, Reyes et al. Cost effectiveness of contraceptives in the United States. Contraception 2009; 79 (1): 5–14.
44. Sivin I, Stern J, Diaz S et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. Am J Obstet Gynecol 1992; 166 (4): 1208–13.
45. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception 1992; 46 (6): 575–84.
46. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility – follow-up after participation in a randomized clinical trial. Contraception 2007; 75 (2): 88–92.
47. Moreau C, Bouyer J, Bajos N et al. Frequency of discontinuation of contraceptive use: results from a French population-based cohort. Hum Reprod 2009; 24 (6): 1387–92.
48. Cleland J. Contraception in historical and global perspective. Best Pract Res Clin Obstet Gynaecol 2009; 23 (2): 165–76.
49. Kofinas JD, Varrey A, Sapra KJ et al. Adjunctive Social Media for More Effective Contraceptive Counseling A Randomized Controlled Trial Obstet Gynecol 2014; 123: 763–70.
50. Long Acting Reversible Contraception Program Welcome to the College's Long-Acting Reversible Contraception (LARC). Program web page; http://www.acog.org/About_ACOG/ACOG_Departments/Long_Acting_Reversible_Contraception
________________________________________________
1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006;
38 (2): 90–6.
2. Kaye K, Suellentrop K, Sloup C. The Fog Zone: how misperceptions, magical thinking, and ambivalence put young adults at risk for unplanned pregnancy. Washington, DC: The National Campaign to Prevent Teen and Unplanned Pregnancy 2009.
3. United Nations, Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2009; http://www.un.org/esa/population/publications/WCU2009/Main.html 2010
4. Mosher WD, Martinez GM, Chandra A et al. Use of contraception and use of family planning services in the United States: 1982–2002. Adv Data 2004; 350: 1–36.
5. Nelson AL, Westhoff C, Schnare SM. Real-world patterns of prescription refills for branded hormonal contraceptives: a reflection of contraceptive discontinuation. Obstet Gynecol 2008; 112 (4): 782–7.
6. Winner B, Peipert JF, Zhao Q et al. Effectiveness of Long-Acting Reversible Contraception. N Engl J Med 2012; 366: 1998–2007.
7. NICE. Implementation uptake report: Long-acting reversible contraception. CG30 2010; guidance.nice.org.uk/cg30
8. Bajos N, Leridon H, Goulard H et al. Contraception: from accessibility to efficiency. Hum Reprod 2003; 18: 994–9.
9. Allen RH, Goldberg AB, Grimes DA. Expanding access to intrauterine contraception. Am J Obstet Gynecol 2009; 201 (5): 456–61.
10. Leeman L. Medical barriers to effective contraception. Obstet Gynecol Clin North Am 2007; 34 (1): 19–29.
11. Jones R, Darroch JE, Henshaw SK. Contraceptive use among US women having abortions in 2000–2001. Perspect Sex Reprod Health 2002; 34: 294–303.
12. Smith JD, Oakley D. Why do women miss oral contraceptive pills? An analysis of women's self-described reasons for missed pills. J Midwifery Womens Health 2005; 50: 380–5.
13. Grimes DA. Forgettable contraception. Contraception 2009; 80: 497–9.
14. Trussell J. Contraceptive efficacy. In: Hatcher RA, Nelson TJ, Guest F et al. Contraceptive technology. 19th ed. NY: Ardent Media 2007; 747–826.
15. Peipert JF, Zhao Q, Allsworth JE et al. Continuation and satisfaction of reversible contraception. Obstet Gynecol 2011; 117: 1105–13.
16. Moreau C, Trussell J, Desfreres J, Bajos N. Patterns of contraceptive use before and after an abortion: results from a nationally representative survey of women undergoing an abortion in France. Contraception 2010; 82: 337–44.
17. Mavranezouli I. The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline. Hum Reprod 2008; 23: 1338–45.
18. Trussell J, Wynn LL. Reducing unintended pregnancy in the United States. Contraception 2008; 77: 1–5.
19. ACOG Committee on Gynecologic Practice; Long-Acting Reversible Contraception Working Group. ACOG Committee Opinion No. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy. Obstet Gynecol 2009; 114 (6): 1434–8
20. Blumenthal PD, Voedisch A, Gemzell-Danielsson K. Strategies to prevent unintended pregnancy: increasing use of long-acting reversible contraception. Hum Reprod Update 2010; 17 (1): 121–37.
21. ACOG Practice Bulletin No. 121: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstet Gynecol 2011; 118: 184–96.
22. Cleland K, Peipert JF, Westhoff C et al. Family planning as a cost-saving preventive health service. N Engl J Med 2011; 364 (18): e37.
23. Mansour D, Rosales C, Cox M. Women’s awareness of long-acting, reversible contraceptive methods (LARCs) in community family planning clinics and general practice. Eur J Contracept Reprod Health Care 2008; 13: 396–9.
24. Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75 (Suppl. 6): S16–S30.
25. Hidalgo MM, Hidalgo-Regina C, Bahamondes MV et al. Serum levonorgestrel levels and endometrial thick ness during extended use of the levonorgestrel-releasing intrauterine system. Contraception 2009; 80 (1): 84–9.
26. Lewis RA, Taylor D, Natavio MF et al. Effects of the levonorgestrel-releasing intrauterine system on cervical mucus quality and sperm penetrability. Contraception 2010; 82: 491–6.
27. Wilcox AJ, Weinberg CR, Armstrong EG, Canfield RE. Urinary human chorionic gonadotropin among intrauterine device users: detection with a highly specific and sensitive assay. Fertil Steril 1987; 47 (2): 265–9.
28. SPF Clinical guideline Use of the MirenaR LNG–IUS and Paragard™. CuT380A intrauterine devices in nulliparous women. Contraception 2010; 81: 367–71.
29. ACOG Committee opinion no. 392. December 2007: intrauterine device and adolescents. Obstet Gynecol 2007; 110: 1493–5.
30. Yen S, Saah T, Hillard PJ. IUDs and adolescents – an under-utilized opportunity for pregnancy prevention. J Pediatr Adolesc Gynecol 2010; 23 (3): 123–8.
31. Deans EI, Grimes DA. Intrauterine devices for adolescents: a systematic review. Contraception 2009; 79 (6): 418–23.
32. Stanwood NL, Bradley KA. Young pregnant women’s knowledge of modern intrauterine devices. Obstet Gynecol 2006; 108 (6): 1417–22.
33. Whitaker AK, Johnson LM, Harwood B et al. Adolescent and young adult women’s knowledge of and attitudes toward the intrauterine device. Contraception 2008; 78 (3): 211–7.
34. Marions L, Lovkvist L, Taube A et al. Use of the levonorgestrel releasing intrauterine system in nulliparous women – a non-interventional study in Sweden. Eur J Contraception Reprod Health Care 2011; 16: 126–34.
35. Suhonen S, Haukkamaa M, Jakobsson T, Rauramo I. Clinical performance of a levonorgestrel-releasing intrauterine system and oral contraceptives in young nulliparous women: a comparative study. Contraception 2004; 69 (5): 407–12.
36. Godfrey EM, Memmel LM, Neustadt A et al. Intrauterine contraception for adolescents aged 14–18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the Copper T 380A. Contraception 2010; 81 (2): 123–7.
37. Heikinheimo O, Inki P, Schmelter T, Gemzell-Danielsson K. Bleeding pattern and user satisfaction in second consecutive levonorgestrel releasing intrauterine system users: results of a prospective 5-year study. Hum Reprod 2014; 29 (6): 1182–8.
38. Margolis MB, Zieman M, Cohen J et al. The Myths and Facts of Intrauterine Contraception Bleeding Profiles. OBG Management. The Female Patient 2011 (Suppl. 1): 1–8.
39. Heliövaara-Peippo S, Hurskainen R, Teperi J et al. Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial. Am J Obstet Gynecol 2013; 209 (6): 535–14.
40. Stoegerer-Hecher E, Kirchengast S, Huber JC, Hartmann B. Amenorrhea and BMI as independent determinants of patient satisfaction in LNG-IUD users: Cross-sectional study in a Central European district. Gynecol Endocrinol 2012; 28 (2): 119–24.
41. Farley TM, Rosenberg MJ, Rowe PJ et al. Intrauterine devices and pelvic inflammatory disease: an international perspective. Lancet 1992; 339 (8796): 785–8.
42. World Health Organization, Department of Reproductive Health. Medical Eligibility Criteria for Contraceptive Use. 4th ed. Geneva: WHO; 2009. (http://www.who.int/reproductivehealth/publications/family_planning/9789241563888/en/index.html) 2010.
43. Trussell J, Lalla AM, Doan QV, Reyes et al. Cost effectiveness of contraceptives in the United States. Contraception 2009; 79 (1): 5–14.
44. Sivin I, Stern J, Diaz S et al. Rates and outcomes of planned pregnancy after use of Norplant capsules, Norplant II rods, or levonorgestrel-releasing or copper TCu 380Ag intrauterine contraceptive devices. Am J Obstet Gynecol 1992; 166 (4): 1208–13.
45. Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception 1992; 46 (6): 575–84.
46. Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility – follow-up after participation in a randomized clinical trial. Contraception 2007; 75 (2): 88–92.
47. Moreau C, Bouyer J, Bajos N et al. Frequency of discontinuation of contraceptive use: results from a French population-based cohort. Hum Reprod 2009; 24 (6): 1387–92.
48. Cleland J. Contraception in historical and global perspective. Best Pract Res Clin Obstet Gynaecol 2009; 23 (2): 165–76.
49. Kofinas JD, Varrey A, Sapra KJ et al. Adjunctive Social Media for More Effective Contraceptive Counseling A Randomized Controlled Trial Obstet Gynecol 2014; 123: 763–70.
50. Long Acting Reversible Contraception Program Welcome to the College's Long-Acting Reversible Contraception (LARC). Program web page; http://www.acog.org/About_ACOG/ACOG_Departments/Long_Acting_Reversible_Contraception
Авторы
Г.Е.Чернуха
ФГБУ Научный центр акушерства, гинекологии и перинатологии им. акад. В.И.Кулакова Минздрава России, Москва