GyneFix-LNG: preliminary clinical experience with a copper and levonorgestrel-releasing intrauterine system

Assessment of menstrual blood loss in Belgian users of the frameless copper-releasing IUD with copper surface area of 200 mm2 and users of a copper-levonorgestrel-releasing intrauterine system

OBJECTIVE

This study was conducted to evaluate the effect of a miniaturized frameless copper IUD (GyneFix 200 small) and a copper-levonorgestrel (GynePlant) intrauterine system (IUS) on the amount of menstrual blood loss (MBL).

METHODS

In 60 Belgian women using GyneFix 200 and 21 using GynePlant, MBL was assessed with the visual assessment technique.

RESULTS

MBL scores in GyneFix 200 users did not change from baseline during the mean observation period of 31 months. In GynePlant users, mean MBL scores decreased by at least 50% in all but one user.

CONCLUSION

The impact of copper IUDs on MBL can be minimized by reducing the surface area of the foreign body. Reduction of MBL, without causing amenorrhea, can be obtained by adding levonorgestrel.

Randomised controlled trial assessing the acceptability of GyneFix versus Gyne-T380S for emergency contraception

OBJECTIVE

To assess insertion-linked pain and the short-term user-acceptability and safety of the GyneFix as compared with T-framed intrauterine devices (IUDs).

DESIGN

A randomised controlled trial in an outpatient clinic setting.

METHOD

Women requesting an IUD for emergency contraception (EC) were allocated to either the short-term arm (GyneFix versus Nova-T200, or the long-term arm (GyneFix versus Gyne-T380S, and then randomised within each group. Visual analogue scores were used to assess the women's perception of the pain associated with insertion, which was patient-blinded. Follow-up was double-blinded, at 6 weeks, with bleeding and pain recorded over this time.

RESULTS

A total of 175 women received an IUD in the long-term arm. The short-term arm was discontinued due to low recruitment (17 women at 20 months) and therefore the results relate to the long-term arm only. Outcome was known in 98% of subjects. The actual insertion procedure was scored as more painful for the GyneFix, both by the women (p = 0.013) and the doctors making their assessment of the women's pain (p = 0.04). The women with GyneFix described less pain in the subsequent 30 days after insertion (p = 0.005). Only 13% of women with GyneFix requested removal as compared with 20% with Gyne-T380S, with the difference being attributed to removal due to pain. The bleeding pattern was similar for those using GyneFix and Gyne-T380S.

CONCLUSIONS

Our study suggests that although the actual fitting may be more painful, pain is less during the 6 weeks after insertion of GyneFix and fewer women discontinue its use because of pain, as compared with Gyne-T380S. The high overall continuation rate of all emergency IUDs at 6 weeks and low morbidity seen in this study favours more frequent IUD insertion where unprotected intercourse has occurred, given also its higher efficacy over oral hormonal EC.

Efficacy of a mini version of the frameless GyneFix intrauterine system (IUS) with effective copper surface area of 200 mm2. dirk.wildemeersch@contrel.be

This study was conducted to evaluate the efficacy of a 'mini' version of the frameless intrauterine system (IUS) (GyneFix) that has a copper surface area of approximately 200 mm(2). The GyneFix-mini consists of four copper cylinders instead of six and is only 2 cm long. A total of 301 insertions were performed in an open nonrandomized pilot study in parous (77%) and nulligravid/nulliparous (23%) women in Belgium and China. This interim analysis reports on 4110 women-months of use. All women were followed-up for a minimum of 12 months. Two pregnancies occurred with the mini GyneFix IUS in this study. However, only one occurred with the device in situ. The cumulative removal rate for medical reasons (bleeding and pain) was 0.39 at 1 year. The expulsion rate was 1.04. These low event rates resulted in a high continuation rate (95.02 at 1 year). Neither perforations nor pelvic inflammatory disease cases were encountered in this study. This study indicates that only a minimal amount of copper, positioned in the upper part of the uterine cavity, is sufficient to provide a high contraceptive effect. This is made possible by anchoring the active contraceptive substance to the fundus of the uterus. The fact that 100% of the copper surface area of the frameless IUS is available for copper release is an additional advantage.