# Levonorgestrel Intrauterine System

> Levonorgestrel intrauterine system for NEET-PG Obstetrics and Gynaecology, covering mechanism, contraception, menorrhagia, hyperplasia and side effects.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/levonorgestrel-intrauterine-system
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Hatcher's Contraceptive Technology; Dutta's Textbook of Obstetrics
- How to cite: "Levonorgestrel Intrauterine System", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/levonorgestrel-intrauterine-system

## Direct answer

The levonorgestrel intrauterine system is a T-shaped device that releases about 20 micrograms of levonorgestrel daily and provides contraception for several years. Beyond contraception, it treats heavy menstrual bleeding and endometrial hyperplasia without atypia, and it protects the endometrium in women receiving unopposed oestrogen replacement.

## What you must remember

- **Mechanism:** Local progestogen thickens cervical mucus and atrophies the endometrium. Ovulation is not consistently suppressed.
- **Duration:** Five years for most products in India, though newer labels extend the 52 mg system to eight years, so quote the product named.
- **Menorrhagia:** Substantially reduces menstrual blood loss, and is a standard option for heavy bleeding without a structural cause.
- **Endometrial hyperplasia:** Effective for hyperplasia without atypia, which can avoid hysterectomy in suitable women.
- **HRT protection:** Protects the endometrium in women on unopposed oestrogen.
- **Common side effects:** Irregular spotting early on, amenorrhoea in many users, functional ovarian cysts, acne and mood change.
- **Contraindications:** Pregnancy, active pelvic infection, breast cancer and active liver disease.

## A stepwise pathway for choosing LNG-IUS

The vignette usually presents a woman with a specific complaint, and the pathway below shows how the device fits.

1. **Define the indication:** The same device serves contraception, heavy menstrual bleeding, endometrial protection and hyperplasia without atypia.
2. **Exclude contraindications:** Pregnancy, pelvic infection, breast cancer and active liver disease are excluded before insertion.
3. **Insert under copper IUD rules:** Timing follows the same principles as for copper IUD, including postpartum and post-abortion insertion.
4. **Counsel about bleeding:** Irregular spotting usually settles over three to six months, and amenorrhoea is common and acceptable to many women.
5. **Follow up and replace:** Review after the first few months and remove or replace the device at the end of its licensed period.

The same device can be chosen for different purposes, so the indication decides the expected duration and follow-up. A vignette often tests whether the student identifies the indication before choosing an option.

## Where the exam tries to catch you

LNG-IUS questions often test the difference between expected side effects and warning signs, and between hyperplasia with and without atypia.

- **Trap:** Removing the device at once for early irregular bleeding. — **Correct:** Early spotting is expected and usually settles, but persistent bleeding needs infection and pathology excluded first.
- **Trap:** Assuming the LNG-IUS reliably blocks ovulation. — **Correct:** Its action is mainly local on the cervix and endometrium, so ovulation may continue.
- **Trap:** Using the device alone for atypical hyperplasia. — **Correct:** It is effective mainly for hyperplasia without atypia, and atypical hyperplasia needs specialist assessment and consideration of hysterectomy.

## Frequently asked questions

### What is the main use of levonorgestrel IUS beyond contraception?

Beyond contraception, the levonorgestrel intrauterine system is used to treat heavy menstrual bleeding and endometrial hyperplasia without atypia. It also protects the endometrium in women receiving unopposed oestrogen replacement therapy.

### Does the levonorgestrel intrauterine system suppress ovulation consistently?

The levonorgestrel intrauterine system does not consistently suppress ovulation, because its effect is mainly local on the endometrium and cervical mucus. Its contraceptive action therefore rests on local changes rather than reliable ovulation suppression.

### Which side effects of levonorgestrel IUS are most common?

Irregular spotting in the early months and amenorrhoea are the most common side effects of the levonorgestrel intrauterine system. Functional ovarian cysts, acne and mood changes can also occur, and most irregular bleeding settles over the first few months.

### Which conditions contraindicate levonorgestrel IUS insertion?

Pregnancy, active pelvic infection, breast cancer and active liver disease contraindicate levonorgestrel intrauterine system insertion. Unexplained vaginal bleeding should be evaluated before insertion so that underlying pathology is not missed.