Sustanon 250 for saletherapeutic intrauterine system (IUS) releasing levonorgestrel, has a mainly local gestagenic action. Progestogen (levonorgestrel) is released directly into the uterine cavity, it can be used in extremely low daily dose. High concentrations of levonorgestrel endometrial help to reduce the sensitivity of its estrogen and progesterone receptors, making the endometrium insensitive to estradiol and providing strong antiproliferativnos action. When using Mirena observed morphological changes of the endometrium and a weak local reaction to the presence of a foreign body in the uterus. The thickening of the mucous membrane of the cervical canal prevents the penetration of sperm into the uterus. Prevents fertilization, due to oppression and mobility of sperm function in the uterus and fallopian tubes. In some women, ovulation occurs and depression.
Prior use of does not affect the reproductive function. Approximately 80% of women who want to have children, pregnancy occurs within 12 months after the removal of the IUD.
In the first months, due to inhibition of proliferation of the endometrium of the process, there may be an initial increase in spotting. Following this, a pronounced suppression of the endometrium leading to a reduction in the duration and volume of menstrual bleeding in women using. Scarce bleeding is often transformed into oligo- or amenorrhea. At the same time ovarian function and the level of estradiol in the blood are normal.By the end of the third month from the date of installation in women with menorrhagia, the volume of menstrual bleeding was reduced by 88%. When menorrragii caused by submucosal fibroid, treatment effect is less pronounced. The decrease menstrual blood loss reduces the risk of iron deficiency anemia.Mirena also reduces the severity of dysmenorrhea.
Sustanon 250 for sale in preventing endometrial hyperplasia during continuous estrogen therapy was equally high in both oral and transdermal application of an estrogen. Observed at moioterapii estrogen incidence of endometrial hyperplasia was 20%. In a clinical study in used perimsnoiauze women and 259 postmenopausal women; during the observation period up to 5 years in the group of women who were postmenopausal, no cases of endometrial hyperplasia. Pharmacokinetics
Taken internally levonorgestrel is rapidly and completely absorbed; its absolute bioavailability is close to 90%. Levonorgeetrel binds to serum albumin and binding globulin sex steroids (SHBG). Relative distribution (free, bound to albumin, linked to GTN) GTN is dependent on the concentration in the blood serum. Only about 2.5% of levonorgestrel serum in free form, while 47.5% and 50% bound to SHBG and albumin, respectively. The mean volume of distribution of levonorgestrel is about 137 L, and the rate of metabolic clearance of serum – about 5.7 l / h. The terminal half-life of levonorgestrel in serum after a single reception is within 14-20 hours. Lsvonorgsstrel as metabolites released in about equal proportions with urine and feces. Metabolites have weak or no pharmacological activity have generally shu. The main metabolite in urine – tetragidronorgestrel, which accounts for 10% of the radioactivity was detected in urine after administration of radiolabeled levonorgestrel with.
Approximately 0.1% of the dose received by the mother of levonorgestrel can pass through breast milk to the baby.
- Idiopathic menorrhagia.
- Prevention of endometrial hyperplasia during estrogen replacement therapy.
- Pregnancy or suspected it.
- Existing or recurrent inflammatory diseases of the pelvic organs.
- Infections of the lower genital tract.
- Postpartum endometritis.
- Septic abortion during the last three months. Cervicitis.
- Diseases accompanied by increased susceptibility to infections.
- Cervical Dysplasia.
- Malignant tumors of the uterus or cervix.
- Progestogen-dependent tumors, including breast cancer.
- Abnormal uterine bleeding of unknown etiology.
- Congenital or acquired abnormalities of the uterus, including fibroids, leading to deformation of the uterine cavity.
- Acute liver disease or a tumor.
- Hypersensitivity to the drug.
Application with caution
under the following conditions MIRENA should be used with caution, after consultation with a specialist. It discuss whether removal system in the presence of nerve or any of the conditions listed below:
- migraine, focal migraine with asymmetrical visual loss or other symptoms indicating transient cerebral ischemia,
- unusually severe headache;
- severe hypertension;
- severe circulatory disorders, including stroke and myocardial infarction
Pregnancy and lactation
Should not be used during pregnancy or suspected it. If pregnancy occurs in women during Mirena use, it is recommended to remove the IUD, since any intrauterine contraceptive left in situ, increases the risk of miscarriage and premature birth. Removal of sustanon 250 for sale or probing of the uterus may result in spontaneous abortion. If you carefully remove the intrauterine contraceptive can not be, it should discuss the appropriateness of abortion. If a woman wants to keep the pregnancy and IUD can not be removed, the patient should be informed about the risks and possible consequences of premature birth to the child. In such cases of pregnancy should be carefully monitored. It is necessary to exclude ectopic pregnancy. A woman should explain that she should report any symptoms suggestive of complications of pregnancy, particularly the colicky abdominal pain, accompanied by fever.
Due to the use of intrauterine and local action of the hormone can not completely exclude its teratogenic effects (especially virilization). Due to the high contraceptive efficacy of Mirena clinical experience relating to the outcomes of pregnancy in its application is limited. However, women should be informed that to date evidence of birth defects caused by the use Mirena if they continue the pregnancy until delivery without removing the IUD, no.
Levonorgestrel has been found in hrudnom milk, but it is unlikely to represent a risk for the child if doses released Mirren, located in the uterine cavity.
It is believed that the use of any progestogen-only contraceptive method six weeks after childbirth has no adverse effect on the growth and development of the child. Progestogen-only methods do not affect the quantity and quality of breast milk. It was reported about rare cases of uterine bleeding in women using MIRENA during lactation.
Dosage and administration
Mirena is inserted into the uterine cavity and is effective for five years. Lsvonorgesgrela release rate in vivo in the beginning is about 20 micrograms per day and after five years reduced to about 11 micrograms per day. The average release rate of levonorgestrel – about 14 micrograms per day for up to five years. MIRENA may be used in women receiving hormone replacement therapy, in combination with oral estrogen or tranedermalnymi preparations containing no progestogen.
When properly installed, Mirena, carried out in accordance with the instructions for use, the Pearl index (an indicator of the number of pregnancies in 100 women using a contraceptive during the year) is approximately 0.1% per year. 11ri expulsion or perforation Pearl Index may increase.
Instructions on the use of IUDs and handling of
Mirena is supplied in a sterile package which is opened only immediately prior to installation of the intrauterine system. You must abide by the rules of aseptic handling with opening system. If the sterility of the package seems to be impaired, the IUD should be destroyed as medical waste. The same should apply to the Navy, and removed from the uterus, because it contains hormone residues.
Installation, removal and replacement of the intrauterine system
is recommended that MIRENA installed only by a doctor who has experience working with this Navy or well trained for this procedure.
Before installing Mirena woman should be informed about the effectiveness, risks and side effects of the IUD. It is necessary to hold a general and gynecological examination, including a pelvic examination and breast, as well as the smear from the cervix. It is necessary to exclude pregnancy and diseases, sexually transmitted infections, and genital infections have to be completely cured. Determine the position of the uterus and the size of its cavity. Especially important to the correct location of Mirena in the bottom of the uterus, which provides uniform exposure to the progestogen on the endometrium, IUD prevents expulsion and create conditions for its maximum effectiveness. Therefore, you should carefully fulfill the requirements of the installation instructions Mirena. Since the installation of equipment in the uterus various Navy is different, special attention should be paid to practicing proper technique specific installation system.
The woman should be reevaluated in 4-12 weeks after installation, and then 1 time per year, or more frequently if clinically indicated.
Women of childbearing age MIRENA be installed into the uterus within seven days from the onset of menses. IUDs can also be installed immediately after the abortion in the first trimester of pregnancy.
Postpartum IUD insertion should be delayed until involution of the uterus does not happen, but at least 6 weeks after delivery. If involution is significantly delayed, you can postpone the procedure until the completion of involution. If you have trouble installing the Navy and / or very severe pain or bleeding during or after the procedure, you should immediately conduct a physical and ultrasonography (US) to avoid perforation.
It can be set at any time to protect the endometrium during estrogen replacement therapy in women with amenorrhea Mirena; in women with preserved menstrual installation is carried out in the last days of menstruation or withdrawal bleeding.
MIRENA should not be used for emergency contraception.
Prior to installation, Mirena should be excluded pathological processes in the endometrium, as in the first months of its application are often marked by irregular bleeding / spotting. You should also exclude the pathological processes in the endometrium when bleeding occurs after the onset of estrogen replacement therapy in women, which continues to use MIRENA, previously set for contraception. Appropriate diagnostic measures should be taken and when irregular bleeding occur during long-term treatment.
MIRENA is removed by gently pulling the strings captured forceps. If the thread is not visible, and the system is in the uterine cavity, it can be removed with the traction hook for extraction of the IUD. The extension of the cervical canal may be required.
The system should be removed after five years after installation. If a woman wants to continue using the same method, a new system can be installed immediately after the removal of the previous one.
If desirable pregnancy, women of childbearing age must perform removal of the IUD during menstruation, provided that the menstrual cycle is saved. If the system is removed in the middle of the cycle, and the woman in the previous week had sexual intercourse, she is at risk of getting pregnant, except in cases where the new system was installed immediately after removing the old one. Installing and removing the IUD may be accompanied by a certain pain and bleeding. The procedure can cause fainting due to a vasovagal reaction, or a seizure in epileptic patients.
Side effects are more likely to develop in the first months after the introduction of Mirena in the uterus; with prolonged use they will gradually disappear.
It is very common side effects (observed in more than 10% of women using MIRENA) include uterine / vaginal bleeding, spotting, and oligo-amenorrhea, benign ovarian cysts. The average number of days during which spotting in women of childbearing age is gradually reduced from nine to four days per month during the first six months after IUD insertion. The number of women with prolonged (more than eight days), bleeding is reduced from 20 to 3% in the first three months of use of Mirena. In clinical studies, it sustanon 250 for sale has been found that in the first year of Mirena 17% of women had amenorrhea duration of at least three months. When MIRENA is used in combination with estrogen replacement therapy in the first months of treatment in the majority of women in the peri- and post-menopausal observed spotting and irregular bleeding. In the future, their frequency decreases, and approximately 40% of women treated with this therapy in the last three months of the first year of treatment of bleeding in general disappear.Changes in the nature of bleeding are more common in the perimenopausal period than in postmenopausal. The frequency of benign ovarian cysts depends on the diagnostic method used. According to clinical trials enlarged follicles have been diagnosed in 12% of women using MIRENA. In most cases, the increase in the follicles are asymptomatic and disappear within three months. The table presents side effects that are classified by body system, according to MedDRA. The frequency corresponds to clinical studies. q pharma