The 52-mg levonorgestrel-releasing intrauterine system in the transition from contraception to menopausal hormone therapy in perimenopausal women: a narrative literature review

Introduction. The perimenopausal transition is accompanied by progressive decline in ovarian function, variability of sex steroid secretion, menstrual cycle disturbances, abnormal uterine bleeding (AUB), and vasomotor and psychoemotional symptoms. Despite age-related decline in fertility, a risk of unintended pregnancy remains in sexually active women of late reproductive age thereby emphasing a choice of effective and safe contraception as a clinically important task.

Aim: to analyze and summarize current literature assessing 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) use during the transition from contraception to menopausal hormone therapy (MHT) in perimenopausal women, focusing on contraceptive efficacy, endometrial protection, safety, tolerability, and its place among alternative strategies.

Materials and Methods. A narrative literature review in PubMed/MEDLINE, ScienceDirect, eLibrary, and Google Scholar databases was carried out. Publications addressing the use of the 52-mg LNG-IUS in late reproductive-age and perimenopausal women were included primarily assessing contraceptive efficacy, AUB control, endometrial protection during estrogen-containing MHT, safety, tolerability, and patient-oriented outcomes.

Results. The 52-mg LNG-IUS is a highly effective long-acting reversible contraceptive method with additional non-contraceptive benefits, including reduction of menstrual blood loss, treatment of heavy menstrual bleeding, and prevention of endometrial hyperplasia. In perimenopause, the system may simultaneously provide contraception and AUB control; when estrogen therapy is initiated, it may serve as a local progestogen component of MHT and protect the endometrium. This approach may be particularly relevant for women with contraindications to estrogen-containing contraception, a need for a long-term delivery method, and concomitant menstrual cycle disorders.

Conclusion. The 52-mg LNG-IUS may be considered a clinically relevant tool for transition from contraception to MHT in perimenopausal women. However, data on long-term oncological, cardiovascular, and metabolic outcomes remain heterogeneous. Chosing this strategy should be individualized according to age, bleeding pattern, endometrial status, risk profile, contraindications to alternative methods, and patient preferences.

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