Mirena® system

A 54-year-old woman fitted with a Mirena system soon developed fever and progressive skin lesions. A skin biopsy confirmed Sweet s syndrome. She was treatment with topical and oral glucocorticoids, but the condition relapsed on reduction of the dose. Her symptoms finally resolved on removal of the intrauterine system and she remained symptom free after 9 months. 

Reproductive system Endometrial polyps during tamoxifen treatment can be prevented by the simultaneous use of intrauterine levonorgestrel (the Mirena system), but the method is of limited usefiil-ness, since its effects lasts only as long as the Mirena is in place once it is removed, and while tamoxifen is continued, the polyps recur [57 ]. There are differing opinions on this form of administration (see the special review below). 

The Mirena system for intrauterine administration of levonorgestrel is estimated to release some 20 micrograms of the drug daily. This has been the subject of some sharply differing assessments. In a mailed questionnaire study of 1056 British women who had been treated with this product for menstrual disorders, 73% had continued using the system, having found that it provided relief the most common adverse effect was menstrual spotting (19%) [73 ]. 

Mirena is a relatively new intrauterine contraceptive device that releases levonorgestrel into the uterine cavity for 5 years. Use of this contraceptive device is associated with fewer systemic progestin side effects and is at least as effective as Norplant. 

Sweet s syndrome has been reported several times in women taking oral contraceptives, but a well-documented recent case concerned the use of the Mirena uterine system for the administration of menorrhagia, where the... 

Other complications (acne, alopecia, and pruritus) have been associated with Mirena, an intrauterine system containing levonorgestrel. 

A systematic review of Mirena, an intrauterine progestogen release system (56), has attracted correspondence (57,58). Like other devices, Mirena releases levonorgestrel, in this case 20 micrograms/day. Since it had no greater efficacy than the Copper T device and was very much more costly, the debate has turned on safety. Amenorrhea is common with this device, as with others like it, and correspondents have pointed out that this is regarded by many women as an unwelcome complication. 

Hamill M, Bowling J, Vega-Lopez F. Sweet syndrome and a Mirena intrauterine system. J Fam Planning Reprod Health Care 2004 30 115-6. 

Levonorgestrel-releasing (20 microgram/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives. BJOG 2000 107(10) 1218-25. 

Acceptability of the long-term contraceptive levonorgestrel-releasing intrauterine system Mirena a 3-year followup. Contraception 2003 67 87-91. 

Mirena (Levonorgestrel Intrauterine System). Schering Health Care Ltd. UK Summary of product characteristics, July 2004. 

Robinson R, China S, Bunkheila A, Powell M. Mirena intrauterine system in the treatment of menstrual disorders a survey of UK patients experience, acceptability and satisfaction. J Obstet Gynaecol 2008 28 728-31. 

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