Abstract
Abstract
Objectives
Levonorgestrel-releasing intrauterine contraceptive devices (LNG-IUDs) are designed to exhibit only local hormonal effects. There is an ongoing debate on whether LNG-IUDs can have side effects similar to systemic hormonal medication. Benign background parenchymal enhancement (BPE) in dynamic contrast–enhanced (DCE) MRI has been established as a sensitive marker of hormonal stimulation of the breast. We investigated the association between LNG-IUD use and BPE in breast MRI to further explore possible systemic effects of LNG-IUDs.
Methods
Our hospital database was searched to identify premenopausal women without personal history of breast cancer, oophorectomy, and hormone replacement or antihormone therapy, who had undergone standardized DCE breast MRI at least twice, once with and without an LNG-IUD in place. To avoid confounding aging-related effects on BPE, half of included women had their first MRI without, the other half with, LNG-IUD in place. Degree of BPE was analyzed according to the ACR categories. Wilcoxon-matched-pairs signed-rank test was used to compare the distribution of ACR categories with vs. without LNG-IUD.
Results
Forty-eight women (mean age, 46 years) were included. In 24/48 women (50% [95% CI: 35.9–64.1%]), ACR categories did not change with vs. without LNG-IUDs. In 23/48 women (48% [33.9–62.1%]), the ACR category was higher with vs. without LNG-IUDs; in 1/48 (2% [0–6%]), the ACR category was lower with vs. without LNG-IUDs. The change of ACR category depending on the presence or absence of an LNG-IUD proved highly significant (p < 0.001).
Conclusion
The use of an LNG-IUD can be associated with increased BPE in breast MRI, providing further evidence that LNG-IUDs do have systemic effects.
Key Points
• The use of levonorgestrel-releasing intrauterine contraceptive devices is associated with increased background parenchymal enhancement in breast MRI.
• This suggests that hormonal effects of these devices are not only confined to the uterine cavity, but may be systemic.
• Potential systemic effects of levonorgestrel-releasing intrauterine contraceptive devices should therefore be considered.
Funder
Universitätsklinikum RWTH Aachen
Publisher
Springer Science and Business Media LLC
Subject
Radiology, Nuclear Medicine and imaging,General Medicine
Reference40 articles.
1. Nelson AL, Massoudi N (2016) New developments in intrauterine device use: focus on the US. Open Access J Contracept 7:127
2. Finer LB, Zolna MR (2016) Declines in unintended pregnancy in the United States, 2008–2011. N Engl J Med 374:843–852
3. Danvers AA, Stuart GS, Bryant AG (2014) Lawsuits against Mirena®: potential impact on public health. Contraception 89:489–492
4. CDC, reproductive health, contraception, birth control methods. Available via https://www.cdc.gov/reproductivehealth/contraception/index.htm On March 15, 2021
5. Conz L, Mota BS, Bahamondes L et al (2020) Levonorgestrel-releasing intrauterine system and breast cancer risk: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 99:970–982. https://doi.org/10.1111/aogs.13817
Cited by
6 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献