Kyleena and PCOS: Assessing PROS and CONS

Kyleena and PCOS: Let’s talk about the effects of Kyleena on women with PCOS.

Kyleena is an intrauterine contraceptive device that releases the progestin hormone, Levonorgestrel.

Levonorgestrel is one of the most potent 2nd generation progestin. It is derived from androgens and hence has some negative effects on the metabolic profile in patients with PCOS.

However, because progestins keep the endometrial lining healthy and have far fewer side effects compared to estrogens in women with PCOS, they may be preferred in situations where other contraceptives are contraindicated.

What is Kyleena?

Kyleena is an FDA-approved Levonorgestrel-containing IUD (intrauterine device) indicated for the long-term prevention of pregnancy.

It is effective for up to 5 years and needs to be removed or replaced after five years.

Kyleena contains: 19.5 mg of levonorgestrel

Kyleena releases: Levonorgestrel @ 17.5 mcg/day

Kyleena can be identified by a silver ring seen on ultrasound and blue-colored threads.

Kyleena should not be used in women who are pregnant or for emergency contraception.

It is also contraindicated in women with pelvic inflammation or infection, current or a past history of breast cancer, cervical or uterine cancer, liver disease, and in women with a uterine anomaly [Ref].

Kyleena in Women with PCOS:

Kyleena is a progestin-only contraceptive and may be preferred over other contraceptives containing estrogens.

Progestin-only contraceptives have relatively favorable effects in women because of their anti-androgenic effects.

However, Levonorgestrel is a second-generation progestin and has little antiandrogenic effect compared to Etonorgestrel, the active component of Nexplanon.

Kyleena, Mirena, and Nexplanon are considered second-line of treatment after oral contraceptives for treating menstrual irregularities in women with PCOS.

Oral progestins, and to some extent, progestin-containing IUDs and Implants may help in relieving some of the symptoms of high testosterone in women with PCOS such as acne and hirsutism. 

Kyleena and PCOS:

Kyleena is considered a second line of treatment for prolonged or painful periods in women with PCOS. However, one of the side effects observed in women using Kyleena IUD was ovarian cysts. 

During clinical trials, about 22% of women using Kyleena developed ovarian cysts. About 0.6% of the women had to remove Kyleena because of ovarian cysts.

Since women with PCOS already have ovarian cysts, Kyleena can make these cysts worse.

They may become abnormally enlarged and cause pelvic pain and discomfort.

It was observed that in women who developed cysts while using Kyleena, the cysts disappeared on their own without the need for any medical or surgical interventions.

However, persistently enlarged ovarian cysts may need timely intervention before the cysts become huge.

Kyleena works locally and does not always stop ovulation in women of childbearing age. This means that women using Kyleena can still have regular ovulatory cycles.

Effects of Kyleena on Periods in Women with PCOS:

Kyleena can affect your menstrual cycle and cause changes in your bleeding patterns. This can include spotting, irregular periods, heavy bleeding, having fewer periods (oligomenorrhea), or even not having periods at all (amenorrhea).

In the first 3 to 6 months of using Kyleena, you might have more days with bleeding or spotting, and your periods might not follow a regular schedule. After that initial period, the number of days with bleeding or spotting usually decreases, but your periods may still be irregular.

In studies, about 12% of women using Kyleena stopped having their periods by the end of the first year. A small number (4.8%) of women discontinued using Kyleena because of issues related to uterine bleeding.

To make sure there are no underlying issues like polyps or cancer, it’s important for women with persistent or unusual bleeding to have a check-up before getting Kyleena inserted.

If you notice a significant change in your bleeding after using Kyleena for a while, it’s a good idea to consult your healthcare provider to rule out any potential problems with the uterus lining.

If you’re using Kyleena and your period doesn’t come within six weeks after the previous one, it’s important to consider the possibility of pregnancy.

If pregnancy is ruled out, you usually don’t need to keep taking pregnancy tests unless you experience other pregnancy symptoms or pelvic pain.

Kyleena and Metabolic Profile in Patients with PCOS:

Kyleena, like other female hormones, can impair glucose tolerance. Insulin resistance is increased resulting in dysglycemia.

In a meta-analysis that evaluated the effect of contraceptives on the metabolic parameters in women, it was found that Levonorgestrel, the active component of Kyleena, resulted in lowering HDL levels (good cholesterol), an increase in LDL levels, and an increase in Triglyceride levels.

Interestingly, there was no significant effect on insulin resistance, fasting blood glucose, and BMI.

Kyleena Vs Mirena in Women with PCOS:

Kyleena and Mirena are both IUDs for preventing pregnancy. Both are effective for up to 5 years.

Both Kyleena and Mirena contain levonorgestrel, however, their doses are different. Mirena contains 52 mg Levonorgestrel while Kyleena contains 19.5 mg Levonorgestrel.

Kyleena releases Levonorgestrel at a rate of 17.5 mcg/day while Mirena releases Levonorgestrel at a rate of 21 mcg/day.

Both Kyleena and Mirena effectively prevent pregnancy in up to 99% of the patients.

In women with PCOS, Kyleena and Mirena’s IUD are considered second-line interventions for reducing menstrual bleeding and pain.

These intrauterine devices keep the uterine lining healthy, rather than in an overstimulated state, and may prevent the development of uterine cancer.

In conclusion:

Kyleena use in women with PCOS has its own PROS and CONS. Pros include less pain and better cycles without added androgenic effects like acne or hirsutism.

CONS include impaired metabolic profiles such as low HDL, elevated LDL and triglycerides, and impaired glucose tolerance.