Generic Name

Eligard

Mechanism

Eligard delivers a local dose of levonorgestrel (LNG), a synthetic progestin, directly into the uterine cavity. The high intrauterine concentration of LNG produces several pharmacologic effects that prevent pregnancy:
• Endometrial thickening: induces a decidua‑like state that impairs implantation.
• Cervical mucus modification: increases thickness and reduces pH, creating a hostile environment for sperm.
• Inhibition of ovulation: at the highest LNG dose, suppression of the luteinizing hormone surge may occur, although ovulation is reduced but not reliably blocked in all users.

Thus, Eligard protects against fertilization, implantation, and early embryonic development.

Pharmacokinetics

Key note: Because systemic absorption is low, systemic side effects are rare and mild.

Indications

• Primary prevention of pregnancy in women aged 15–45 with a documented IAA/IUD (intra‑uterine device) in situ.
• Long‑term contraception for up to 3 years.
• Appropriate for women who desire non‑hormonal copper IUD alternatives or for those with copper key‑antagonistic ferron with side‑effects.

Contraindications

• Absolute contraindications: congenital uterine anomalies (e.g., complete absence of uterus), active pelvic inflammatory disease (PID), known or suspected ectopic pregnancy.
• Relative contraindications: previous failed IUD insertion, unknown pregnancy status, active infections, syphilis or HIV untreated.
• Warnings:
• Hypersensitivity to levonorgestrel or polymer components.
• Coagulation abnormalities or platelet dysfunction (rare).
• Use caution in patients on drugs strongly inducing CYP3A4 (e.g., rifampin) which may reduce local LNG levels.

Dosing

• Insertion: Performed in a sterile office setting. Insert the pre‑loaded applicator into the cervical os and thrust the IUS into the endometrial cavity. The copper‑free loop glides into place.
• Re‑placement: If the IUS is expelled or reportedly expulsed, reinsertion is possible after evaluation.
• Removal: Pull the string gently; or perform a hysteroscopic removal if string retrieval fails.

Recommended lifespan: 3 years (36 months).

Adverse Effects

Note: Because LNG release is uterine localized, systemic adverse effects seen with oral levonorgestrel (e.g., mood changes, weight gain) are uncommon.

Monitoring

• Insertion check: Verify correct placement (US or observation) and document string location.
• Bleeding pattern: Counsel patients; expect spotting up to 6 months.
• Expulsion surveillance: Educate on spotting/expulsion signs; request return visit if expulsion suspected.
• Pregnancy test: Conduct if bleeding changes or expulsion.
• Follow‑up: Re‑visit at 1–3 months post‑placement for initial assessment, then annually or when indicated.

Clinical Pearls

• Lower systemic bioavailability → minimal estrogen‑mediated side effects; ideal for women avoiding systemic hormonal therapy.
• Expulsion risk (~4–5 %) is higher in nulliparous or post‑supervision IUD insertions; counseling on insertion technique and using ultrasound guidance can reduce this.
• Contraceptive reliability: >99 % effective after 12 months when correctly inserted; essentially “set‑and‑forget.”
• Bone health: As a progestin‑only device, does not negatively impact bone mineral density, an advantage over combined oral contraceptives in young women.
• Infection consideration: Perform routine pelvic exam before insertion; treat any symptomatic PID prior to IUS placement to avoid infection spread.

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• Keywords: Eligard, levonorgestrel IUD, uterine contraception, pregnancy prevention, drug insertion, pharmacokinetics, contraindications, patient counseling.