The 52mg levonorgestrel-releasing intrauterine system (LNG-IUS), the Mirena® (Bayer), is a long-acting reversible contraceptive which releases 20mcg of levonorgestrel daily into the uterine cavity. The LNG-IUS is licensed for use as contraception and for heavy menstrual bleeding (1). Its ‘off-label’ uses include treating dysmenorrhoea, endometriosis, and endometrial hyperplasia (2, 3, 4). A lower dose 19.5 mg LNG-IUS is now available; its use for non-contraception conditions is unclear. In this paper LNG-IUS will refer only to the 52mg LNG-IUS.

The LNG-IUS has a favourable side effect profile. Progesterone-related side effects are minimal (migraine, mastalgia, nausea, weight gain, mood disturbance) (5), and initial irregular bleeding tends to improve after 3-6 months. Uncommon complications include pelvic pain, infection, uterine perforation and expulsion (2).

For many clinicians, concerns regarding sexually transmitted infection risk, future fertility, and insertion difficulty have limited use of the LNG-IUS in adolescents (6,7). However, over the past two decades there has been increasing experience using LNG-IUS in adolescents, with evidence of high efficacy and satisfaction rates (7,8). It was first available in 1990 (1998 in Australia), with use in adolescents at The Royal Children's Hospital(RCH) in Melbourne from 2000 (9). Since then, its use at RCH has progressively increased, mainly for menstrual management, heavy menstrual bleeding, and dysmenorrhea.

Increasingly, the LNG-IUS is being utilised to manage menstrual concerns amongst specific adolescent groups including gender diverse youth, patients with an intellectual disability (ID), and patients with a chronic pain history (10,11). The LNG-IUS has been well studied in adolescents with an ID and is recognised to be safe and effective for menstrual management (11, 12, 13). Conversely, data relating specifically to LNG-IUS use and satisfaction amongst gender diverse youth and adolescents with chronic pain is limited (10,14). The available evidence is often conflicting and more pertinent to LNG-IUS use in adult populations, making it difficult to draw meaningful conclusions that can guide clinical practice in adolescents.

Studies describing success of LNG-IUS use in adolescent populations are limited to its use as a contraceptive, or for menstrual suppression in patients with intellectual disability (ID) (13,15, 16, 17, 18, 19). The aim of this study is thus to review the use of the LNG-IUS at the RCH in diverse adolescent populations and identify factors predicting removal in adolescents.