By L. Matytsina-Quinlan
Despite Jaydess levonorgestrel intrauterine system (LNG-IUS) being introduced to UK users in 2014, there are no recent publications regarding Jaydess use. My recently published manuscript, Jaydess audit standards and benefits, is a result of a small audit. This audit is an important first step towards increasing clinical use because more robust data are required to confirm advantages of offering Jaydess. The Summary of Product Characteristics states that it is not a first choice contraception in nulliparous women due to its limited clinical use.
One of the benefits of Jaydess is that insertion is thought to be less painful than a Mirena Coil due to thinner insertion tube, although there is no clinical trials proving this. Furthermore, Jaydess is more cost effective with an NHS price of £69.22 (compared to £88 for Mirena). Levosert IUS is less expensive (£66) than Mirena (£88), but similarly priced to Jaydess which is £69.22.
Furthemore. Levorset IUS has a wide introducer at 4.8mm, even wider than Mirena which is 4.4 mm, while Jaydess is only 3.8mm. (See more here and here.) This would would not always be suitable in nulliparous women as would cause more discomfort and required the use of a local anaesthetic, dilatators and doctors insertion (making it, overall, less cost effective). This could increase the number of cases with vaso-vagal reaction. Local anaesthetic and dilatators are available at specialist sexual services, but not at peripheral clinics and not when nurses insert IUDs.
A cervical stenosis does not contraindicate any intrauterine contraceptive method, but is likely to require insertion in a gynae theatre setting. The patient with stenosis of endocervical canal in our audit made informed decision for Jaydess as she wanted to avoid cervical dilatation and anaesthetic use. Furthermore, Jaydess IUS was the only choice for insertion at Integrated Sexual Health (ISH) setting to avoid using cervical dilatators.
Mental Health and Jaydess
Several independent studies have now documented an increased risk of depression development with progesterone only contraception, including LNG-IUS, especially in young women. But the level of progesterone in Jaydess IUS is a minimal amount compared with other types of available progesterone-only contraception. Jaydess IUS releases 13.5mg compared with 52mg of levonorgestrel in Mirena and Levosert. (That’s 3.85 times more than Jaydess) (4,5,6) .
Furthemore, the FSRH CEU Statement “The relationship between progestin hormonal contraception and depression” states that “the bulk of the evidence does not support an association between use of POC and depression based on validated measures” and that meta-analysis was not possible due to “the heterogeneity of studies”.
However, all women must be asked about mental health issues, including depression and suicidal ideations, as contraceptive choice is must take into account a risk assessment, especially in young nulliparous women. All women should receive information about possible mood effects of progesterone containing contraception as part of a routine contraception counselling at separate appointments. This is crucial to ensure women who attend ISH service make an informed contraception choice prior to IUS insertion.
Adverse Drug Reactions and Clinical Decisions
All the patients should be informed about the frequencies of Adverse Drug Reactions (ADRs) reported with Jaydess and medical leaflets were given to all patients as part of their routine counselling. Within each frequency grouping, undesirable effects are presented in order of decreasing seriousness. Frequencies of depression are defined as common (≥ 1/100 to < 1/10) (3). All the patients in our audit made informed choice. Nobody reported depression at follow up. Only one patient (5%) in our audit requested Jaydess removal because of low mood problems in conjunction with continuous spotting and discomfort after 3 months.
In summary, this audit showed that the majority of patients were happy with Jaydess: 16 (80%) kept Jaydess and two (10 %) had IUS re-insertion. Our audit highlights a high rate of users under the age of 25 who were satisfied with Jaydess at 1 year. As a result, we would recommend promoting Jaydess in nulliparous patients. IUS standards were achieved in the majority of the criteria. Follow up is important as it reflects patient satisfaction. A prospective outcome of the audit is that nulliparous patients could benefit from Jaydess insertion. It is also cost effective, as Jaydess could be beneficial for patients planning to have children in 3 years, saving approximately £20 per patient compared with Mirena. However, of course, every contraceptive choice must be based on risk assessment.
Jaydess audit standards and benefits by L Matytsina-Quinlan was published in BMJ Sexual and Reproductive Health