{"id":2208,"date":"2019-09-09T18:41:23","date_gmt":"2019-09-09T18:41:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjsrh\/?p=2208"},"modified":"2019-09-09T18:41:23","modified_gmt":"2019-09-09T18:41:23","slug":"jaydess-an-underused-ius","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjsrh\/2019\/09\/09\/jaydess-an-underused-ius\/","title":{"rendered":"Jaydess \u2013 An Underused IUS"},"content":{"rendered":"<p style=\"text-align: right\">By L.\u00a0Matytsina-Quinlan<\/p>\n<p>Despite Jaydess\u00a0levonorgestrel\u00a0intrauterine system (LNG-IUS)\u00a0being <a href=\"https:\/\/srh.bmj.com\/content\/familyplanning\/40\/3\/165.full.pdf\">introduced to UK\u00a0users\u00a0in 2014<\/a>, there are no recent publications regarding\u00a0Jaydess\u00a0use. My recently published manuscript, <em><a href=\"https:\/\/srh.bmj.com\/content\/early\/2019\/08\/07\/bmjsrh-2019-200308\">Jaydess audit standards and benefits<\/a><\/em>, 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 <a href=\"https:\/\/www.fsrh.org\/standards-and-guidance\/documents\/cec-ceu-newproductreview-jaydess-apr-14\/\">Summary of Product Characteristics<\/a> states that it is\u00a0not a first choice contraception in\u00a0nulliparous\u00a0women due to its limited clinical\u00a0use.<\/p>\n<p><strong>Cost effectiveness<\/strong><\/p>\n<p>One of the benefits of\u00a0Jaydess\u00a0is that insertion\u00a0is thought to be less painful than a Mirena Coil due to thinner insertion tube, although there is no clinical trials proving this. Furthermore<strong>, <\/strong>Jaydess\u00a0is more cost effective with an NHS price of\u00a0\u00a369.22<strong>\u00a0<\/strong>(compared to\u00a0\u00a388 for\u00a0Mirena).\u00a0Levosert\u00a0IUS is less expensive\u00a0(\u00a366)\u00a0than Mirena\u00a0(\u00a388), but\u00a0similarly\u00a0priced to\u00a0Jaydess\u00a0which is \u00a369.22.<\/p>\n<p><strong>Insertion<\/strong><strong>\u00a0<\/strong><\/p>\n<p>Furthemore. Levorset\u00a0IUS\u00a0has a wide introducer\u00a0at 4.8mm,\u00a0 even wider than\u00a0Mirena\u00a0which is 4.4 mm, while Jaydess is only 3.8mm. (See more <a href=\"https:\/\/www.fsrh.org\/standards-and-guidance\/documents\/ceuguidanceintrauterinecontraception\/\">here<\/a> and <a href=\"https:\/\/www.fsrh.org\/standards-and-guidance\/documents\/new-product-review-levosert-intrauterine-delivery-system-april\/\">here<\/a>.) This would\u00a0would not always be suitable\u00a0in\u00a0nulliparous\u00a0women\u00a0as would cause\u00a0more discomfort and required the use of a local anaesthetic, dilatators and doctors insertion\u00a0(making it, overall, less cost effective). This\u00a0could increase the number\u00a0of cases with\u00a0vaso-vagal\u00a0reaction.\u00a0Local anaesthetic and dilatators are\u00a0available at specialist sexual services, but not at peripheral clinics and not when nurses insert IUDs.<\/p>\n<p>A cervical\u00a0stenosis\u00a0does not contraindicate any intrauterine contraceptive method, but\u00a0is\u00a0likely\u00a0to require insertion in\u00a0a\u00a0gynae\u00a0theatre setting.\u00a0The patient with\u00a0stenosis\u00a0of\u00a0endocervical\u00a0canal in our audit made informed decision for\u00a0Jaydess\u00a0as she wanted to avoid cervical dilatation and\u00a0anaesthetic\u00a0use. Furthermore,\u00a0Jaydess\u00a0IUS was the only choice for insertion at Integrated Sexual Health (ISH) setting to avoid using cervical dilatators.<\/p>\n<p><strong>Mental Health and Jaydess<\/strong><strong>\u00a0<\/strong><\/p>\n<p>Several independent studies have now documented an increased risk of depression development with\u00a0progesterone only contraception, including LNG-IUS, especially in young women. But the level of progesterone in Jaydess IUS is a minimal\u00a0amount\u00a0compared with other types of available progesterone-only contraception. Jaydess IUS releases 13.5mg compared with 52mg\u00a0of\u00a0levonorgestrel\u00a0in\u00a0Mirena\u00a0and\u00a0Levosert. (That\u2019s 3.85 times more than Jaydess) (4,5,6) .<\/p>\n<p>Furthemore, the <a href=\"https:\/\/www.fsrh.org\/standards-and-guidance\/documents\/fsrh-ceu-statement-to-published-systematic-review-the\/\">FSRH CEU Statement<\/a> \u201cThe relationship between progestin hormonal contraception and depression\u201d states that \u201cthe bulk of the evidence does not support an association between use of POC and depression based on validated measures\u201d and that meta-analysis was not possible due to \u201cthe heterogeneity of studies\u201d.<\/p>\n<p>However, all women must be asked about mental health issues,\u00a0including\u00a0depression\u00a0and suicidal ideations,\u00a0as\u00a0contraceptive choice is must take into account a risk assessment, especially\u00a0in\u00a0young\u00a0nulliparous\u00a0women. All women\u00a0should receive\u00a0 information about possible mood effects of progesterone\u00a0containing contraception\u00a0as part of a routine contraception counselling at separate appointments. This is crucial to ensure women who attend ISH service\u00a0 make\u00a0an informed contraception choice prior to IUS insertion.<\/p>\n<p><strong>Adverse Drug Reactions and Clinical Decisions<\/strong><\/p>\n<p>All the patients should be informed about the frequencies of Adverse Drug Reactions (ADRs) reported with\u00a0Jaydess\u00a0and 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 (\u2265 1\/100 to &lt; 1\/10) (3). All the patients in our audit made informed choice. Nobody reported depression at follow up. Only one patient\u00a0(5%)\u00a0in our audit requested\u00a0Jaydess\u00a0removal because of\u00a0low\u00a0mood problems\u00a0in\u00a0conjunction with continuous spotting and discomfort\u00a0after 3 months.<\/p>\n<p>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 \u00a320 per patient compared with Mirena. However, of course, every contraceptive choice must be based on risk assessment.<\/p>\n<p>&nbsp;<\/p>\n<p><strong><a href=\"https:\/\/srh.bmj.com\/content\/early\/2019\/08\/07\/bmjsrh-2019-200308\">Jaydess audit standards and benefits<\/a> by L Matytsina-Quinlan was published in BMJ Sexual and Reproductive Health<\/strong><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By L.\u00a0Matytsina-Quinlan Despite Jaydess\u00a0levonorgestrel\u00a0intrauterine system (LNG-IUS)\u00a0being introduced to UK\u00a0users\u00a0in 2014, there are no recent publications regarding\u00a0Jaydess\u00a0use. 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. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2019\/09\/09\/jaydess-an-underused-ius\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":364,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[599],"tags":[],"class_list":["post-2208","post","type-post","status-publish","format-standard","hentry","category-screening"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jaydess \u2013 An Underused IUS - BMJ Sexual &amp; Reproductive Health blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjsrh\/2019\/09\/09\/jaydess-an-underused-ius\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jaydess \u2013 An Underused IUS - BMJ Sexual &amp; Reproductive Health blog\" \/>\n<meta property=\"og:description\" content=\"By L.\u00a0Matytsina-Quinlan Despite Jaydess\u00a0levonorgestrel\u00a0intrauterine system (LNG-IUS)\u00a0being introduced to UK\u00a0users\u00a0in 2014, there are no recent publications regarding\u00a0Jaydess\u00a0use. 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. 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