Reactions 1704, p9 - 2 Jun 2018
psychiatric adverse events
According to study results reported in Drug Safety,
there is an association "consistent with a causal effect"
between levonorgestrel-containing IUDs (LNG-IUDs)
and anxiety or sleep problems; no significant
associations were found with panic attacks or
The cohort study used data from the UK’s THIN
general practice database in 2000
2016 to investigate
the incidence of psychiatric adverse events in new users
of non-hormonal IUDs (n=6871) or LNG-IUDs
(n=10 872). Evaluation continued for up to 5 years from
the start of treatment.
The incidence of depression, a known outcome used
as a positive control, was 22%. The incidence of anxiety
was 13.5%, along with 6.8% for sleep problems, 1.4%
for panic attacks, and 0.3% for restlessness.
In patients without a prior history of psychiatric
disorders, there was a significantly higher risk in LNG-
IUD users compared with non-hormonal IUD users of
depression (adjusted hazard ratio [HR] 1.17; 95% CI
1.08, 1.26), anxiety (HR 1.18; 1.08, 1.29) and sleep
problems (HR 1.22; 1.08, 1.38). The risk was not
significantly increased for panic attacks (HR 1.01; 0.79,
1.30) or restlessness (HR 0.95; 0.53, 1.72), although the
authors note that the much lower frequency of these
outcomes "mean that power was lacking to investigate
these outcomes". Results followed a similar pattern for
patients with a prior history of psychiatric disorders, but
the differences were not statistically significant.
"Substantive differences in baseline characteristics of
the treated groups make robust conclusions difficult"
note the authors, particularly gynaecological conditions
like menorrhagia, "but the results strongly suggest that
additional studies are warranted".
Slattery J, et al. Cohort Study of Psychiatric Adverse Events Following Exposure
to Levonorgestrel-Containing Intrauterine Devices in UK General Practice. Drug
Safety : 21 May 2018. Available from: URL: https://doi.org/10.1007/
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