What is the rate of release of levonorgestrel into the uterus from Mirena, a progestin releasing intrauterine device?
**Core Concept**
The Mirena intrauterine device (IUD) is a type of hormone-releasing contraceptive that delivers a steady, low dose of levonorgestrel directly into the uterine cavity. This localized delivery of the progestin hormone helps prevent pregnancy by thickening cervical mucus, thinning the uterine lining, and altering the endometrial environment to make it inhospitable for implantation.
**Why the Correct Answer is Right**
The rate of release of levonorgestrel from Mirena is carefully controlled to provide a consistent, therapeutic dose of the hormone to the uterus. This controlled release is achieved through the use of a small reservoir of levonorgestrel embedded in the IUD, which is designed to release a steady 20 micrograms of the hormone per day. This rate of release is tailored to mimic the natural fluctuations of menstrual hormones, helping to maintain a healthy uterine environment and prevent unintended pregnancy.
**Why Each Wrong Option is Incorrect**
**Option B:** 30 microgm/d is incorrect because it is higher than the actual rate of release, which could potentially lead to excessive levels of levonorgestrel in the uterus and adverse effects.
**Option C:** 50 microgm/d is incorrect because it is significantly higher than the actual rate of release, which could result in excessive hormone levels and increased risk of side effects.
**Option D:** 70 microgm/d is incorrect because it is far higher than the actual rate of release, which could lead to severe hormonal imbalances and adverse effects.
**Clinical Pearl / High-Yield Fact**
It's essential to note that the Mirena IUD is designed for long-term use, typically up to 5 years, and can be effective in managing heavy menstrual bleeding and endometriosis symptoms.
✓ Correct Answer: A. 20 microgm/d