After how long should a Levonorgestrel (LNG) IUCD be replaced?

Appeared in: Raj. CHO -2020

Explanation

The Levonorgestrel-releasing intrauterine system (LNG-IUS) is a hormonal contraceptive.
The most common LNG-IUDs, such as Mirena (52 mg) and Kyleena (19.5 mg), are approved by the FDA for five years of continuous use.
The device works by slowly releasing the progestin hormone levonorgestrel, which thickens cervical mucus, thins the uterine lining, and may prevent ovulation.
After five years, the hormone reservoir depletes, reducing its contraceptive effectiveness, which necessitates replacement.

Visual 1: Infographic - A clear comparison chart showing images of the different IUDs (Mirena, Kyleena, ParaGard), their names, whether they are hormonal or copper, and their approved duration of use. This helps learners visually associate the device with its lifespan.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Replacement duration of Levonorgestrel (LNG) Intrauterine Contraceptive Device (IUCD) as background academic context rather than a clinical decision trigger.
A key nursing responsibility is patient education. The nurse must ensure the patient knows which type of IUD she has received and its specific replacement date to prevent contraceptive failure and unplanned pregnancies.
Nurses must instruct patients on how to perform a monthly self-check for the IUD strings and to recognize warning signs (e.g., severe pain, fever, foul discharge, missed period) that require immediate medical follow-up.
What if? If a patient with a 5-year LNG-IUD presents at 6 years, having forgotten to replace it, the nurse's first action is to assess for pregnancy. A urine pregnancy test should be performed, and emergency contraception should be discussed if there has been recent unprotected intercourse.

How to Approach the Question

First, identify the keyword in the question: 'Levonorgestrel (LNG) IUCD'. This specifies a hormonal IUD.
Recall the different types of contraceptives and their durations of action. Differentiate hormonal methods from non-hormonal methods.
Specifically, contrast the duration of the LNG-IUD with the Copper T IUD, as this is a common point of confusion.
Recall that the standard LNG-IUD (like Mirena) is effective for 5 years.
Compare this fact with the given options. 'Five years' matches the known duration.
Eliminate the other options: 10 years (for Copper T), and 15/20 years (not standard for any IUD).

Concept Tested & Keywords

Concept Tested: Replacement duration of Levonorgestrel (LNG) Intrauterine Contraceptive Device (IUCD).
Stem keywords: Levonorgestrel, LNG, IUCD, replaced
Lead-in keywords: After how long

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DC Dutta's Textbook of Obstetrics p. 32-35

Practise the full Raj. CHO -2020

Attempt every question from this paper in a timed mock, then review the full solution for each one.