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In the ongoing quest to discover the lowest effective dose of medical treatments, hormonal intrauterine devices (IUDs) are no exception. In a 3-year, industry-funded, open-label phase III trial, investigators evaluated the safety and efficacy of two small, low-dose levonorgestrel (LNG) IUDs containing 13.5 mg or 19.5 mg LNG. The 2885 participants (age range, 18–35) included parous and nulliparous (39%) women in 11 countries.
From August 2007 to July 2011, 10 pregnancies occurred in each group, representing 0.33 and 0.31 pregnancies per 100 woman-years for the 13.5-mg and 19.5-mg groups, respectively. Five pregnancies were associated with IUD expulsion (four in the 13.5-mg group), and 10 ectopic pregnancies were reported (seven with the 13.5-…