Pretreatment With Mifepristone Prior to Mirena Insertion

Study Overview
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Brief Summary
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Hypothesis: Pretreatment with mifeprsitone prior to Mirena placement will induce amenorrhea and reduce bleeding irrregularities during the initial months of Mirena use.

Detailed Description
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The levonorgestrel releasing intrauterine system (IUS), Mirena, represents a highly effective contraceptive method that is cost-effective and requires limited patient effort. Furthermore Mirena offers numerous noncontraceptive benefits and addresses different medical needs for women in reproductive and non reproductive age. Side effects such as menstrual abnormalities are important reasons for early discontinuation of a contraceptive method. Irregular bleeding pattern and spotting represents a well known adverse effect during the first months of use with Mirena and corresponds to the most important factor that negatively influences the acceptability of the IUS. Up to today no standard treatment has been suggested to resolve this issue. By inducing amenorrhea within a short period of treatment with an anti-progesterone, mifepristone, prior to insertion of Mirena, the bleeding irregularities during the first months of use might be reduced and could therefore represent an important strategy for increasing acceptability of this contraceptive system. The purpose of the present study is to evaluate the bleeding pattern during the first months of use of Mirena in patients treated with mifepristone compared to placebo in women using Mirena for contraception. The study will also address the effect of mifepristone on endometrial morphology and breast tissue.

Official Title
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Pre-treatment With Mifepristone in Patients With Mirena for Optimizing Bleeding Pattern in Pre-menopausal Women

Conditions
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Women in Need of Long Acting Reversibel Cntraception With the Intrauterine Levonorgestrel Releasing System, Mirena

Intervention / Treatment
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* Drug: Mifepristone prior to Mirena
* Drug: Placebo prior to Mirena insertion


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Pre-menopausal women, >/= 18 years of age. Desire of Mirena for contraception Good general health (as judged by; general physical examination Willing and able to participate after giving informed consent Exclusion criteria: Any hormonal treatment or IUD use within 2 months prior to study start History of malignant disorder of the breast Any contraindication to mifepristone Pregnancy or breast feeding within 2 months prior to study start

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mifepristone prior to Mirena<br>Pretreatment with mifepristone prior to Mirena insertion | Drug: Mifepristone prior to Mirena<br> <br> * Other names: Mifepristone;|
| Placebo Comparator: Placebo prior to Mirena<br>Pretreatment with placebo prior to Mirena insertion | Drug: Placebo prior to Mirena insertion<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Days with bleeding and spotting | To study the effect of pre-treatment with mifepristone on the initial bleeding pattern in women using LNG-IUS (Mirena) | During the first 3 months of Mirena use | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Endometrial changes | To study the effect of mifepristone pre treatment on the endometrium in women before and during treatment with Mirena with special regard to progesteron receptor modulator associated endometrial changes observed following continuos treatment with mifeprsitone (PAEC). | 3 months post Mirena insertion | 
| Effects on breast tissue | Breast biopsies are obtained at baseline and following 2 months treatment with mifepristone | Evaluated at end of mifeprsitone treatment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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LNG-IUS, Mirena, Contraception, Bleeding, Hormonal effects in the breast