Acne Incidence Higher With Higher-Dose LNG-IUS, Meta-Analysis Finds

A new systematic review and meta-analysis highlights the incidence of acne among users of the levonorgestrel-releasing intrauterine system (LNG-IUS), identifying both dosage and age as influential factors. The review included nine randomized controlled trials with a combined 6,305 patients and evaluated LNG-IUS devices at 52 mg, 19.5 mg, and 13.5 mg dosages.

Across all LNG-IUS users, the pooled acne incidence was 15.0% (95% CI; 9.8% to 20.3%). Patients using the 52 mg device had higher acne rates (19.5%; 95% CI 5.2% to 33.7%) compared with those using the 13.5 mg device (13.1%; 95% CI 8.3% to 17.9%; P < 0.001 for difference). Studies enrolling younger populations (mean age ~24 years) had higher acne incidence (19.3%; 95% CI 11.0% to 27.5%).

Notably, when data from Suhonen et al. were excluded, acne incidence estimates dropped significantly across all subgroups, and heterogeneity was reduced in the younger cohort (I² = 0%). However, heterogeneity remained high across most analyses (I² ≈ 95%–97%), reflecting variability in trial design, reporting, and patient demographics.

"These findings suggest that device dosage and age influence acne occurrence among LNG-IUS users," the authors concluded.

Source: de Oliveira ECF, et al. British Journal of Gynecology and Obstetrics. 2025. Doi:10.1111/1471-0528.70108