Brazil: A recent study in the journal Contraception suggests placing the 52 mg levonorgestrel (LNG) 52 mg intrauterine system (IUS) following the cesation of bleeding or a reduction of menstrual flow among women having heavy menstrual bleeding. This is because the strategy was related to similar expulsion risk compared to users for contraception.
Abnormal uterine bleeding is the most common ground for women seeking gynecologic care during reproductive age, and can be related to many gynecologic diseases. Women who consult for abnormal uterine bleeding who do not desire more children have been treated with procedure such as endometrial ablation, hysterectomy, and uterine artery embolization. These procedures are limited by their expensive cost and morbidity and mortality associated with its use.
LNG 52 mg IUS was introduced as a successful treatment for heavy menstrual bleeding in recent decades. In 2015, this device was approved by the US FDA as a contraceptive method and as a medical treatment for heavy menstrual bleeding. One of the concerns related to its use is the possibility of expulsion, which certainly impairs the efficacy of treatment.
Against the above background, Ilza Monteiro, University of Campinas Faculty of Medical Sciences (UNICAMP), Campinas, São Paulo, Brazil, and colleagues conducted the study with an objective of comparing the expulsion rates of LNG 52 mg IUS in wiomne with heavy menstrual bleeding compared to women using solely for contraception.
For this purpose, the researchers conducted an audit study of 548 (8.8%) women with heavy menstrual bleeding and 5655 (91.2%) users for contraception (comparison group) for 4 years in Campinas, Brazil. They retrieved expulsion rates, sociodemographic data, and variables associated to device placement. In women with heavy menstrual bleeding, the device was placed after the cesstion of bleeding or after the reduction of menstrual flow.
Following were the study's key findings:
· Thirty-one of 548 (5.6%) women with heavy menstrual bleeding and 315 of 5655 (5.6%) from the comparison group expelled the device.
· This constituted 7.8 expulsions/100 women-years in women with heavy menstrual bleeding and 10.3 expulsions/100 women-years from the comparison group.
· Expulsion risk was associated with previous cesarean delivery in both groups (OR 1.93).
"Expulsion rates of the LNG IUS among women with heavy menstrual bleeding whose IUS was placed after the cessation or reduction of bleeding were same to expulsion rates among users for contraception," wrote the authors. "Previous cesarean delivery was a risk factor for expulsion."
Reference:
The study titled, "Expulsion rates of the levonorgestrel 52 mg intrauterine system are similar among women with heavy menstrual bleeding and users for contraception," was published in the journal Contraception.
DOI: https://doi.org/10.1016/j.contraception.2021.09.001