A case series on the use of levonorgestrel 52 mg intrauterine system after organ transplant

Abstract

ObjectiveTo assess the clinical performance (pregnancy and occurrence of pelvic infection) of the levonorgestrel 52-mg intrauterine system (LNG IUS) in solid organ transplant recipients. Study designWe performed a retrospective chart review of all patients seen in the Family Planning Clinic at the University of Campinas Department of Obstetrics and Gynecology from 2007 to 2017 to identify women with solid organ transplantation using immunosuppression who received an LNG IUS. Our routine clinical practice for such patients is to perform initial follow-up 40–60 days after placement and then every 12 months. We analyzed women's sociodemographic characteristics, duration of use of the LNG IUS, continuation and discontinuation reasons, and complications. ResultsOf the 23 women evaluated, 21 had kidney transplantation and 2 had liver transplantation. One woman received an LNG IUS prior to solid organ implantation (1.7 years, renal transplant). The 22 other women received the LNG IUS a median of 6.3 years (interquartile [IQ25–75] range 1.7–15 years). Seventeen (74%) women primarily used the LNG IUS for contraception; the other 6 desired the LNG IUS for contraception and heavy menstrual bleeding (HMB) treatment. We observed no cases of pregnancy or pelvic infection. Over the median follow-up time of 49.3 months (IQ25–75 15–80 months), 7 women used the same IUS for more than 60 months and 8 women received a second IUS. ConclusionsDue to the fact that no pregnancies or pelvic infections were observed in this case series, we concluded that the LNG IUS is an option for transplanted women for contraception and for HMB treatment. ImplicationsWomen at reproductive age after solid organ transplantation needs contraception for long time and the LNG IUS is a safe and effective option.