Abstract
Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52 mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use. We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p < 0.05. We evaluated 301 women aged (mean ± SD) 32 (±6.1) years, with lengths of use of 68.9 (±16.8) and 20.3 (±16.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for ≥ 7 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p = 0.012). No differences were observed among the 80 women with ≤ 6 months of use. Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.
Highlights
Changes in bleeding patterns occur during the use of LNG-intrauterine system (IUS) and should not be decisive for the early replacement of the device
The authors reported that as LNG decreased over time, the amenorrhea rate decreased from 41.8% at 84 months to 31.5% at 102 months of use, but no correlations were found between serum LNG levels and bleeding patterns.[11]
We reviewed the medical charts of 316 women who received a 2nd consecutive levonorgestrel-releasing intrauterine system (LNG-IUS) on the same day as the removal of the 1st one at the end of the approved lifespan
Summary
The 52 mg levonorgestrel-releasing intrauterine system (LNG-IUS) is a long-acting, reversible contraceptive method, used as treatment for heavy menstrual bleeding.[1,2] It has been widely used with high satisfaction rates, and many women opt for the insertion of a new IUS after the end of the approved lifespan of 5 years.[3,4] In addition, it has been reported that this device could be used beyond the approved 5-year lifetime, and data have been published up to 7 years of use, which improves cost-effectiveness.[5,6,7] some users and healthcare professionals (HCPs) associate changes in bleeding patterns at the end of the approved lifespan with decreasing contraceptive efficacy of the method, which does not seem supported by the medical literature.[5,6,7]The high effectiveness of LNG-IUS is attributable to two mechanisms of local action: the antiproliferative effect upon the endometrium, which induces amenorrhea, and the effect on cervical mucus, which impairs sperm penetration.[8,9,10] The 52 mg LNG-IUS releases 20 μg/day immediately after device placement and declines over time to 10 to 12 μg/day up to 5 years of use; LNG has been detected in the 8th year of use.[11,12] The serum mean (ÆSEM) LNG levels decreased from 253 Æ 27 pg/ml (range, 86–760) during the first 2 months after placement to 137 Æ 12 (range, 23–393) at 7 years of use and 119 Æ 9 pg/ml (range, 110–129) at 8 years after placement.[11]. The authors reported that as LNG decreased over time, the amenorrhea rate decreased from 41.8% at 84 months to 31.5% at 102 months of use, but no correlations were found between serum LNG levels and bleeding patterns.[11]
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