Consecutive Use of the 52 mg Levonorgestrel-releasing Intrauterine System: Variations in Bleeding Patterns

Wittmann, Barbara Zantut; Monteiro, Ilza; Juliato, Cássia; Fernandes, Arlete

doi:10.1055/s-0040-1708092

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article, Contraception • Rev Bras Ginecol Obstet. 42 (4) • Apr 2020 • https://doi.org/10.1055/s-0040-1708092 copy

Consecutive Use of the 52 mg Levonorgestrel-releasing Intrauterine System: Variations in Bleeding Patterns

Uso consecutivo do sistema intrauterino de levonorgestrel 52 mg: Variações no padrão de sangramento

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

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.

Methods

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.

Results

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.

Conclusion

Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.

Keywords
levonorgestrel intrauterine system; consecutive use; bleeding patterns

Variables	n = 301 (100%) n (%)
Age at IUS-1 placement, mean (SEM)	32.0 (0.35)
Age at IUS-2 placement, mean (SEM) ^* * Missing = 2 (299 women evaluated);	37.7 (0.37)
Schooling (years), n (%) ^ Missing = 7 (294 women evaluated);
≤ 8	243 (82.6)
> 8	51 (17.1)
Marital status, n (%) ^* ***** Missing = 4 (297 women evaluated).
With a partner	246 (82.8)
Without a partner	51 (17.1)
Number of pregnancies, mean (SD)	1.7 (0.9)
Number of deliveries, mean (SD)	1.5 (0.8)
Length of use of the IUS-1 (months), mean (SEM)	68.9 (0.97)
Length of use of the IUS-2 (months), mean (SEM)	20.3 (0.96)

Variables	Amenorrhea n = 132 (43.8%) n (%)	Infrequent n = 72 (23.9%) n (%)	Regular n = 75 (24.9%) n (%)	Frequent/prolonged n = 22 (7.3%) n (%)	p- value ^* * Kruskal Wallis test;
Age at IUS-1, mean (SD) ^¶ ¶ Age at first placement;	31.8 (6.1)	32.3 (6.0)	32.0 (6.0)	33.1 (7.7)	0.742
Age at IUS-2, mean (SD) ^¥ ¥ Age at second placement;	37.9 (6.2)	37.8 (6.4) ^* * Missing = 1 (71 women evaluated);	37.1 (6.6) ^ Missing = 1 (74 women evaluated).	38.3 (8.4)	0.758
Number of pregnancies, mean (SD)	1.7 (0.9)	1.9 (0.8)	1.8 (0.9)	1.6 (1.4)	0.082
Number of deliveries, mean (SD)	1.5 (0.7)	1.7 (0.7)	1.6 (0.8)	1.4 (0.9)	0.183
Number of abortions, mean (SD)	0.1 (0.5)	0.1 (0.4)	0.3 (0.7)	0.1 (0.6)	0.362
Length of use of IUS-1, months, mean (SD)	73.0 (10.4)	68.7 (17.4)	63.8 (22.4)	63.1 (18.3)	0.0002 ^# # Post-hoc Dunn test - amenorrhea > frequent/prolonged and amenorrhea > regular; spotting > frequent/prolonged;
Length of use of IUS-2, months, mean (SD)	21.9 (16.8)	16.6 (15.6)	20.0 (18.2)	23.5 (13.4)	0.055
Total length of use months, mean (SD)	95.4 (21.0)	85.4 (18.2)	84.3 (21.7)	86.5 (23.6)	0.0006 ^& & Post-hoc Dunn test - amenorrhea > frequent/prolonged and amenorrhea > regular;

Bleeding pattern	Last 90 days of use of the IUS-1 n = 301 n (%)	Length of use of the IUS-2
Bleeding pattern	Last 90 days of use of the IUS-1 n = 301 n (%)	≤ 6 months n = 80 n (%)	> 7 months-6 years n = 221 n (%)
Amenorrhea	132 (43.8)	35 (43.7)	118 (53.4)
Infrequent	72 (23.9)	24 (30.0)	62 (28.0)
Regular	75 (24.9)	17 (21.2)	30 (13.5)
Frequent/prolonged	22 (7.3)	4 (5.0)	11 (4.9)

Bleeding pattern with IUS-1	Bleeding pattern with IUS-2
Bleeding pattern with IUS-1	Amenorrhea n = 118 n (%)	Infrequent n = 62 n (%)	Regular n = 3 0n (%)	Frequent/prolonged n = 11 n (%)	p-value^@ @ McNemar test. Excludes the 80 women with length of use of the IUS-2 ≤ 6 months.
Amenorrhea, n = 104	70 (59.3)	25 (40.3)	3 (10.0)	6 (54.5)	0.012
Infrequent, n = 48	23 (19.5)	19 (30.6)	5 (16.6)	1 (9.0)
Regular, n = 50	16 (13.5)	14 (22.5)	18 (60.0)	2 (18.1)
Frequent/prolonged, n = 19	9 (7.6)	4 (6.4)	4 (13.3)	2 (18.1)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Arlete Maria dos Santos Fernandes, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil (e-mail: arlete@fcm.unicamp.br).