Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use

Miranda, Laura; Sousa, Maria Helena de; Faundes, Anibal; Juliato, Cássia

doi:10.1055/s-0041-1726056

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Original Article • Rev. Bras. Ginecol. Obstet. 43 (04) • Apr 2021 • https://doi.org/10.1055/s-0041-1726056 copy

Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use

Taxas de continuação com o sistema intrauterino de liberação de levonorgestrel de 52mg de acordo com o motivo principal de seu uso

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone.

Methods

A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis.

Results

Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group.

Conclusion

The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.

Keywords:
levonorgestrel IUS; indication for use; continuation rate; amenorrhea; bleeding and spotting; counselling

Characteristics of users	Reason for use
	Contraception only		Medical reasons only		p-value
	n	%	n	%
Age (years) (n = 5,045)
≤ 24	629	14.6	37	4.9	< 0.001^a a Pearson chi-squared test; b Yates chi-squared test.
25–34	2,124	49.4	222	29.7
≥ 35	1,544	35.9	489	65.4
Parity (n = 5,037)
1	2,190	51.0	302	40.6	< 0.001^a a Pearson chi-squared test; b Yates chi-squared test.
2	1,633	38.0	283	38.1
≥ 3	471	11.0	158	21.3
Marital status (n = 4,769)
In a stable union	3,325	79.0	395	70.4	< 0.001^b
No steady partner	883	21.0	166	29.6	< 0.001^b
Schooling (n = 4,750)
≤ 12 years	3146	75.0	407	73.5	0.473^b
≥ 13 years	1,050	25.0	147	26.5

Time (years)	Contraception only			Medical reasons only			p-value ^a a Wilcoxon-Gehan test.
Time (years)	Number of users end of the year	Continuation rate (%)	SE rate (%)	Number of users end of the year	Continuation rate (%)	SE rate (%)	p-value ^a a Wilcoxon-Gehan test.
1	4,287	85.8	0.6	747	83.4	1.5	0.002
2	2,451	77.4	0.8	438	76.0	1.8	0.045
3	1,559	70.1	0.9	323	71.3	2.0	0.121
4	1,059	63.2	1.1	245	67.7	2.2	0.166
5	752	57.5	1.2	186	61.2	2.5	0.186

Time of use/ Characteristics	Coef.	SD coef.	p-value
Up to one year
Age (years)	0.020	0.004	< 0.001
Reason for use (contraception)	0.281	0.074	< 0.001
Up to 2 years
Age (years)	0.022	0.004	< 0.001
Reason for use (contraception)	0.177	0.074	0.017
Up to 3 years
Age (years)	0.021	0.004	< 0.001
Up to 4 years
Age (years)	0.022	0.004	< 0.001
Up to 5 years
Age (years)	0.023	0.004	< 0.001

Cause of discontinuation	Indication for using the LNG-IUS
	Contraception		Medical reasons		p-value^a a Chi-squared test with Yates correction.
	N	(%)	N	(%)	p-value^a a Chi-squared test with Yates correction.
After 1 year	4,287		747
Expulsion		7.9		11.6	< 0.001
Bleeding/spotting		0.8		1.3	0.004
Pain		1.4		0.8	0.320
Amenorrhea		0.0		0.0
Acne		0.2		0.2	0.204
Desire to conceive		1.0		0.4	0.004
Other		3.5		2.9	0.061
After 2 years	2,451		438
Expulsion		10.5		15.2	< 0.001
Bleeding/spotting		1.4		2.1	0.023
Pain		2.4		1.8	0.264
Amenorrhea		0.0		0.0
Acne		0.7		0.2	0.194
Desire to conceive		4.0		1.7	0.001
Other		5.8		5.2	0.610
After 3 years	1,559		323
Expulsion		11.9		16.3	< 0.001
Bleeding/spotting		1.8		3.2	0.057
Pain		3.2		1.8	0.257
Amenorrhea		0.0		0.0
Acne		1.0		0.6	0.199
Desire to conceive		8.5		4.2	< 0.001
Other		7.7		6.5	0.807
After 4 years	1,059		245
Expulsion		13.3		17.9	< 0.001
Bleeding/spotting		2.1		3.2	0.087
Pain		4.3		2.3	0.253
Amenorrhea		0.0		0.0
Acne		1.7		0.6	0.227
Desire to conceive		11.7		5.5	0.001
Other		10.6		7.5	0.557
After 5 years	752		186
Expulsion		13.9		18.9	< 0.001
Bleeding/spotting		2.6		5.1	0.113
Pain		5.0		2.3	0.238
Amenorrhea		0.0		0.0
Acne		2.0		0.6	0.236
Desire to conceive		14.5		6.6	< 0.001
Other		14.4		12.0	0.489

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[1] Address for correspondence Laura Miranda, Rua Lôbo de Resende, 100, 13202-440, Jundiaí, SP, Brazil (e-mail: miranda.laura88@gmail.com).