Download PDF
CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(11): e654-e660
DOI: 10.1055/s-0043-1776032
Original Article
Contraception

Five-year Contraceptive Use of 52-mg Levonorgestrel Releasing Intrauterine System in Young Women, Menstrual Patterns, and New Contraceptive Choice

Cinco anos de uso contraceptivo do sistema intrauterino liberador de levonorgestrel 52 mg em mulheres jovens, padrões menstruais e nova escolha contraceptiva
Elaine Cristina Fontes de Oliveira 
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
,
Ana Luiza Lunardi Rocha 
1   Departament of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective To evaluate the continuation rates of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) during the first 5 years of use, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year, in adolescents and young women.

Methods The present study was a 5-year prospective cohort conducted in a Family Planning Service of a tertiary hospital in Brazil. We selected 100 healthy women between 15 and 24 years old who used 52-mg LNG-IUS for contraception. The clinical follow-up of these women took place from June 2017 to December 2022. The study evaluated the continuation rates of the method, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year. Continuous data were reported as mean ± standard deviation (SD) and range (minimum-maximum). Categorical variables were described as percentages.

Results The continuation rates of LNG-IUS were 89.1% (82/92), 82.9% (72/87), 75.3% (64/85), 70.5% (60/85), and 64.2% (54/84) in the 1st, 2nd, 3rd, 4th, and 5th years of use, respectively. The main reason for discontinuation was acne (11/30). Amenorrhea rates were 50, 54.1, 39, 35.7, and 51.8% at 12, 24, 36, 48, and 60 months, respectively. All patients who completed the study and needed contraception after the 5th year opted for long-acting contraceptive methods (LARC).

Conclusion The LNG-IUS showed high continuation rates in adolescents and young women in the first 5 years of use. Most patients who completed the study chose a LARC method after the 5th year.

Resumo

Objetivo Avaliar as taxas de continuação do sistema intrauterino liberador de levonorgestrel (SIU-LNG) 52 mg durante os primeiros 5 anos de uso, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano, em adolescentes e mulheres jovens.

Métodos O estudo foi uma coorte prospectiva de 5 anos realizada em um Serviço de Planejamento Familiar de um hospital terciário no Brasil. Selecionamos 100 mulheres saudáveis entre 15 e 24 anos que usaram o SIU-LNG 52 mg para contracepção. O acompanhamento clínico dessas mulheres ocorreu de junho de 2017 a dezembro de 2022. O estudo avaliou as taxas de continuação do método, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano. Os dados contínuos foram relatados como média ± DP e intervalo (mínimo-máximo). As variáveis categóricas foram descritas como porcentagens.

Resultados As taxas de continuação do SIU-LNG foram 89,1% (82/92), 82,9% (72/87), 75,3% (64/85), 70,5% (60/85) e 64,2% (54/84) no 1°, 2°, 3°, 4° e 5° anos de uso, respectivamente. O principal motivo de descontinuação foi a acne (11/30). As taxas de amenorreia foram de 50, 54,1, 39, 35,7 e 51,8% aos 12, 24, 36, 48 e 60 meses, respectivamente. Todas as pacientes que completaram o estudo e necessitaram de contracepção após o 5° ano optaram por métodos contraceptivos de longa duração (LARC).

Conclusão O SIU-LNG apresentou altas taxas de continuação em adolescentes e mulheres jovens nos primeiros 5 anos de uso. A maioria das pacientes que completou o estudo escolheu um método LARC após o 5° ano.

Keywords

levonorgestrel intrauterine system - adolescents - amenorrhea - menstruation - contraception - long-acting reversible contraception

Palavras-chave

sistema intrauterino de levonorgestrel - adolescentes - amenorreia - menstruação - contracepção - contracepção reversível de longa duração

Contributions

ECFO conceived the study, performed the experiments, analyzed data, and wrote the paper. ALLR conceived the study, analyzed data, and wrote the paper.




Publication History

Received: 08 April 2023

Accepted: 24 July 2023

Article published online:
29 November 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Sedgh G, Finer LB, Bankole A, Eilers MA, Singh S. Adolescent pregnancy, birth, and abortion rates across countries: levels and recent trends. J Adolesc Health 2015; 56 (02) 223-230
    CrossrefPubMedGoogle Scholar
  • 2 Apter D. Contraception options: Aspects unique to adolescent and young adult. Best Pract Res Clin Obstet Gynaecol 2018; 48: 115-127
    CrossrefPubMedGoogle Scholar
  • 3 Lindberg L, Santelli J, Desai S. Understanding the decline in adolescent fertility in the United States, 2007–2012. J Adolesc Health 2016; 59 (05) 577-583
    CrossrefPubMedGoogle Scholar
  • 4 Birgisson NE, Zhao Q, Secura GM, Madden T, Peipert JF. Preventing Unintended Pregnancy: The Contraceptive CHOICE Project in Review. J Womens Health (Larchmt) 2015; 24 (05) 349-353
    CrossrefPubMedGoogle Scholar
  • 5 Jatlaoui TC, Riley HEM, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception 2017; 95 (01) 17-39
    CrossrefPubMedGoogle Scholar
  • 6 Aoun J, Dines VA, Stovall DW, Mete M, Nelson CB, Gomez-Lobo V. Effects of age, parity, and device type on complications and discontinuation of intrauterine devices. Obstet Gynecol 2014; 123 (03) 585-592
    CrossrefPubMedGoogle Scholar
  • 7 Braverman P, Adelman W, Alderman E. et al; Committee on Adolescence. Contraception for adolescents. Pediatrics 2014; 134 (04) e1244-e1256
    CrossrefPubMedGoogle Scholar
  • 8 Francis JKR, Gold MA. Long-Acting Reversible Contraception for Adolescents: A Review. JAMA Pediatr 2017; 171 (07) 694-701
    CrossrefPubMedGoogle Scholar
  • 9 Burke PJ, Coles MS, Di Meglio G, Gibson EJ, Handschin SM, Lau M. et al; Society for Adolescent Health and Medicine. Sexual and reproductive health care: a position paper of the Society for Adolescent Health and Medicine. J Adolesc Health 2014; 54 (04) 491-496
    CrossrefPubMedGoogle Scholar
  • 10 Daniels K, Abma JC. Current contraceptive status among women aged 15-49: United States, 2017-2019. NCHS Data Brief 2020; (388) 1-8
    PubMedGoogle Scholar
  • 11 Miranda L, Sousa MH, Faundes A, Juliato C. Continuation Rates of the 52-mg Levonorgestrel-releasing Intrauterine System according to the Primary Reason for its Use. Rev Bras Ginecol Obstet 2021; 43 (04) 291-296
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Sznajder KK, Tomaszewski KS, Burke AE, Trent M. Incidence of Discontinuation of Long-Acting Reversible Contraception among Adolescent and Young Adult Women Served by an Urban Primary Care Clinic. J Pediatr Adolesc Gynecol 2017; 30 (01) 53-57
    CrossrefPubMedGoogle Scholar
  • 13 Jones AE, Kaul S, Harding J, Weldon DLM, Akers AY. Follow-Up Care and 6-Month Continuation Rates for Long-Acting Reversible Contraceptives in Adolescents and Young Adults: A Retrospective Chart Review. J Pediatr Adolesc Gynecol 2020; 33 (01) 39-44
    CrossrefPubMedGoogle Scholar
  • 14 Adeyemi-Fowode OA, Bercaw-Pratt JL. Intrauterine Devices: Effective Contraception with Noncontraceptive Benefits for Adolescents. J Pediatr Adolesc Gynecol 2019; 32 (5S): S2-S6
    CrossrefPubMedGoogle Scholar
  • 15 Teal SB, Turok DK, Chen BA, Kimble T, Olariu AI, Creinin MD. Five-Year Contraceptive Efficacy and Safety of a Levonorgestrel 52-mg Intrauterine System. Obstet Gynecol 2019; 133 (01) 63-70
    CrossrefPubMedGoogle Scholar
  • 16 Pritt NM, Norris AH, Berlan ED. Barriers and facilitators to adolescents' use of long-acting reversible contraceptives. J Pediatr Adolesc Gynecol 2017; 30 (01) 18-22
    CrossrefPubMedGoogle Scholar
  • 17 Oliveira ECF, Baêta T, Cotta RCF, Rocha ALL. Use of 52-mg Levonorgestrel-Releasing Intrauterine System in Adolescents and Young Adult Women: 3-Year Follow-Up. J Pediatr Adolesc Gynecol 2023; 36 (01) 45-50
    CrossrefPubMedGoogle Scholar
  • 18 Usinger KM, Gola SB, Weis M, Smaldone A. Intrauterine Contraception Continuation in Adolescents and Young Women: A Systematic Review. J Pediatr Adolesc Gynecol 2016; 29 (06) 659-667
    CrossrefPubMedGoogle Scholar
  • 19 Habeshian KA, Cohen BA. Current Issues in the Treatment of Acne Vulgaris. Pediatrics 2020; 145 (Suppl. 02) S225-S230
    CrossrefPubMedGoogle Scholar
  • 20 Lullo JJ, Ethington E, Arshanapalli A, Reserva J, Jiang A, Adams W. et al. Incidence of androgenic dermatologic side effects following placement of a levonorgestrel intrauterine device for menorrhagia: A survey-based study. J Am Acad Dermatol 2018; 79 (02) 364-365
    CrossrefPubMedGoogle Scholar
  • 21 Lortscher D, Admani S, Satur N, Eichenfield LF. Hormonal Contraceptives and Acne: A Retrospective Analysis of 2147 Patients. J Drugs Dermatol 2016; 15 (06) 670-674
    PubMedGoogle Scholar
  • 22 Hidalgo M, Bahamondes L, Perrotti M, Diaz J, Dantas-Monteiro C, Petta C. Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years. Contraception 2002; 65 (02) 129-132
    CrossrefPubMedGoogle Scholar
  • 23 Madden T, McNicholas C, Zhao Q, Secura GM, Eisenberg DL, Peipert JF. Association of age and parity with intrauterine device expulsion. Obstet Gynecol 2014; 124 (04) 718-726
    CrossrefPubMedGoogle Scholar