Long-term Reversible Contraceptive Methods (LARCS), mainly represented by copper and levonorgestrel intrauterine devices (IUDs) (Mirena and Kyllena),in addition to subcutaneous implant (Implanon),are widely indicated in family planning practice in primary health care, given their high rates of efficacy, safety and adem. However, such characteristicscan be contradicted due to the occurrence of adverse effects, ranging from simple complications to more severe complications, which require other levels of health care for their management. Taking this into account, it became the objective of thisstudy to analyze the incidence of the main complications in LARCS users in primary care according to the percentage of occurrence. For this purpose, descriptive methodology was used, and a literature review was carried out based on articles published on pubmed, scielo and health journals, including The Brazilian Journal of Health Review. Thus, itwas observed that adversities related to the use of IUDs include dysmenorrhea and bleeding (up to 25%) and, less often, ectopic pregnancy (2.9 to 8.9%) and uterine perforation and adjacent structures (up to 1.3%). In addition, pelvic inflammatory disease has also been reported (less than 1%), being more prevalent in cases of cervicitis pre-existing at device insertion. Regarding subcutaneous implants, more moderate alterations such as amenorrhea (39%), acne (16%), weight gain (35%), headache (36%), dizziness (25%) and mastalgia (14%), as well as changes in the gastrointestinal tract (21%). Thus, according to the evidence collected, the superiority of LARCS in relation to the other methods available in the SUS is notorious, with regard to efficacy versus unwanted effects.
Os Métodos Contraceptivos Reversíveis de Longa Duração (LARCS), representados pelos Dispositivos Intrauterinos (DIU) de Cobre e de Levonorgestrel (Mirena e Kyllena), além do implante subcutâneo (Implanon), são amplamente indicados na prática do planejamento familiar na atenção primária à saúde, dada suas elevadas taxas de eficácia, segurança e adesão. Entretanto, tais aspectos podem ser contraditados devido à ocorrência de efeitos adversos, que variam desde complicações simples a intercorrências mais severas, as quais requerem outros níveis da atenção em saúde para seu manejo. Levando isso em consideração, tornou-se objetivo principal deste estudo analisar a porcentagem de incidência das principais intercorrências em usuárias de LARCS na atenção primária. Para tal fim, utilizou-se da metodologia descritiva, sendo realizado uma revisão bibliográfica com base em artigos publicados nas plataformas PubMed, Scielo e revistas de saúde, incluindo Brazilian Journal of Development. Dessa maneira, observou-se que as adversidades relacionadas ao uso do DIU compreendem dismenorreia e sangramentos (até 25%) e, menos frequentemente, gravidez ectópica (2,9 a 8,9%) e perfuração uterina e de estruturas adjacentes (até 1,3%). Além disso, a doença inflamatória pélvica também foi relatada (menos de 1%), sendo mais prevalente em casos de cervicites pré-existentes à inserção do dispositivo. Em relação ao implante subcutâneo, foram documentadas alterações mais moderadas tais como amenorreia (39%), cefaleia (36%), ganho de peso (35%), tonturas (25%), acne (16%) e mastalgia (14%), além de alterações do trato gastrointestinal (21%). Assim, de acordo com as evidências coletadas, é notório a superioridade dos LARCS em relação aos outros métodos contraceptivos disponíveis no SUS, no que diz respeito à eficácia versus efeitos indesejados, dadas às desprezíveis taxas de adversidades severas relatadas.
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The Long-Term Reversible Contraceptive Methods (LARCS), represented by the Copper and Levonorgestrel Intrauterine Devices (IUD), in addition to the subdermal implant, are widely indicated in the practice of family planning in the scope of primary health care, given their high rates of efficacy, safety and adherence. However, such characteristics can be refuted due to the occurrence of adverse effects, which range from simple complications to more severe complications, which require other levels of health care for their management. Taking this into account, it became the main objective of this study to analyze the degree of incidence of the main complications in users of LARCS in primary care. For this purpose, a descriptive methodology was used, and a literature review was carried out based on articles published in Pubmed, Scielo and health journals, including the Brazilian Journal of Gynecology and Obstetrics. Adversities related to the IUD have been observed to include dysmenorrhea, bleeding, expulsion of the device and, less frequently, ectopic pregnancy, perforation of the uterus and adjacent structures, and pelvic inflammatory disease. In relation to the subdermal implant, alterations such as amenorrhea, acne, weight gain, irritability, headache, dizziness and breast tenderness have been documented. Thus, according to the evidence collected, the superiority of LARCS in relation to other contraceptive methods available in the SUS (Unified Health System) is notorious, with regard to efficacy versus undesired effects.
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