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

Abstract

Objective To evaluate whether continuation rates with the 52-mg levonorgestrel-releasing 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.

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

“…18 A retrospective cohort that evaluated continuation rates of the 52-mg LNG-IUS in the general population found continuation rates for the entire group of 85, 77, 70, 64, and 58 per 100 women years at 1, 2, 3, 4, and 5 years after insertion, respectively. 11 The main reason for the discontinuation of LNG-IUS in this group was acne, which contrasts with previous studies. 6,11,15 Younger patients are more likely to report acne onset or worsening, possibly due to the higher incidences of acne in this age group.…”

“…18 A retrospective cohort that evaluated continuation rates of the 52-mg LNG-IUS in the general population found continuation rates for the entire group of 85, 77, 70, 64, and 58 per 100 women years at 1, 2, 3, 4, and 5 years after insertion, respectively. 11…”

“…The main reason for the discontinuation of LNG-IUS in this group was acne, which contrasts with previous studies. 6 11 15 Younger patients are more likely to report acne onset or worsening, possibly due to the higher incidences of acne in this age group. 15 19 In addition, our study's patients who had previously used oral contraceptives were more likely to report worsening acne (RR 1.68).…”

“…10 Several studies have demonstrated high continuity rates for using the 52-mg levonorgestrel-releasing system (LNG-IUS) among young women. [11][12][13] Counseling candidates about possible bleeding patterns and adverse effects could lead to lower IUD discontinuation rates. 11 Contraceptive counseling should include anticipatory guidance for adolescents and their parents regarding possible menstrual changes (such as lighter bleeding, spotting, or amenorrhea), side effects (such as acne, headaches, nausea, breast tenderness, and mood changes), and noncontraceptive benefits such as management of irregular or abnormal uterine bleeding and treatment of dysmenorrhea.…”

“…[11][12][13] Counseling candidates about possible bleeding patterns and adverse effects could lead to lower IUD discontinuation rates. 11 Contraceptive counseling should include anticipatory guidance for adolescents and their parents regarding possible menstrual changes (such as lighter bleeding, spotting, or amenorrhea), side effects (such as acne, headaches, nausea, breast tenderness, and mood changes), and noncontraceptive benefits such as management of irregular or abnormal uterine bleeding and treatment of dysmenorrhea. 14 Regarding the side effects of LNG-IUS, some studies demonstrated that participants aged between 16 and 35 years old at enrollment were significantly more likely to report new or worsening acne, dyspareunia, pelvic pain, and dysmenorrhea.…”