Association between menorrhagia and risk of intrauterine device–related uterine perforation and device expulsion: results from the Association of Uterine Perforation and Expulsion of Intrauterine Device study

Demographic, Reproductive, and Medical Risk Factors for Intrauterine Device Expulsion

“…Our finding that diagnosed heavy menstrual bleeding is a risk factor for IUD expulsion is consistent with other APEX-IUD analyses and with other studies. 2,3,14 One of the LNG-IUD types has an indication for treatment of heavy menstrual bleeding, and the majority of individuals with a recent or past diagnosis of heavy menstrual bleeding, or both, were LNG-IUD users in our study. An increased risk of expulsion in individuals with a history of heavy menstrual bleeding was also observed in the (much smaller) copper IUD cohort.…”

“…12,13 The study also evaluated risks of IUD expulsion and uterine perforation in individuals with heavy menstrual bleeding and by IUD type (copper IUDs vs levonorgestrel-releasing intrauterine systems [LNG-IUDs]). 14,15 Although APEX-IUD was conducted to address a postmarketing requirement from the U.S. Food and Drug Administration, data from the study were also used to address questions raised by the European Medicines Agency about specific demographic, reproductive, and medical risk factors associated with IUD expulsion. The objective of this analysis of APEX-IUD data was to determine the extent to which six variables of interest to the European Medicines Agency were independent risk factors for IUD expulsion among individuals with no record of delivery in the past year-age, race and ethnicity, parity, BMI, history of heavy menstrual bleeding, and history of dysmenorrhea-and the extent to which these risk factor associations differed for LNG-IUD compared with copper IUD users.…”

“… 12 , 13 The study also evaluated risks of IUD expulsion and uterine perforation in individuals with heavy menstrual bleeding and by IUD type (copper IUDs vs levonorgestrel-releasing intrauterine systems [LNG-IUDs]). 14 , 15 …”

Heavy Menstrual Bleeding Treatment With a Levonorgestrel 52-mg Intrauterine Device

“…12,13 Two recent retrospective studies have compared expulsion rates in levonorgestrel 52-mg IUD users desiring contraception or with subjective heavy menstrual bleeding. 14,15 A Brazilian analysis reported identical expulsion rates of 5.6% over an average follow-up duration of 45 months among contraceptors (n55,655) and those with subjective heavy menstrual bleeding (n5548). 14 However, a much larger retrospective study that used data from three integrated health care systems found an adjusted hazard ratio of 2.84 (95% CI 2.66-3.03) for expulsion among patients with a listed heavy menstrual bleeding diagnosis (n531,600) com-pared with those without the diagnosis (n5197,234).…”

“… 14 However, a much larger retrospective study that used data from three integrated health care systems found an adjusted hazard ratio of 2.84 (95% CI 2.66–3.03) for expulsion among patients with a listed heavy menstrual bleeding diagnosis (n=31,600) compared with those without the diagnosis (n=197,234). 15 Recent studies have shown higher expulsion rates in IUD users who are parous 12 , 16 and have obesity. 12 The prior phase 3 levonorgestrel 52-mg IUD heavy menstrual bleeding study performed in the United States reported a 6% expulsion rate at 6 months.…”