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 1^st and 2^nd 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.

Resumo

Objetivo Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas.

Métodos Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavam somente por razoes médicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida

Resultados No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia.

Conclusão A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.

Keywords

levonorgestrel IUS - indication for use - continuation rate - amenorrhea - bleeding and spotting - counselling

Palavras-chave

sistema liberador de levonorgestrel (SIUS) - indicação para uso - taxa de continuação - amenorreia - sangramento e microrragia intermenstrual - aconselhamento

Contributions

Laura Miranda and Anibal Faúndes prepared the research proposal, including this analysis, and collected the data. Laura Miranda and Anibal Faúndes wrote the first draft of the article, which was reviewed by Cássia Juliato and Maria Helena de Sousa. Maria Helena de Sousa was also responsible for the data analysis.

Financial Support

The present study received partial financial support from the Foundation for Research Support of the State of São Paulo (FAPESP) grant No. 2015/20504–9 and from the National Council for Scientific and Technological Development (CNPq, in the Portuguese acronym) grant No. 573747/2008–3. The International Contraceptive Access Foundation, Turku, Finland, has been donating the LNG-IUS devices used at this clinic since 2007 under an unrestricted grant.

Publication History

Received: 30 August 2020

Accepted: 06 January 2021

Article published online:
12 May 2021

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