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Rev Bras Ginecol Obstet 2016; 38(05): 210-217
DOI: 10.1055/s-0036-1583758
Original Article
Thieme Publicações Ltda Rio de Janeiro, Brazil

The Use of Long Acting Reversible Contraceptives and the Relationship between Discontinuation Rates due to Menopause and to Female and Male Sterilizations

Uso de contraceptivos reversíveis de longa duração e a relação entre taxas de descontinuidade devido à menopausa e à esterilização de homens e mulheres
Jessica Mayra Ferreira
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
,
Ilza Monteiro
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
,
Sara Castro
2   Family Planning Clinic, Women's Hospital (CAISM), Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
,
Marina Villarroel
2   Family Planning Clinic, Women's Hospital (CAISM), Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
,
Carolina Silveira
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
,
Luis Bahamondes
1   Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas – Unicamp, Campinas, SP, Brazil
› Author Affiliations
Further Information

Publication History

01 January 2016

16 March 2016

Publication Date:
17 May 2016 (online)

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Abstract

Introduction Women require effective contraception until they reach menopause. The long acting reversible contraceptives (LARC) and the depot-medroxyprogesterone acetate (DMPA, Depo-Provera®, Pfizer, Puurs, Belgium) are great options and can replace possible sterilizations.

Purpose To assess the relationship between the use of LARCs and DMPA and terminations ascribed to menopause and sterilizations in a Brazilian clinic.

Methods We reviewed the records of women between 12 and 50 years of age attending the clinic that chose to use a LARC method or DMPA. Cumulative termination rates due to sterilization or because the woman had reached menopause were computed using single decrement life-table analysis over 32 years. We also examined all records of surgical sterilization at our hospital between the years 1980–2012.

Results Three hundred thirty-two women had continuously used the same contraceptive until menopause, and 555 women had discontinued the method because they or their partners underwent sterilization. From year 20 to year 30 of use, levonorgestrel intrauterine-releasing system (LNG-IUS – Mirena®, Bayer Oy, Turku, Finland; available since 1980), copper intrauterine device (IUD – available since 1980) and DMPA users showed a trend of cumulative higher discontinuation rates due to menopause when compared with the discontinuation rates due to sterilization. Over the study period, a steep decline in the use of sterilization occurred.

Conclusion Over the past 15 years of research we have observed a trend: women usually preferred to continue using LARC methods or DMPA until menopause rather than decide for sterilization, be it their own, or their partners'. The annual number of sterilizations dropped in the same period. The use of LARC methods and DMPA until menopause is an important option to avoid sterilization, which requires a surgical procedure with potential complications.

Resumo

Introdução Mulheres necessitam de contracepção até atingirem a menopausa. Os contraceptivos reversíveis de longa duração e o acetato de medroxiprogesterona de depósito (AMPD) são ótimas opções para substituir possíveis esterilizações.

Objetivo Avaliar a relação entre o uso de contraceptivos reversíveis de longa duração (LARCs) e AMPD com terminações atribuídas à menopausa e a esterilizações em uma clínica brasileira.

Métodos Revisamos os registros de mulheres entre 12 e 50 anos de idade atendidas em clínica e que escolheram usar LARC ou AMPD. Índices de terminação acumulada devido à esterilização ou à menopausa foram computados usando análise de tabela de vida durante 32 anos. Também examinamos todos os registros de cirurgias de esterilização em nosso hospital no período de 1980 a 2012.

Resultados Trezentas e trinta e duas mulheres usaram continuamente o mesmo contraceptivo até a menopausa, e 555 mulheres não deram continuidade ao método pelo fato de elas ou seus parceiros terem se submetido à esterilização. De 20 a 30 anos de uso, usuários de sistema intrauterino de levonorgestrel, dispositivo intrauterino de cobre e AMPD apresentaram tendência de maiores índices de descontinuidade devido à menopausa quando comparados a índices de descontinuidade devido à esterilização. No período de estudo, ocorreu um declínio acentuado no uso de esterilização.

Conclusão Nos últimos 15 anos do estudo, foi observada uma tendência na qual mulheres optaram mais por continuar usando LARC ou AMPD até a menopausa do que pela esterilização própria ou de seus parceiros. O número anual de esterilizações caiu no mesmo período. O uso de LARC e AMPD até a menopausa é uma opção importante para evitar a esterilização, que exige um procedimento cirúrgico com potenciais complicações.

Keywords

long acting reversible contraceptives - sterilization - menopause - copper IUD - LNG-IUS

Palavras-chave

contraceptivos reversíveis de longa duração - esterilização - menopausa - Diu de cobre - SIU-LNG
 

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