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Intrauterine Device Outcomes in Young Women with Heavy Menstrual Bleeding: Comparing Patients with and without Inherited Bleeding Disorders

      ABSTRACT

      Study Objective

      To evaluate the use of intrauterine devices (IUDs) in two young women's hematology clinics and compare adverse events in adolescents with and without inherited bleeding disorders (BDs)

      Design

      Retrospective multicenter cohort study from February 2014 through February 2020

      Setting

      Young women's hematology clinics at Nationwide Children's Hospital in Columbus, Ohio, and Children's Medical Center in Dallas, Texas

      Participants

      Female patients evaluated for heavy menstrual bleeding (HMB) who underwent IUD placement

      Interventions and Main Outcome Measures

      Rates of IUD expulsion, malposition, and ongoing HMB requiring additional medical treatment

      Results

      We identified 43 patients with BDs and 35 patients without BDs who underwent placement of an IUD for HMB. The mean age was 14.9 years (range 11.0-21.4 years) at the time of presentation and 15.8 years (range 11.0-21.4 years) at IUD placement. Those with BDs were younger at the time of IUD insertion. Most patients (90%) had previously failed other methods to control HMB. The annual rate of IUD adverse events was 0.25 per year of use, and all adverse events occurred in the first 20 months after placement. There were no significant differences in adverse IUD events in patients with and without BDs, although those without BDs requested IUD removal more frequently.

      Conclusions

      In this cohort of adolescent females, the presence of a BD was not associated with a higher IUD expulsion rate. IUD placement should be considered a first-line option for adolescents with BDs who experience HMB.

      Key Words

      Abbreviations:

      HMB (heavy menstrual bleeding), BDs (bleeding disorders), LNG-IUD (levonorgestrel-releasing intrauterine device), BMI (body mass index), IUD-EFS (IUD event-free survival)
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