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)To read this article in full you will need to make a payment
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References
- Bleeding disorders among young women: a population-based prevalence study.Acta Obstet Gynecol Scand. 2006; 85: 200-206https://doi.org/10.1080/00016340500342912
- Heavy menstrual bleeding in adolescents.J Pediatr Adolesc Gynecol. 2017; 30: 335-340https://doi.org/10.1016/j.jpag.2017.01.002
- Bleeding disorders in adolescents with heavy menstrual bleeding in a multicenter prospective US cohort.Haematologica. 2020; 105: 1969https://doi.org/10.3324/haematol.2019.225656
- Intrauterine devices: effective contraception with noncontraceptive benefits for adolescents.J Pediatr Adolesc Gynecol. 2019; 32: S2-S6https://doi.org/10.1016/j.jpag.2019.07.001
- Standardizing care to manage bleeding disorders in adolescents with heavy menses—A joint project from the ISTH pediatric/neonatal and women's health SSCs.J Thromb Haemost. 2020; 18: 2759-2774https://doi.org/10.1111/jth.14974
- Malposition and expulsion of the levonorgestrel intrauterine system among women with inherited bleeding disorders.Haemophilia. 2013; 199330938https://doi.org/10.1111/hae.12184
- Levonorgestrel-releasing intrauterine system for the management of heavy menstrual bleeding in women with inherited bleeding disorders: long-term follow-up.Contraception. 2011; 83: 242-247https://doi.org/10.1016/j.contraception.2010.07.010
- Retrospective review of intrauterine device in adolescent and young women.J Pediatr Adolesc Gynecol. 2012; 25: 195-200https://doi.org/10.1016/j.jpag.2012.01.005
- Efficacy, acceptability and side effects of the levonorgestrel intrauterine system for menorrhagia.Int J Gynaecol Obstet. 2007; 97: 190-194https://doi.org/10.1016/j.ijgo.2007.01.009
- The effectiveness of the levonorgestrel-releasing intrauterine system in menorrhagia: a systematic review.BJOG. 2001; 108: 74-86https://doi.org/10.1111/j.1471-0528.2001.00020.x
- Association of age and parity with intrauterine device expulsion.Obstet Gynecol. 2014; 124: 718-726https://doi.org/10.1097/AOG.0000000000000475
- Levonorgestrel-releasing intrauterine device use in female adolescents with heavy menstrual bleeding and bleeding disorders: single institution review.J Pediatr Adolesc Gynecol. 2017; 30: 479-483https://doi.org/10.1016/j.jpag.2016.04.001
- Use of the levonorgestrel intrauterine system to treat heavy menstrual bleeding in adolescents and young adults with inherited bleeding disorders and Ehlers-Danlos syndrome.J Pediatr Adolesc Gynecol. 2021; https://doi.org/10.1016/j.jpag.2021.11.002
- Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American Heart Association.Circulation. 2013; 128: 1689-1712https://doi.org/10.1161/CIR.0b013e3182a5cfb3
- Rates of intrauterine device expulsion among adolescents and young women.J Pediatr Adolesc Gynecol. 2021; 34: 362-365https://doi.org/10.1016/j.jpag.2020.11.003
- Bleeding patterns among adolescents using the levonorgestrel intrauterine device: a single institution review.J Pediatr Adolesc Gynecol. 2020; 33: 555-558https://doi.org/10.1016/j.jpag.2020.04.006
- Gynecologic management of pediatric and adolescent patients with Ehlers-Danlos syndrome.J Pediatr Adolesc Gynecol. 2020; 33: 291-295https://doi.org/10.1016/j.jpag.2019.12.011
- Bleeding assessment in haemophilia carriers—high rates of bleeding after surgical abortion and intrauterine device placement: a multicentre study in China.Haemophilia. 2020; 26: 122-128
- Provider attitudes and practices regarding intrauterine system (IUS) insertion in adolescents with and without bleeding disorders for management of heavy menstrual bleeding.J Pediatr Adolesc Gynecol. 2021; https://doi.org/10.1016/j.jpag.2021.01.014
Article info
Publication history
Published online: July 08, 2022
Accepted:
July 5,
2022
Received in revised form:
June 3,
2022
Received:
February 10,
2022
Footnotes
This work was presented virtually as a poster at the 62nd American Society of Hematology Annual Meeting and Exposition on December 5-8, 2020, due to the COVID-19 pandemic.
Identification
Copyright
© 2022 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
