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Levonorgestrel-Releasing Intrauterine System Utilization in Patients with Developmental Delays

  • C.M. Lutz
    Affiliations
    Center for Surgical Outcomes, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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  • A. Onwuka
    Affiliations
    Center for Surgical Outcomes, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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  • A.E. Lawrence
    Affiliations
    Center for Surgical Outcomes, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio

    Pediatric Surgery, Department of Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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  • H. Richards
    Affiliations
    Center for Surgical Outcomes, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
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  • K.J. Deans
    Affiliations
    Center for Surgical Outcomes, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio

    Pediatric Surgery, Department of Surgery and the Research Institute, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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  • K. McCracken
    Correspondence
    Address correspondence to: Kate McCracken, MD, Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43215; Phone (614) 722-2250
    Affiliations
    Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
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Published:September 07, 2022DOI:https://doi.org/10.1016/j.jpag.2022.09.003

      ABSTRACT

      Introduction

      Adolescent females with developmental delays (DDs) experience unique physical and emotional challenges related to menstruation. Providers often recommend hormonal medication for menstrual management. The objective of our study was to describe the utilization and safety of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescents with DDs.

      Methods

      We utilized the Pediatric Health Information System to identify females aged 10-25 with DDs who underwent an LNG-IUS insertion between 2011 and 2020. Using a gynecologic procedure and diagnosis codes, we assessed indications for and complications of LNG-IUS use. We also evaluated early LNG-IUS removal.

      Results

      One thousand five hundred and sixty female patients with DDs underwent LNG-IUS insertion. LNG-IUS insertion under anesthesia was most commonly performed in patients with autism and Down syndrome, and unspecified menstrual issues were documented for 40% of the cohort. Perforation was observed in 11 patients (1%), and mechanical complications (malpositioned IUS or lost threads) were observed in 23 patients (1%).

      Discussion

      This is the largest analysis of LNG-IUS use in patients with DDs to our knowledge and shows the utilization of LNG-IUS in patients with DDs. We provide descriptive information that providers can use to accurately advise their patients with DDs on the risks and benefits of LNG-IUS use for menstrual management.

      Key Words

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