Advertisement

Use of 52-mg Levonorgestrel-Releasing Intrauterine System in Adolescents and Young Adult Women: 3-Year Follow-Up

  • Elaine Cristina Fontes de Oliveira
    Affiliations
    Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
    Search for articles by this author
  • Thaís Baêta
    Affiliations
    Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
    Search for articles by this author
  • Rossana Cristina Fontes Cotta
    Affiliations
    Departament of Pediatrics, Hospital Vila da Serra, Belo Horizonte, Minas Gerais, Brazil
    Search for articles by this author
  • Ana Luiza Lunardi Rocha
    Correspondence
    Address correspondence to: Ana Luiza Lunardi Rocha, MD, PhD., Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena 190, Santa Efigênia, Belo Horizonte, MG 30130100, Brazil.
    Affiliations
    Department of Obstetrics and Gynecology, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

    Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
    Search for articles by this author
Published:September 07, 2022DOI:https://doi.org/10.1016/j.jpag.2022.09.001

      Abstract

      Study Objective

      To evaluate continuance rates, bleeding patterns, and patient satisfaction with 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) use in adolescents and young adult women during the first 3 years of use

      Design

      We conducted an observational prospective study.

      Setting

      Family Planning Service of a tertiary hospital in Brazil

      Participants

      One hundred adolescents and young women aged 16-24 years.

      Intervention

      Insertion of 52-mg LNG-IUS for the main purpose of contraception. Follow-up visits were conducted at 12, 24, and 36 months after insertion.

      Main Outcome Measures

      Continuance rates, reasons for discontinuation of the method, and women's satisfaction and bleeding patterns

      Results

      Among those who were not lost to follow-up, LNG-IUS continuance rates were 89.1% (82/92), 82.9% (72/87), and 75.3% (64/85) in the first, second, and third years of use, respectively. The main reason for discontinuation was acne, followed by expulsion of/malpositioned LNG-IUS. Other reasons for discontinuation were irregular uterine bleeding, dysmenorrhea, and abdominal pain. The amenorrhea rates were 50%, 54.1%, and 39% at 12, 24, and 36 months, respectively. Spotting rates increased during the first 3 years of use (20.8%, 16.7%, and 26.6%, respectively). Adolescents and young women using the LNG-IUS showed high rates of satisfaction, with 93.9%, 100%, and 96.8% of women being very satisfied/satisfied in the first 3 years of use. Only 2 participants who continued using the LNG-IUS reported being very dissatisfied/dissatisfied in the third year of follow-up.

      Conclusion

      The LNG-IUS showed high rates of continuation and satisfaction in the first 3 years of use in Brazilian adolescents and young adults. Most women reported a favorable bleeding pattern.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Singh S
        • Sedgh G
        • Hussain R
        Intended and unintended pregnancy worldwide in 2012 and recent trends.
        Stud Fam Plan. 2010; 41: 241-250
        • Krashin J
        • Tang JH
        • Mody S
        • Lopez LM
        Hormonal and intrauterine methods for contraception for women aged 25 years and younger.
        Cochrane Database Syst Rev. 2015; CD009805
        • Viellas EF
        • Domingues RM
        • Dias MA
        • et al.
        Prenatal care in Brasil.
        Cad Saude Publica. 2014; 30 (S1-15)
        • Birgisson NE
        • Quiuong Z
        • Secura GM
        • et al.
        Preventing unintended pregnancy: the Contraceptive CHOICE project in review.
        J Womens Health. 2015; 24: 349-353
        • Trussel J
        Contraceptive failure in the United States.
        Contraception. 2011; 83: 397-404
        • ACOG Committee Opinion No. 735
        Summary: adolescents and long-acting reversible contraception: implants and intrauterine devices.
        Obstet Gynecol. 2018; 131: 947-948
        • Committee on Adolescent Health Care
        Committee Opinion No 699: Adolescent pregnancy, contraception, and sexual activity.
        Obstet Gynecol. 2017; 129: e142-e149
        • Braverman P
        • Adelman W
        • Alderman E
        • et al.
        Contraception for adolescents.
        Pediatrics. 2014; 134: e1244-e1256
        • Francis KR
        • Gold M
        Long-acting reversible contraception for adolescence.
        JAMA Pediatr. 2017; 171: 694-701
        • Burke PJ
        • Coles MS
        • et al.
        • Society for Adolescent Health and Medicine
        Sexual and reproductive health care: a position paper of the Society for Adolescent Health and Medicine.
        J Adolesc Health. 2014; 54: 491-496
      1. Tyson N, Berlan E, Hewit G, et al: Provision of reproductive health for teens during a pandemic. 2022. Available: https://www.naspag.org/naspag-provision-of-reproductive-health-for-teens-during-pandemic. Accessed April 26, 2022

        • Mavranezouli I
        • LARC Guideline Development Group
        The cost-effectiveness of long-acting reversible contraceptive methods in the UK: analysis based on a decision-analytic model developed for a National Institute for Health and Clinical Excellence (NICE) clinical practice guideline.
        Hum Reprod. 2008; 23: 1338-1345
        • Trussell J
        • Lalla AM
        • Doan QV
        • et al.
        Cost effectiveness of contraceptives in the United States.
        Contraception. 2009; 79: 5-14
      2. Daniels K, Abma JC: Current contraceptive status among women aged 15-49: United States, 2015-2017 (NCHS Data Brief No 327)

        • Pritt NM
        • Norris AH
        • Berlan ED
        Barriers and facilitators to adolescents' use of long-acting reversible contraceptives.
        J Pediatr Adolesc Gynecol. 2017; 30: 18-22
        • Espey E
        • Yoder K
        • Hofler L
        Barriers and solutions to improve adolescent intrauterine device access.
        J Pediatr Adolesc Gynecol. 2019; 32: S7-S13
      3. Contracepção reversível de longa ação: São Paulo: Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO). 2016. ISSN 2525-6416 NLM WP630 Série orientações e recomendações FEBRASGO. v. 3, n.1, Nov. 2016

        • Miranda L
        • Sousa MH
        • Faundes A
        • Juliato C
        Continuation rates of the 52-mg levonorgestrel-releasing intrauterine system according to the primary reason for its use.
        Rev Bras Ginecol Obstet. 2021; 43: 291-296
        • Godfrey EM
        • Memmel LM
        • Neustadt A
        • et al.
        Intrauterine contraception for adolescents aged 14-18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the Copper T 380A.
        Contraception. 2010; 81: 123-127
        • Hall AM
        • Kutler BA
        Intrauterine contraception in nulliparous women: a prospective survey.
        J Fam Plann Reprod Health Care. 2016; 42: 36-42
        • Teal SB
        • Turok DK
        • Chen BA
        • et al.
        Five-year contraceptive efficacy and safety of a levonorgestrel 52-mg intrauterine system.
        Obstet Gynecol. 2019; 133: 63-70
        • Grunloh DS
        • Casner T
        • Secura GM
        • et al.
        Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use.
        Obstet Gynecol. 2013; 122: 1214-1221
        • World Health Organization (WHO)
        Medical Eligibility Criteria for Contraceptive Use-5th ed 2015.
        WHO, Geneva2010
        • Akers AY
        • Harding J
        • Perriera LK
        • et al.
        Satisfaction with the intrauterine device insertion procedure among adolescent and young adult women.
        Obstet Gynecol. 2018; 131: 1130-1136
        • Bahamondes MV
        • Hidalgo MM
        • Bahamondes L
        • Monteiro I
        Ease of insertion and clinical performance of the levonorgestrel-releasing intrauterine system in nulligravidas.
        Contraception. 2011; 84: e11-e16
        • Abraham M
        • Zhao Q
        • Peipert JF
        Young age, nulliparity, and continuation of long-acting reversible contraceptive methods.
        Obstet Gynecol. 2015; 126: 823-829
        • Patseadou M
        • Michala L
        Usage of the levonorgestrel-releasing intrauterine system (LNG-IUS) in adolescence: what is the evidence so far?.
        Arch Gynecol Obstet. 2017; 295: 529-541
        • Madden T
        • McNicholas C
        • Zhao Q
        • et al.
        Association of age and parity with intrauterine device expulsion.
        Obstet Gynecol. 2014; 124: 718-726
        • Zaenglein AL
        • Pathy AL
        • Schlosser BJ
        • et al.
        Guidelines of care for the management of acne vulgaris.
        J Am Acad Dermatol. 2016; 74 (945-73.e33)
        • Pakey J
        • Nassim JS
        • Reynolds RV
        Hormonal intrauterine devices and acne.
        Obstet Gynecol. 2022; 139: 919-921
        • Hidalgo M
        • Bahamondes L
        • Perrotti M
        • et al.
        Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up two years.
        Contraception. 2002; 65: 129-132
        • Heikinheimo O
        • Inki P
        • Schmelter T
        • Gemzell-Danielsson K
        Bleeding pattern and user satisfaction in second consecutive levonorgestrel-releasing intrauterine system users: results of a prospective 5-years study.
        Hum Reprod. 2014; 29: 1182-1188