Bleeding Patterns among Adolescents Using the Levonorgestrel Intrauterine Device: A Single Institution Review

Parks, Melissa; Zwayne, Noor; Temkit, Mʼhamed

doi:10.1016/j.jpag.2020.04.006

Cited by 13 publications

(5 citation statements)

References 11 publications

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“…In WGBD, treatment options for HMB include haemostatic agents (such as tranexamic acid, factor replacement therapy), hormonal therapies (such as oral contraceptive agents), or combinations, and rarely surgical options 63 . Consideration of the use of hormonal intrauterine devices (IUDs) is not dependent on age or parity as studies have identified these IUDs as an appropriate and effective treatment option for adolescents with HMB 64 . HTC/CCCs should offer treatment options, personalized according to age, fertility/pregnancy wishes, other gynaecological symptoms, patient's views and acceptance of treatment options and side effects, respecting cultural and psychological aspects 19 …”

Section: Resultsmentioning

confidence: 99%

European principles of care for women and girls with inherited bleeding disorders

Galen

Lavin²,

Skouw-Rasmussen³

et al. 2021

Haemophilia

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Introduction Despite increasing awareness of issues faced by women and girls with inherited BDs (WGBD), standards of care are lacking, with disparities in diagnosis and treatment for WGBD across Europe. We aimed to develop practical principles of care (PoC) to promote standardization of care for WGBD within European Haemophilia Treatment and Comprehensive Care Centres (HTC/CCCs). Methods The co‐creation process, supported by the European Association for Haemophilia and Allied Disorders, consisted of four multidisciplinary meetings with health care providers (HCPs) experienced in WGBD care, and European Haemophilia Consortium representatives, combined with broad patient and HCP consultations in the European haemophilia community. Relevant medical societies outside Europe were contacted for confirmation. Results We developed ten PoC for WGBD, stressing the importance and benefits of a centralized, multidisciplinary, comprehensive, family‐centred approach to support and manage WGBD during all life stages. These PoC emphasise the right to equitable access and quality of care for all people with BDs, irrespective of gender. Multiple medical societies outside Europe also confirmed their support for endorsement. Conclusions Ten PoC for WGBD evolved from an iterative process among stakeholders, supported by relevant medical societies worldwide. These PoC can serve as a benchmark for diagnosis and comprehensive multidisciplinary management of WGBD, and improve awareness of their unique challenges. They offer a framework to guide HTC/CCCs in providing equitable care for all WGBD, both in their own services and in other healthcare settings. Implementation of these principles aims to positively impact the health, wellbeing and quality of life for WGBD.

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Section: Resultsmentioning

confidence: 99%

European principles of care for women and girls with inherited bleeding disorders

Galen

Lavin²,

Skouw-Rasmussen³

et al. 2021

Haemophilia

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“…The most diverse class of medications that can be used for menstrual suppression is synthetic progestins 3,7,24,30,[35][36][37][38][39][40] These medications are available for a wide variety of indications, can be contraceptive if that is a patient's goal, and have many different methods of delivery. This diversity of use and preparation as well as a generally favorable safety profile makes progestins as a drug class very appealing for menstrual manipulation in adolescents who have a need for it for a broad number of reasons, including disability, 6 bleeding disorder, 41 catamenial disorders including epilepsy, 42,43 or who simply prefer to avoid menstruation, 7,44 regardless of gender.…”

Section: Progestinsmentioning

confidence: 99%

Reversible interventions for menstrual management in adolescents and young adults with gender incongruence

Roden

2023

Clin Med�Insights�Reprod�Health

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The newly released World Professional Association for Transgender Health Standards of Care, 8th Edition specify that adolescents should be offered menstrual suppression as part of their treatment plans to suppress menses and alleviate dysphoria, provide contraception, or improve irregular bleeding on testosterone therapy. This is a review of current evidence-based options for reversible interventions for menstrual suppression in adolescents with gender dysphoria or incongruence. Shared decision-making should be used by the clinician at all times, and the clinician should be intentional in prioritizing the patient’s stated needs and desires when offering interventions. No method should be withheld due to the experience of gender incongruence alone. Contraceptive options offering menstrual suppression include depot-medroxyprogesterone acetate, levonorgestrel intrauterine systems, progestin-only contraceptive pills, and combined hormonal contraceptives. Non-contraceptive options include norethindrone acetate, oral medroxyprogesterone acetate, gonadotropin-releasing hormone analogues/agonists, and danazol. Certain patients may also benefit from non-pharmacologic interventions, such as specialty menstrual underwear. Plain language summary Using medicine to stop Menstrual periods in teens with gender incongruence Summary: Newly released recommendations for the care of teens and young adults with gender dysphoria or incongruence specifically recommend using medications to get rid of menstrual periods if desired or medically necessary. Patients may ask for this to help improve dysphoria, as a feature they want in birth control, or simply because they do not want to have periods. Because temporarily getting rid of periods is something that doctors can do for any patient old enough to have periods, patients with gender dysphoria should also be able to have their periods temporarily stopped using medications if requested. Doctors should ensure that they always help the patient make a decision that is right for them instead of prescribing what they think is right without considering the patient’s input. Options for temporarily getting rid of periods can include birth control, such as oral contraceptive pills, patches, or rings; intrauterine devices; or shots, and it can also be done with things that are not birth control, such a progesterone pills or puberty blockers. Finally, some patients may only need improved period hygiene with period underwear to feel better in their bodies.

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“…70 In a single-institution review of bleeding patterns among adolescents using the LNG-IUD (52 or 13.5 mg), the overall rate of amenorrhea was 40%, and rates of amenorrhea or spotting were 59% over an average time period of 17.8 months. 17 There are survey data suggesting that the LNG-IUD is well tolerated by transgender and gender nonbinary individuals. In one recent study of transgender and gender diverse people with an intrauterine device (IUD) in place for > 6 months, 73% chose a 52 mg LNG-IUD with menstrual suppression being the primary reason for this choice.…”

Section: Progestin-only Pills (Pops)mentioning

confidence: 99%

“…The incidence of amenorrhea increases with longer duration of use and higher dosage of levonorgestrel with ∼50% of patients experiencing amenorrhea with the 52 mg LNG-LUD at 12 months of use 70. In a single-institution review of bleeding patterns among adolescents using the LNG-IUD (52 or 13.5 mg), the overall rate of amenorrhea was 40%, and rates of amenorrhea or spotting were 59% over an average time period of 17.8 months 17. There are survey data suggesting that the LNG-IUD is well tolerated by transgender and gender nonbinary individuals.…”

Section: Strategies For Menstruation Suppression In Transgender and G...mentioning

confidence: 99%

Management of Menstruation in Transgender and Gender Nonbinary Adolescents

Berrahou

Grimes

Autry

et al. 2022

Clinical Obstetrics &Amp; Gynecology

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A growing number of adolescents in the United States identify as transgender and gender nonbinary, and many will seek medical management of menstruation. In this evidence-based review, we recommend a model of gender-affirming care grounded in the tenants of reproductive justice, emphasizing patient autonomy and the development of holistic management plans centered around the patient’s unique goals for affirming their gender identity. We then review strategies for achieving menstruation suppression for transgender and gender nonbinary adolescents, including dosing considerations, menstruation, ovulation, contraceptive effects, and metabolic considerations specific to the adolescent population.

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Bleeding Patterns among Adolescents Using the Levonorgestrel Intrauterine Device: A Single Institution Review

Cited by 13 publications

References 11 publications

European principles of care for women and girls with inherited bleeding disorders

European principles of care for women and girls with inherited bleeding disorders

Reversible interventions for menstrual management in adolescents and young adults with gender incongruence

Management of Menstruation in Transgender and Gender Nonbinary Adolescents

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