The influence of the levonorgestrel‐releasing intrauterine system position on bleeding patterns in reproductive age women

Alves, Renata Dantas Monteiro Santana; Rabelo, Maiara M.; Andrade, Venandra R.; Cabral, Renata; Merriman, Joely W.; Brito, Milena Bastos

doi:10.1002/ijgo.12962

Cited by 6 publications

(2 citation statements)

References 19 publications

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“…(Table no.5) LNG-IUS is usually well tolerated but its most common side effects are menstrual bleeding cycle change and spotting off and on, maybe breakthrough bleeding. Most authors report decrease in number of bleeding days and improvement in symptoms from 1st through 3 months of insertion [12,13,14,15,16] . The treatment of this breakthrough bleeding by oral progesterone or by SERMs were not much different [13] .…”

Section: Discussionmentioning

confidence: 99%

“…Associated medical diseases in which LNG IUS can be used for treatment of HMB are obesity, severe anaemia, coagulopathies where surgery is either contraindicated, is high risk or is not affordable because of high cost [5,6,7,8] . LNG has been associated with irregular spotting for up to 6weeks after insertion and is associated with progressive amenorrhoea [11][12][13][14][15] . Irregular bleeding if associated is treated by various methods like cyclical progesterone or with raloxifene or simple reassurance [9,13] .…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of non-contraceptive benefits of LNG-IUS: A clinical study

Anju¹,

Kaur²,

Gupta³

2022

Int. J. Clin. Obstet. Gynaecol.

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Introduction: IUCDs are the most widely used and effective contraceptive methods and are safe. Huge variety of IUCDs are available which include inert, copper containing, and medicated with levonorgestrel or indomethacin. LNG has been explored for its non-contraceptive benefits by various researchers and found to be effective for women and adolescents as first line therapy with heavy menstrual bleeding and is associated with improved dysmenorrhoea.so we did a two year perspective study in deptt of obs and gynae at GMC Patiala to assess the role of LNG-IUS IN various gynaecological indication otherthan contraception. Material and Methods: Women with heavy menstrual period, dysmenorrhea or both who reported in the OPD were examined, including breast and pelvic examination. USG was done to note various pathologies like fibroid, endometriosis, endometrial hyperplasia, adenomyosis and functional ovarian cyst. This was followed by endometrial biopsy. After the biopsy report was available, decision for LNG-IUS insertion was taken. LNG-IUS was inserted, under all sterile conditions without anaesthesia. After insertion, patient was followed up at 1-, 3-, 6-and 12-month interval for menstrual pattern change any complications compliance on part of patient. Results: A total of 30 patients were enrolled over a period of two years. 28 patients were in the age group 30-50 years and only 2 patients were post-menopausal. 56.6% had rural background, 43% were illiterate and 83.3% were multipara. In 50% of the women, the chief complaint was heavy menstrual bleeding with dysmenorrhea and 36% had heavy menstrual bleeding alone. 6.6% had dysmenorrhea alone and another 10% reported with irregular bleeding. According to PALM-COIEN classification, AUB-A was diagnosed in 16.6%, AUB-L in 30%, AUB-O in 40%, AUB-M in 3.3%, endometriosis in 13.3%. LNG-IUS was not used as contraception or HRT in any of the cases. On post insertion follow up after one month, 90 percent had relief from heavy menstrual bleeding. At sixmonth follow-up, 23.3% reported spotting and 60% reported normal flow during periods. After one year 73.9% patient had normal flow and 13% patients achieved amenorrhoea. The irregular bleeding or spotting was managed by giving supportive therapy in form of reassurance in 30%, NSAIDS in 16.6%, and norethisterone in 46.6%. Ormeloxifene and OCPs were given in 3.3% each and response was satisfactory. At one year follow up it was seen that 76.6% patients continued with LNG IUS and found it comfortable with enhanced quality of life. Conclusion: LNG-IUS is a better choice for the management of endometrial hyperplasia simple or complex, with or without atypia, AUB, adenomyosis and endometriosis. LNG-IUS can be a good alternative to hysterectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of non-contraceptive benefits of LNG-IUS: A clinical study

Anju¹,

Kaur²,

Gupta³

2022

Int. J. Clin. Obstet. Gynaecol.

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Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management

Castillo

Zambrano

Barba

et al. 2022

European Journal of Obstetrics & Gynecology and Reproductiv

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Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review

Henkel

Goldthwaite

2020

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review To describe common bleeding patterns and treatment strategies to minimize bothersome bleeding in users of progestin-based long-acting reversible contraception (LARC). Recent findings Most levonorgestrel intrauterine device users will establish a favorable bleeding pattern within a year; NSAIDs are the most effective bridge to help with bothersome bleeding during that time period. Early follicular phase insertion and fundal placement are associated with more favorable early bleeding profiles. Recent studies exploring tranexamic acid, mifepristone, and tamoxifen's adjunct role show modest or no benefit. The progestin implant is associated with more persistent unpredictable bleeding disproportionately affecting women with higher etonogestrel serum levels; recent studies indicate that oral contraceptives, ulipristal acetate, and tamoxifen may all provide temporary relief. Summary Women's healthcare providers can offer patients adjunct medical therapies to minimize bothersome bleeding associated with progestin LARC use, which may result in increased satisfaction and continuation rates of these effective forms of contraception.

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The influence of the levonorgestrel‐releasing intrauterine system position on bleeding patterns in reproductive age women

Cited by 6 publications

References 19 publications

Evaluation of non-contraceptive benefits of LNG-IUS: A clinical study

Evaluation of non-contraceptive benefits of LNG-IUS: A clinical study

Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management

Management of bothersome bleeding associated with progestin-based long-acting reversible contraception: a review

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