Use of Levonorgestrel Intrauterine System: A Portuguese University Hospital Experience
ESC Congress Library. Maltez R. May 28, 2014; 50575; A-160
Dr. Rita Maltez
Dr. Rita Maltez
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Abstract
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Despite the availability of a wide range of contraceptive options, unintended pregnancy rates remain high, particularly among young women. In fact, their most popular form of birth control are oral contraceptives which effectiveness is user dependent and may fail when multiple pills are dropped per month.

The levonorgestrel intrauterine system (Mirena®) is an effective, reversible, long-acting contraceptive method, non-dependent of user's compliance, with many others health benefits. However, it is unlikely to be one of the provider's choices for adolescents' contraception. Concerns about difficult insertion, nulliparity, pelvic inflammatory disease or infertility consist in provider's barriers for this option while reduced menstrual bleeding or decreased dysmenorrhea that affect lot of teens are often neglected.

The aim of this study is to quantify how many Mirena® devices were applied at one University Hospital between 2006 and 2012 and characterize its users by age, obstetric history and goal of Mirena®'s use.

DESIGN & METHODS:
This is an observational, transversal, analytical study which sample included women to whom Mirena® was applied at the Hospital between 1st.January.2006 until 31.December.2012.

The studied variables were user's age, obstetric index (nulliparous vs parous woman) and the main purpose for Mirena®'s choice (contraceptive option; heavy menstrual bleeding; endometriosis; endometrial hyperplasia therapy).   

RESULTS:
The use of Mirena® at this University Hospital started in 2002.
In the studied period, 3.965 Mirena® were applied.
Since 2006, the use of Mirena® gradually increased from 375 in that year to 540 in 2009 and reaching the maximum of 745 along 2012.  Most of the users were parous women whose age was between 40 to 49 years old. A minority referred to young woman aged about 20 years or less and that had never been pregnant.

The main reason for Mirena®'s application was its contraceptive effect, followed by treatment of heavy menstrual bleeding and its role as endometrial hyperplasia therapy.

CONCLUSIONS:
At this University Hospital, Mirena® remains as an underused contraceptive method in young women, particularly among nulliparous. Further education is needed to skip this barrier. Practical hands-on training should also be available in order to improve providers' confidence in performing Mirena®'s insertion in this population.
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