Clinical performance of the 52-mg 20 µg/day levonorgestrel-releasing intrauterine system in women who have undergone bariatric surgery
ESC Congress Library. Urbano Monteiro I. May 10, 2018; 208127; ESC165
Dr. Ilza Maria Urbano Monteiro
Dr. Ilza Maria Urbano Monteiro
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Abstract
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Objective: To assess the clinical performance of the 52-mg 20 µg/day levonorgestrel-releasing intrauterine system (LNG-IUS) in formerly obese women consulting for heavy menstrual bleeding (HMB) after having been submitted to bariatric surgery.   Design and methods: This was a cohort study evaluating 157 women referred to a family planning clinic at the Department of Obstetrics and Gynecology, University of Campinas Medical School, Campinas, São Paulo, Brazil between 2009 and 2015. All the women complained of HMB following a Roux-en-Y gastric bypass for obesity. Sociodemographic data were obtained. Bleeding patterns were evaluated at the first 90 days following insertion of the LNG-IUS and again after 6 and 18 months of use. A life-table analysis was performed to determine continuation and discontinuation rates including reasons for discontinuation. Results: At LNG-IUS insertion, mean age was 34.8 ± 0.45 years (± SEM) and body mass index (BMI; kg/m2) was 30.5 ± 0.48. Mean weight was 114.0 ± 1.56 kg before surgery and 81.1 ± 1.33 kg at LNG-IUS insertion, with a difference of -31.5 ± 1.72 kg between these two moments. Time between surgery and LNG-IUS insertion was 31.6 ± 34.3 months. No correlation was found between three different categories of BMI (kg/m2) at LNG-IUS insertion and continuation rates (p=.823). A significant association was found between the occurrence of amenorrhea or infrequent bleeding and a smaller variation in weight following LNG-IUS insertion (p= .023). Conclusions: Obese women submitted to bariatric surgery and who lost weight may present with HMB. The effectiveness of the 52-mg 20 µg/day LNG-IUS in the control of bleeding was significantly better in those women who lost proportionally more weight between surgery and LNG-IUS insertion.         
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