POSITIONING OF THE LEVONORGESTREL LIBERATOR INTRAUTERINE SYSTEM IN THE INFLUENCE OF THE GENITAL BLEEDING PATTERN
ESC Congress Library. Brito M.
May 10, 2018; 208187
Prof. Dr. Milena Bastos Brito
Prof. Dr. Milena Bastos Brito
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Abstract
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OBJECTIVES:  To evaluate the genital bleeding pattern change among users of the levonorgestrel-releasing intrauterine system (LNG-IUS) that were optimally and malpositioned in the uterine cavity during the first six months of use.. DESIGN AND METHODS: A prospective cohort study conducted at a reference hospital for women's health in the State of Bahia, Brazil, from June 2016 to July 2017. It included women aged 18 and 52 years old that did not have contraindications to use the LNG-IUS, according to the World's Health Organization (WHO) and met the eligibility criteria. Patients were allocated in 2 groups, optimally positioned and malpositioned LNG-IUS. Position of the LNG-IUS was evaluated using transvaginal ultrasonography performed immediately after insertion and at 3 and 6 months post insertion. The menstrual bleeding pattern was evaluated using a self-assessment menstrual bleeding perception questionnaire applied before insertion, at 3 and 6 months post-insertion. Clinical notes about blood flow pattern found in the pads (Determination of total menstrual blood loss. Fertile Steril. 2001) and a monthly menstrual bleeding occurrence (or no occurrence) diary were also used. RESULTS: There were 95 patients who met the criteria and were included in this study (32.4 ± 8.2 years old average age), and 29.5% were nulliparous. There were 4 inadvertent dropouts exits. The menstrual cycle average prior to insertion was 27.3 ± 2.9 days and the average duration was 5.1 ± 1.9 days. The LNG-IUS was optimally positioned in 44.2% of the patients immediately after insertion (n = 95), 66.1% (n = 62) in the third month, and 80.9% (n = 47) in the 6th month. There was agreement among the observers with the Kappa coefficient of 0.943 at the initial moment. About 93.7% of the users had a genital bleeding flow reduction by the end of the third month, with a 24.5% amenorrhea frequency among all users with 6 months of usage. There was no statistical difference between the optimally or malpositioned groups. CONCLUSIONS: The study shows genital bleeding flow reduction after LNG-IUS insertion, which did not depend on uterine cavity positioning. However, only ¼ of the patients evolved to amenorrhea by the end of the 6th month of use.
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