Multicentric review of patients' reasons for Mirena coil removal and it's wider clinical & economical implications
ESC Congress Library. Acladious N. May 10, 2018; 208231; ESC235
Nabil Nathan Acladious
Nabil Nathan Acladious
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Abstract
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Introduction: For many years there has been an emphasis on use of long acting reversible contraception due to their cost effectiveness, lower failure rates and reduced frequency of use of contraceptive services leading to reducing total cost to the healthcare system as a whole. Furthermore, these tend to be more convenient for patients and are user independent. In the UK, Mirena, Jaydess and Levosert are the current options of levongestrel-releasing intrauterine system(LNG-IUS). Mirena is licensed for use for 5 years (extended to 7 years for women 45 or over) whilst Jaydess and Levosert are only licensed for 3 years of use. This is reflected in cost, with Mirena costing £88, Jaydess costing £67.22, and Levosert costing £66. Aim: We investigated the reasons for Mirena removal and the length of time in situ. Furthermore, we assessed if the age of the patient, the parity or the mode of delivery, were predictive of these factors. Material and Method: This is a retrospective multicentric cross-sectional study of all patients who had Mirena coil removal across the North-West region of the UK in 2015. The patients were identified by using code 20 recorded on the SHRAD coding system. This produced a total of 769 patients. All the data was recorded onto an EXCEL spreadsheet, collated and analysed.  Results: Preliminary results showed that the main reasons for early removal of the Mirena were pain, bleeding, systemic hormonal side effects and wishing to conceive. Age seems to be a strong predictor of length of time of use of Mirena coil. Less than 1% of patients aged 25 or below had the Mirena for the full 5 years. Between the ages of 25 and 35 this number increased to 5%, with over 70% of patients in this age group citing wishing to conceive as their reason for removal. In the above 40 age group, over 80% of patients kept their coil for 5 years or more. Conclusion: It appears that introduction of use of 3 year LNG-IUS devices such as Levosert and Jaydess may be beneficial for younger women due to their cheaper initial cost, given that most of these patients do not complete the full 5 years of use of the Mirena. Furthermore, the reduced hormonal dose in the Jaydess may benefit these patients by reducing systemic hormonal side effects, which may further reduce the removal rate.
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