Pain at insertion of the levonorgestrel-releasing intrauterine system in nulligravida and parous women with and without cesarean section
ESC Congress Library. Urbano Monteiro I. 05/11/18; 208260; ESC164
Dr. Ilza Maria Urbano Monteiro
Dr. Ilza Maria Urbano Monteiro
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 Objectives: We assessed pain and easy of insertion among three cohort of new acceptors of the LNG-IUS: i) nulligravidas; ii) parous with vaginal deliveries and iii) parous women only with Cesarean delivery (C-delivery). Methods: A total of 211 healthy women who choose the 52-mg 20 µg/day LNG-IUS as a contraceptive method were divided in the three groups. The visual analogue scale (VAS) was applied immediately after LNG-IUS placement and at the first follow-up at 40-60 days after placement. All the insertions were performed by one highly trained professional and were classified as easy, with expected difficult, more difficult than expected or failure of insertion. Results: The mean (±SD) of the VAS were 6.8 (±2.2), 5.4 (±2.9) and 5.5 (±2.7) among nulligravidas, parous without and parous with C-delivery, respectively (p< 0.0288). Despite the referred pain at placement 96.0% of the women reported that they will accept to wearing a new LNG-IUS in the future as contraceptive method. We underestimated the difficulty of insertion among the nulligravidas (29.4% of them presented high difficulty than expected; however, it was low than expected among parous with and without C-deliveries: 1.6% and zero, respectively) (p< 0.0001). At placement of the device 33.1% of the women reported severe pain, however, only 26.5% recall pain at the first follow-up.  Conclusion: Nulligravida women reported high pain at the LNG-IUS when compared to parous women with or without C-deliveries; however, most of them reported that were willingness to use the device again in the future. The recall of pain at one month after placement was lower than the reported immediately after the insertion; which could indicate that the pain was not an important issue at placement which was forget by some women.
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