Contemporary prescriptions pattern of different dose levonorgestrel-releasing intrauterine systems in an Italian service for family planning

Abstract

Objective

Current research informations fail to adequately inform about when levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg is used instead of other lower dose LNG-IUSs (13.5 and 19.5 mg) and other long-acting reversible contraceptives (LARCs) in clinical practice.

Methods

A retrospective cohort study was performed in a third-level Service for Family Planning of Modena University hospital about all the first modern contraceptives prescriptions in the whole year 2019 performed by the same group of physicians. All women included underwent a detailed transvaginal ultrasound (TVUS) at prescription and a second evaluation within 3 months when they were still using the prescribed method.

Results

To 69/160 (43.1%) women a short-acting reversible contraceptive (SARC), while to 91/160 (56.9%) a LARC was prescribed. Women with a LARC prescription were older than them with a short-acting (SARC) (p < .0001). Women with LNG-IUS 52 mg prescription were significantly the oldest (42.9 ± 5.3), while those with intrauterine copper device and lower dose LNG-IUS were of similar age (36.5 ± 7.3 and 34.9 ± 2.3), significantly lower (p < .005). Women with implant prescription had the same age as SARC, being the youngest (30.7 ± 8.9 and 31.0 ± 9.5) (p < .0001). Women with LNG-IUS 52 mg prescription mg presented with bigger uterine volume (p = .001). In multivariate analyses, the LNG-IUS 52 mg prescription was significantly linked only to age (OR 1.24; 95% CI 1.11–1.37, p < .0001) and presence of adenomyosis (OR 4.56; 95% CI 1.45-14.33, p = .009).

Conclusions

The use of LNG-IUS 52 mg instead of other LARCs is preferred for older women, with uteri of increased volume due to adenomyosis, suggesting a possible differential use of available LNG-IUSs in the contemporary clinical practice.

摘要

目的：目前的研究资料不能充分说明在临床实践中左炔诺孕酮宫内缓释系统 (LNG-IUS)52 mg何时可以替代其他低剂量的LNG-IUSs(13.5和19.5 mg) 和其他长效可逆避孕药具 (LARCs)。

方法：在摩德纳大学医院的三级计划生育服务中心, 对同一组医师在2019年全年开具的首批现代避孕药具处方进行了回顾性队列研究, 所有纳入的妇女均在开具处方时接受了详细的经阴道超声检查 (TVUS), 并在仍使用规定方法的3个月内进行了第二次评估。

结果：69/160(43.1%) 的妇女采用了短效可逆避孕方法 (SARC), 而91/160(56.9%)的妇女则开具了LARC。使用LARC处方的女性比使用SARC的女性年龄大 (p<0.0001)。使用LNG-IUS 52 mg处方的妇女年龄最大 (42.9±5.3) 岁, 而使用宫内铜器和低剂量LNG-IUS的妇女年龄相近 (36.5±7.3和34.9±2.3) 岁, 显著减低 (P<0.005)。接受植入剂处方的女性与SARC年龄相同, 年龄最小 (30.7±8.9和31.0±9.5) (p <0.0001)。使用LNG-IUS 52 mg处方的妇女子宫体积更大(p=0.0.001)。多变量分析显示, LNG-IUS 52 mg处方仅与年龄 (OR 1.24; 95%CI 1.11–1.37, p <0.0001) 和子宫腺肌病的存在 (OR 4.56; 95%CI 1.45-14.33, p=0.009)显著相关。

结论：使用LNG-IUS 52 mg代替其他LARCs更适合由于子宫腺肌病导致子宫体积增大的年龄较大的妇女, 这表明在当代临床实践中LNG-IUSs可能会有不同的用途。

Keywords:

• Levonorgestrel-releasing intrauterine system
• LARC
• SARC
• intrauterine
• implant
• contraception
• Mirena
• Levosert
• Benilexa
• Kyleena
• Skyla
• Jaydess

Disclosure statement

G. Grandi received honoraria for sponsored lectures and participation in advisory boards from Bayer AG, Teva/Theramex, Sandoz Novartis, Exeltis Italy, Merck Sharp & Dohme and Effik Italy. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.