Expulsion and continuation rates of the 52 mg levonorgestrel intrauterine system in adolescents and adult women

Abstract

Objective

To compare the continuation rates, expulsion, and other reasons for discontinuation of the hormonal intrauterine device with 52 mg of levonorgestrel (52 mg LNG-IUD) in adolescents and adult women.

Methods

We conducted a retrospective cohort study that included 393 women in whom we placed a 52 mg LNG-IUD and followed up to 5 years. We created two retrospective cohorts, one with 131 adolescents (aged between 12 and 19 years) and the other with 262 women aged ≥20 years. Each adolescent was paired with two adult women who had the same parity and who had a 52 mg LNG-IUD inserted on the same day. We used the Mann-Whitney test to compare numerical variables in both groups, the Kaplan-Meier method, and the log-rank test to compare the continuation, expulsion and other reasons for IUD discontinuation of the two groups.

Results

Age of the adolescents and adult women were mean ± SD 18.1 (±1.1) and 31 (±6.8) years, respectively (p = 0.015). Continuation rates by the fifth year of use were 55.6/100 women-years (W-Y) and 70.3/100 W-Y among adolescents and adult women (p = 0.106); and expulsion rates were 8.4/100 and 6.0/100 W-Y, respectively (p = 0.463). Adolescents had a lower continuation rate during 3 to 5 years of follow-up (p = 0.011) and a high rate of removals due to bleeding/pain (18.5 ± 5.7/100 W-Y vs 6.4/100 ± 2.1 W-Y, p = 0.039).

Conclusion

Adolescents who used the 52 mg LNG-IUD showed a lower continuation rate 3–5 years after device placement than adult women. The expulsion rates were similar in both groups.

SHORT CONDENSATION

Adolescents who used the 52 mg LNG-IUD showed expulsion rates similar than adult women. Despite the good continuation rate, adolescents had a lower continuation rate within 3–5 years of follow-up and high rate of removals due to bleeding/pain than adult users.

摘要

目的:比较52 mg左炔诺孕酮含激素宫内节育器(52 mg LNG-IUD)在青少年和成年女性中的续用率、取出率和其他停用的原因。

方法:本研究进行了一项回顾性队列研究, 纳入393名女性, 放置了52mgLNG-IUD, 随访5年。本研究建立了两个回顾性队列, 一个是131名青少年(年龄在12-19岁之间), 另一个是262名≥20岁的女性。每个青少年与两名相同奇偶性、且在同一天植入了52mgLNG-IUD的成年女性配对。本研究采用Mann-Whitney检验比较两组数值变量, Kaplan-Meier法比较两组宫内节育器续用、取出和其他停用IUD的原因。

结果:青少年和成年女性的平均年龄±SD分别为18.1(±1.1)岁和31(±6.8)岁(p=0.015)。在青少年和成年女性中, 第5年的续用率分别为55.6/100 W-Y和70.3/100 W-Y (p < 0.106);和取出率分别为8.4/100和6.0/100 W-Y (p=0.463)。青少年在3-5年随访期间的延续率较低(p < 0.011), 而因出血/疼痛而取出节育器的比率较高(18.5±5.7/100 W-Y vs 6.4/100±2)。W-Y, p = 0.039)。

结论:应用52 mg LNG-IUD的青少年在放置后3-5年的续用率低于成年女性。两组的取出率相似。

简短总结

应用52mgLNG-IUD的青少年取出率与成年女性相似。尽管续用率很好, 但与成人女性相比, 青少年在3-5年随访期间的续用率较低, 因出血/疼痛而取出的比率较高。

Keywords:

• Intrauterine device
• 52 mg LNG-IUD
• adolescents
• expulsion
• continuation rate

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Fundação de Apoio à Pesquisa do Estado de São Paulo (FAPESP) (2020/14899-9) and Brazilian National Research Council (CNPq) (305179/2019-5).