Does Timing of Levonorgestrel Insertion in Women with Abnormal Uterine Bleeding Affect Its Expulsion and Bleeding Pattern? A Follow-Up Study

Overview

Journal J Obstet Gynaecol India

Specialty Gynecology & Obstetrics

Date 2023 Apr 19

PMID 37073234

Authors

Sunitha Mary Mathew

Alice David

Affiliations

Soon will be listed here.

Abstract

Background: Levonorgestrel Intra Uterine System insertion for contraception is preferred in the follicular phase. However, the ideal time of insertion for Abnormal Uterine Bleeding is not stated clearly. The aim of our study is to find out the effect of timing of insertion on expulsion and irregular bleeding pattern post insertion.

Methods: A follow-up study of patients with LNG-IUS for AUB was conducted. They were grouped into four based on the day of insertion from Last Menstrual Period (LMP). The pattern of irregular bleeding post insertion was compared with odds ratio and the expulsion rate was compared with log rank test.

Results: The most common indication for the 76 patients was ovulatory dysfunction (39.4%) followed by Adenomyosis (36.84%). Those who had LNG-IUS insertion from day 22-30 had quicker expulsions of 25% of patients by 3 months. By 6 months and later expulsion rate was much higher in the luteal phase than the follicular phase ( < 0.03). The least risk of moderate or heavy bleeding was for the 8-15 day group when compared to the 22-30 day group, the odds ratio being 0.03 [95% CI: (0.01-0.2)].

Conclusion: Based on expulsion rate alone, insertion of LNG-IUS at any time in the follicular phase is ideal. Considering both expulsion rate and pattern of bleeding the ideal time would be late follicular phase, that is 8-15th day.

References

Vilos G, Allaire C, Laberge P, Leyland N . The management of uterine leiomyomas. J Obstet Gynaecol Can. 2015; 37(2):157-178. DOI: 10.1016/S1701-2163(15)30338-8. View

Whiteman M, Tyler C, Folger S, Gaffield M, Curtis K . When can a woman have an intrauterine device inserted? A systematic review. Contraception. 2012; 87(5):666-73. PMC: 4578632. DOI: 10.1016/j.contraception.2012.08.015. View

Whitaker L, Critchley H . Abnormal uterine bleeding. Best Pract Res Clin Obstet Gynaecol. 2016; 34:54-65. PMC: 4970656. DOI: 10.1016/j.bpobgyn.2015.11.012. View

Nowitzki K, Hoimes M, Chen B, Zheng L, Kim Y . Ultrasonography of intrauterine devices. Ultrasonography. 2015; 34(3):183-94. PMC: 4484292. DOI: 10.14366/usg.15010. View

Dhamangaonkar P, Anuradha K, Saxena A . Levonorgestrel intrauterine system (Mirena): An emerging tool for conservative treatment of abnormal uterine bleeding. J Midlife Health. 2015; 6(1):26-30. PMC: 4389381. DOI: 10.4103/0976-7800.153615. View

Harris S, Kaneshiro B, Ahn H, Saito-Tom L . Timing of insertion affects expulsion in patients using the levonorgestrel 52 mg intrauterine system for noncontraceptive indications. Contraception. 2020; 103(3):185-189. DOI: 10.1016/j.contraception.2020.11.012. View

Goldstuck N, Wildemeersch D . Role of uterine forces in intrauterine device embedment, perforation, and expulsion. Int J Womens Health. 2014; 6:735-44. PMC: 4132253. DOI: 10.2147/IJWH.S63167. View

Ilavarasi C, Jyothi G, Alva N . Study of the Efficacy of Pipelle Biopsy Technique to Diagnose Endometrial Diseases in Abnormal Uterine Bleeding. J Midlife Health. 2019; 10(2):75-80. PMC: 6643712. DOI: 10.4103/jmh.JMH_109_18. View

Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F . Role of medical therapy in the management of uterine adenomyosis. Fertil Steril. 2018; 109(3):398-405. DOI: 10.1016/j.fertnstert.2018.01.013. View

10.

Jatlaoui T, Whiteman M, Jeng G, Tepper N, Berry-Bibee E, Jamieson D . Intrauterine Device Expulsion After Postpartum Placement: A Systematic Review and Meta-analysis. Obstet Gynecol. 2018; 132(4):895-905. PMC: 6549490. DOI: 10.1097/AOG.0000000000002822. View

11.

Shimoni N, Choudhury T, Goldman A, Frondelli M, Chen P . Bleeding and spotting with the levonorgestrel 13.5 mg intrauterine system: the impact of insertion timing. Contraception. 2019; 99(6):340-344. DOI: 10.1016/j.contraception.2019.02.004. View