Factors affecting the spontaneous expulsion of the levonorgestrel-releasing intrauterine system

Jina Youm, Hyun Ju Lee, Seul Ki Kim, Hoon Kim, Byung Chul Jee
International Journal of Gynecology & Obstetrics · 2014 · vol. 126(2) , pp. 165–169 · doi:10.1016/j.ijgo.2014.02.017 · PMID:24825498 · W2053114594
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This retrospective study of 481 women found a 9.6% spontaneous levonorgestrel-releasing intrauterine system expulsion rate, higher in those with adenomyosis, uterine leiomyoma, heavy bleeding, dysmenorrhea, or prior GnRH agonist use.

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Abstract

OBJECTIVE: To estimate the incidence of, and identify risk factors for, spontaneous expulsion of the levonorgestrel-releasing intrauterine system (LNG-IUS). METHODS: Pre-insertion characteristics for 481 women who received the LNG-IUS at a single institution in the Republic of Korea between 2003 and 2011 were analyzed retrospectively. The median duration of follow-up was 13.4 months. Kaplan-Meier plots were constructed to estimate the time to occurrence of spontaneous expulsion in multiple subgroups. RESULTS: The overall crude incidence of spontaneous LNG-IUS expulsion was 9.6%. The cumulative incidence was 7.9%, 9.1%, and 9.6% at 1, 2, and 3 years, respectively. It was significantly higher in women with adenomyosis (9.1%, 10.6%, and 11.1%) or uterine leiomyoma (14.5%, 15.8%, and 15.8%) than in those with a normal uterus (3.6%, 4.1%, and 4.6%) (P=0.008). Women with heavy menstrual bleeding (11.0%, 12.7%, and 13.4%), dysmenorrhea (8.1%, 9.0%, and 10.0%), or pre-insertion receipt of gonadotropin-releasing hormone agonists (13.3%, 16.0%, and 17.3%) also had higher cumulative incidences than those without these conditions (P<0.05). Most (84.5%) women with a spontaneous expulsion chose to discontinue the device. CONCLUSION: Clinicians need to be aware of the risk factors for spontaneous LNG-IUS expulsion because this can lead to a discontinuation of its use.

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Condition tags

adenomyosisdysmenorrhea

MeSH descriptors

Contraceptive Agents, Female Intrauterine Device Expulsion Intrauterine Devices, Medicated Levonorgestrel Adolescent Adult Contraceptive Agents, Female Female Humans Incidence Kaplan-Meier Estimate Levonorgestrel Middle Aged Risk Factors Young Adult

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