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

Youm J, Jina Youm, Lee HJ, Hyun Ju Lee, Kim SK, Seul Ki Kim, Kim H, Hoon Kim, Byung Chul Jee, Jee BC
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 Device Expulsion Intrauterine Devices, Medicated Intrauterine Devices, Medicated Levonorgestrel Adolescent Adolescent Adult Adult Contraceptive Agents, Female Contraceptive Agents, Female Female Female Humans Humans Incidence Incidence Kaplan-Meier Estimate Kaplan-Meier Estimate

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