Jina Youm1, Hyun Ju Lee1, Seul Ki Kim2, Hoon Kim1, Byung Chul Jee3. 1. Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Republic of Korea. 2. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 3. Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: blasto@snubh.org.
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.
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.
Authors: Mary Anne Armstrong; Tina Raine-Bennett; Susan D Reed; Jennifer Gatz; Darios Getahun; Juliane Schoendorf; Debbie Postlethwaite; Michael J Fassett; Jeffrey F Peipert; Catherine W Saltus; Maqdooda Merchant; Amy Alabaster; Xiaolei Zhou; Laura Ichikawa; Jiaxiao M Shi; Vicki Y Chiu; Fagen Xie; Shannon Hunter; Jinyi Wang; Mary E Ritchey; Giulia Chillemi; Theresa M Im; Harpreet S Takhar; Federica Pisa; Alex Asiimwe; Mary S Anthony Journal: JAMA Netw Open Date: 2022-02-01