Abstract
Objective
To evaluate levonorgestrel 52 mg intrauterine system (IUS) expulsion risk by menstrual
cycle day of insertion (days 1–8 vs days 9 and beyond) in women using the IUS for
noncontraceptive indications.
Study design
We performed a retrospective cohort study of patients with a levonorgestrel IUS inserted
for the management of noncontraceptive, gynecologic conditions at Kaiser Permanente-Hawaii
between January 2009 and December 2010. We used multivariable logistic regression
models to estimate the likelihood of IUS expulsion adjusting for demographic and clinical
factors and a Kaplan-Meier curve for survival analysis.
Results
Of 176 patients identified, insertion occurred in 42 patients in cycle days 1 to 8
and 87 patients after day 8. Patient follow-up within the Kaiser system ranged from
1 to 71 months. Thirty-nine (22%) patients experienced expulsion, 16 (38%) and 15
(17%) for the 2 timing groups, respectively. Expulsion was more likely if the IUS
placement occurred during the menstrual cycle days 1 to 8 (adjusted odds ratio 3.57
[95% confidence interval 1.13, 11.31]), which was consistent with the Kaplan-Meier
analysis (p = 0.008).
Conclusion
Levonorgestrel IUS expulsion among women using the IUS for noncontraceptive indications
occurred more frequently if insertion occurred during the first eight days of the
menstrual cycle.
Implications
In women planning to use the levonorgestrel IUS to treat gynecologic conditions such
as abnormal uterine bleeding, dysmenorrhea, and endometrial hyperplasia, providers
should consider waiting until after cycle day 8 to perform insertion.
Keywords
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Article info
Publication history
Published online: December 04, 2020
Accepted:
November 25,
2020
Received in revised form:
November 25,
2020
Received:
June 2,
2020
Identification
Copyright
Published by Elsevier Inc.
