Reason, myths and fantasies: preliminary data and reflections about the Portuguese experience with LNG-IUS-induced hypomenorrhea.
OBJECTIVE
To evaluate the efficacy and tolerance of the levonorgestrel-releasing intrauterine system (LNG-IUS) among Portuguese women, with particular emphasis on the implications of changes in bleeding pattern.


METHODS
Forty healthy premenopausal women (average age 42.7 +/- 4.5 years) were recruited in each one of the three Portuguese centers (a total of 120) where the LNG-IUS was used as a contraceptive method during a maximum period of 5 years. All women had previously given their informed consent and were informed about the eventual changes in bleeding pattern. Serum ferritin levels and hemogram measurements were performed before and 1 year after the introduction of the IUS. The results were analyzed by the Student t test (raw data and paired test).


RESULTS
Preliminary data showed a continuation rate of 70% with an excellent efficacy rate (no pregnancies) 1 year after the introduction of the IUS. The hypomenorrhea rate was 35% while 12.5% of the women had amenorrhea. The average increase in serum ferritin level was 13 ng/ml and of hemoglobin 0.4 g/dl. The comparisons of hemoglobin results were statistically significant (p = 0.05, t raw data and p = 0.028, t paired test). Most complaints were related to cultural difficulties in accepting the changes in menstrual bleeding pattern.


CONCLUSIONS
In order to minimize and control the most common menstrual bleeding side-effects that occur when using this IUS, as well as to improve the continuation rate, clinicians must make a judicious choice of potential users, owing to the psychological and cultural implications that menstrual bleeding changes can have, mainly among women of low socioeconomic levels. Moreover, non-contraceptive therapeutic benefits should be emphasized.
da Silva
M O
MO
Lisbon Faculty of Medicine, Hospital de Santa Maria, Lisbon, Portugal.
Costa
M M
MM
D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced* / Q000523:psychology; D001294:Attitude to Health; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000627:therapeutic use; D003466:Cultural Characteristics; D016503:Drug Delivery Systems; D005260:Female; D005293:Ferritins / Q000097:blood; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D008599:Menstruation Disturbances / Q000139:chemically induced* / Q000523:psychology; D010865:Pilot Projects; D011174:Portugal; D017697:Premenopause; D012923:Social Class
D003271:Contraceptive Agents, Female; D006454:Hemoglobins; D016912:Levonorgestrel; D005293:Ferritins