title: Bleeding pattern and safety of consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS)--a multicentre prospective study.
abstract: BACKGROUND
  The LNG-IUS has increasingly been used for contraception, treatment of menorrhagia and endometrial protection during hormone replacement therapy since mid-1990s. Thus, many women use the LNG-IUS consecutively. However, published data on the bleeding pattern regarding consecutive use of the LNG-IUS is scarce.
  
  
  METHODS
  We performed a prospective 15-month multicentre study on the bleeding profile, removal and insertion procedures and safety of the second LNG-IUS in fertile-aged women who had used their first LNG-IUS between 4 years 3 months and 4 years 9 months and who opted for the insertion of a second IUS immediately after removal of the first IUS. Bleeding data were reported descriptively starting from the last 90 days of the first IUS use and continuing for up to 1 year.
  
  
  RESULTS
  Of the 234 subjects screened, 204 (87%) entered the trial. The median number of bleeding/spotting days during the last 90 days of the first LNG-IUS was 7 (25 and 75% percentiles 0 and 15). Due to bleeding associated with the insertion procedure, this increased to 8 days (4 and 18) during the first 90-day reference period, thereafter decreasing to 4 (0 and 10) days during the second to fourth reference periods. Only one expulsion and no pregnancies, pelvic inflammatory diseases or perforations occurred. A total of 12 subjects (5.9%) prematurely discontinued the study: five due to an adverse event and seven due to other reasons (inclusive of loss to follow-up).
  
  
  CONCLUSIONS
  This study confirms the favourable bleeding profile and safety of consecutive use of the LNG-IUS.
authors: Department of Obstetrics and Gynaecology, Karolinska University Hospital, Stockholm, Sweden.
authors: K
authors: K
authors: Gemzell-Danielsson
authors: P
authors: P
authors: Inki
authors: L
authors: L
authors: Boubli
authors: M
authors: M
authors: O'Flynn
authors: M
authors: M
authors: Kunz
authors: O
authors: O
authors: Heikinheimo
mesh_terms: D000328:Adult; D020878:Device Removal; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects; D016912:Levonorgestrel / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008598:Menstruation; D008796:Metrorrhagia / Q000209:etiology*; D011446:Prospective Studies; D012449:Safety
chemical_list: D016912:Levonorgestrel