title: Pain and bleeding pattern related to levonorgestrel intrauterine system (LNG-IUS) insertion.
abstract: OBJECTIVE
  To investigate whether the pattern or pain or bleeding during levonorgestrel intrauterine system (LNG-IUS) insertion and in the first 6 weeks thereafter is altered by LNG-IUS malposition.
  
  
  METHODS
  Prospective cohort of 413 women undergoing LNG-IUS insertion or replacement. A first questionnaire on pain perception was completed by the women immediately after insertion. In a second questionnaire the women were asked to record pain in the 3 days following insertion and both pain and bleeding from 4 to 6 weeks after insertion. Six weeks after insertion a 2D- and 3D-ultrasound examination was performed to evaluate the position of the LNG-IUS and of the uterus.
  
  
  RESULTS
  Parity was inversely related to pain at insertion, in the first 3 days and at 4-6 weeks. LNG-IUS insertion was less painful in the postpartum period. Women who had had a LNG-IUS as prior contraceptive method reported a higher percentage of amenorrhea at 4-6 weeks. The position of the LNG-IUS or of the uterus did not influence the pain scores or the bleeding pattern. The fact that the LNG-IUS arms appeared embedded in the uterine wall on coronal 3D-volume reconstruction did not influence pain or the bleeding pattern.
  
  
  CONCLUSIONS
  Because neither pain nor bleeding is a reliable predictor of LNG-IUS position, we suggest an ultrasound examination to confirm correct LNG-IUS placement in all patients at about 6 weeks after insertion.
authors.affiliation: KU Leuven Department of Development and Regeneration, Leuven, Belgium. Electronic address: Dominique.vanschoubroeck@uzleuven.be.
authors.forename: Dominique
authors.initials: D
authors.lastname: Van Schoubroeck
authors.forename: Thierry
authors.initials: T
authors.lastname: Van den Bosch
authors.forename: Lieveke
authors.initials: L
authors.lastname: Ameye
authors.forename: Joan
authors.initials: J
authors.lastname: Veldman
authors.forename: An
authors.initials: A
authors.lastname: Hindryckx
authors.forename: Erika
authors.initials: E
authors.lastname: Werbrouck
authors.forename: Dirk
authors.initials: D
authors.lastname: Timmerman
mesh_terms: D000568:Amenorrhea / Q000209:etiology*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage*; D010146:Pain; D010298:Parity; D011247:Pregnancy; D011446:Prospective Studies; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Bleeding; Levonorgestrel intrauterine system; Mirena; Pain; Ultrasound