Levonorgestrel-Releasing Intrauterine Device Use in Female Adolescents with Heavy Menstrual Bleeding and Bleeding Disorders: Single Institution Review.
OBJECTIVE
To identify complications and efficacy of the levonorgestrel-releasing intrauterine device (LNgIUD) in adolescents with heavy menstrual bleeding (HMB) and bleeding disorders (BD).


METHODS
A retrospective chart review of 13 postmenarchal adolescent girls with HMB/BD who underwent placement of an LNgIUD.


METHODS
Placement of an LNgIUD.


METHODS
Primary outcome was to identify complications from placement of an LNgIUD. Secondary outcome was to evaluate the efficacy of the LNgIUD in adolescents with BD.


RESULTS
Thirteen patients met study criteria. The mean age of diagnosis of HMB was 14.08 ± 1.75 years. BD or bleeding risk factor diagnoses included low von Willebrand (VW) activity in 5, type I VW disease in 5, type IIM VW disease in 1, low VW activity and factor 7 deficiency in 1, and acquired VW disease and factor 7 deficiency in 1. Before LNgIUD placement, other hormonal therapy (n = 13) and hemostatic therapy (antifibrinolytic agents, desmopressin acetate; n = 8) yielded poor control of HMB. The LNgIUD was placed using anesthesia with periprocedure hemostatic therapy with no complications. All patients reported significant improvement in HMB after LNgIUD placement and 60% achieved amenorrhea, with mean time to improvement of 94 ± 69 days. Mean hemoglobin and ferritin levels increased after LNgIUD placement compared with before LNgIUD placement values (P = .02, P = .0085, respectively). Use of supplemental hormonal and hemostatic agents decreased (n = 4) after LNgIUD placement. None required LNgIUD removal; 1 spontaneously expelled the LNgIUD with subsequent replacement.


CONCLUSIONS
Study results indicated the LNgIUD is an effective therapeutic option in postmenarchal adolescents with HMB due to BD/bleeding risk factor with minimal complications, high compliance rate, improvement in HMB and anemia, and no periprocedural bleeding with hemostatic management.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas. Electronic address: adeyemi@bcm.edu.
Oluyemisi A
OA
Adeyemi-Fowode
Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
Xiomara M
XM
Santos
Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
Jennifer E
JE
Dietrich
Department of Pediatrics, Baylor College of Medicine, Houston, Texas; Texas Children's Cancer and Hematology Centers, Houston, Texas.
Lakshmi
L
Srivaths
D000293:Adolescent; D002648:Child; D003271:Contraceptive Agents, Female / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006474:Hemorrhagic Disorders / Q000150:complications / Q000628:therapy*; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000009:adverse effects / Q000627:therapeutic use*; D008595:Menorrhagia / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
Adolescent; Bleeding disorder; Heavy menstrual bleeding; Levonorgestrel-releasing IUD