Does a Bleeding Disorder Lessen the Efficacy of the 52-mg Levonorgestrel-Releasing Intrauterine System for Heavy Menstrual Bleeding in Adolescents? A Retrospective Multicenter Study

Authors

Misha Khalighi, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California. Electronic address: mkhalig88@gmail.com.
Allison P. Wheeler, Department of Pathology, Microbiology, & Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
Oluyemisi A. Adeyemi-Fowode, Department of Pediatric and Adolescent Gynecology, Texas Children's Hospital, Houston, Texas.
Peter A. Kouides, Department of Hematology and Medical Oncology, Rochester General Hospital, University of Rochester School of Medicine and Mary M. Gooley Hemophilia Treatment Center, Rochester, New York.
Ramon A. Durazo-Arvizu, The Saban Research Institute Biostatistics Core, Children's Hospital Los Angeles, Los Angeles, California.
Kristina Haley, Division of Hematology and Oncology, Oregon Health & Sciences University, Portland, Oregon.
Candice M. Dersch, Department of Obstetrics and Gynecology, Maine Medical Center, Portland, Maine.
Angela C. Weyand, Division of Hematology and Oncology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan.
Maureen K. Baldwin, Department of Obstetrics and Gynecology, Oregon Health & Sciences University, Portland, Oregon.
Claudia Borzutzky, Division of Adolescent and Young Adult Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California.

Document Type

Article

Publication Date

4-13-2022

Institution/Department

Obstetrics and Gynecology

Journal Title

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

Abstract

PURPOSE: The aim of this study is to compare the patient-reported bleeding outcomes and complication rates with the use of the 52-mg levonorgestrel-releasing intrauterine system (52-LNG-IUS) for treatment of heavy menstrual bleeding (HMB) among adolescents with and without a diagnosed inherited bleeding disorder (BD) within the first 12 months after insertion. METHODS: Retrospective chart review was conducted of adolescents ages 14-21 years, with and without an inherited BD, who underwent 52-LNG-IUS insertion between September 2013 and February 2020 for the treatment of HMB. RESULTS: One hundred forty-four 52-LNG-IUS insertions among 139 subjects were evaluated. Fifty-nine (41%) of these were among adolescents with a diagnosed inherited BD, and 85 (59%) were among those without a BD. Among subjects with follow-up, documentation of patient-reported bleeding outcome, and a retained IUS (92/144), both groups subjectively reported improvement in bleeding outcome, with 91.7% (33/36) of those with a BD and 94.6% (53/56) of those without a BD reporting that bleeding outcome was better than prior to IUS insertion (p = .675). There was no statistically significant difference in the rate of spontaneous expulsion (p = .233), with the rate of expulsion in the first 12 months after placement among those with a BD of 13.7% (7/51) and 6.8% for those without a BD (5/72). DISCUSSION: Adolescents with HMB both with and without an inherited BD benefit from the 52-LNG-IUS for the treatment of HMB. Rates of spontaneous IUS expulsion are not statistically different regardless of the presence of a BD and are similar to rates found in other studies of intrauterine device use in adolescents.

Recommended Citation

Khalighi M, Wheeler AP, Adeyemi-Fowode OA, et al. Does a Bleeding Disorder Lessen the Efficacy of the 52-mg Levonorgestrel-Releasing Intrauterine System for Heavy Menstrual Bleeding in Adolescents? A Retrospective Multicenter Study [published online ahead of print, 2022 Apr 13]. J Adolesc Health. 2022;S1054-139X(22)00339-1. doi:10.1016/j.jadohealth.2022.02.018