Patient satisfaction, sexual function and decision regret in use of levonorgestrel intrauterine device

Abstract

Aim: Abnormal uterine bleeding is a common condition. The etiological cause and treatments are diverse. LNG-IUD can be used to treat abnormal uterine bleeding.It has been shown to reduce the amount of bleeding in patients with menorrhagia and increase hemoglobin and hematocrit (Hct) values. The aim is to investigate the effects of LNG-IUD on hemoglobin, Hct, bleeding pattern, and its effect on sexual function, decision regret, and menorrhagia effects according to the etiologic cause. Material and Method: Our study included patients who underwent LNG-IUD implantation and had been using it for over six months. Patients with a history of postmenopausal or adolescent bleeding, hematologic or oncologic diseases, and a history of drug use that may cause coagulation disorders were excluded. Patients were grouped according to their indications as polyp (n=26), adenomyosis (n=16), leiomyoma (n=27), hyperplasia (n=18), and non-structural causes (n=81). Hemoglobin (Hb) and Hct values were examined before and after the application, and bleeding patterns were questioned. Participants were administered Menorrhagia Impact Questionnaire (MIQ), Arizona Sexual Experience Scale and Decision Regret Scale. Results: 168 patients were included in our study. The average duration of LNG-IUD use was 627.0±319 days and the average age was 43.4±6.1 years. The frequency of bleeding (number of bleedings per year) was 18.0±8.0 before LNG-IUD application and 7.8±8.0 after treatment (p<0.001), and bleeding duration was 11.5±9.5 days before application and 4.8±6.2 days after application (p<0.001). The number of pads used per day was 7.7±3.9 before the application and 1.1±1.4 after the application (p<0.001). While the average Hb value was 11.2±2.0 and Hct value was 34.8±5.1 (n=112) before LNG-IUD application, the average hemogram value was 12.9±1.6 and Hct value was 39.3±4.1 (n=66) after application and a statistically significant increase was observed in Hb and Hct values (p<0.01). When the groups were compared according to the indication, there was no significant difference in the average number of days of LNG-IUD use, total Arizona score, number of individuals with sexual dysfunction according to the Arizano score and decision regret score. Conclusion: LNG-IUD in treating patients with abnormal uterine bleeding increases Hb and Hct values and decreases the bleeding frequency, duration, and daily pad use. LNG-IUD use did not make a difference in sexual functions and decision regret according to the etiologic cause.

Keywords

• bleeding pattern
• Decision Regret
• Levonorgestrel IUD
• Sexual Function

References

1. Liu Z, Doan Q, Blumenthal P, Dubois RW. A systematic review evaluating health-related quality of life, work impairment, and health-care costs and utilization in abnormal uterine bleeding. Value Health 2007; 10: 183–94.
2. Fraser IS, Critchley HOD, Broder M, Munro MG. The FIGO recommendations on terminologies and definitions for normal and abnormal uterine bleeding. Semin Reprod Med 2011; 29: 383–90.
3. Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence (NICE), Clinical Guidelines Vol. 29, 2018, London.
4. Kaunitz AM, Bissonnette F, Monteiro I, Lukkari-Lax E, DeSanctis Y, Jensen J. Levonorgestrel-Releasing Intrauterine System for heavy menstrual bleeding improves hemoglobin and ferritin levels. Contraception 2012; 86: 452–457.
5. Munro MG, Critchley HOD, Broder MS, Fraser IS, FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet 2011; 113: 3–13.
6. McGahuey CA, Gelenberg AJ, Laukes CA, et al. The Arizona sexual experience scale (ASEX): reliability and validity. J Sex Marital Ther 2000; 26: 25–40
7. Soykan A. The reliability and validity of Arizona sexual experiences scale in Turkish ESRD patients undergoing hemodialysis. Int J Impot Res 2004; 16: 531–4.
8. Bushnell DM, Martin ML, Moore KA, Richter HE, Rubin A, Patrick DL. Menorrhagia Impact Questionnaire: assessing the influence of heavy menstrual bleeding on quality of life. Curr Med Res Opin 2010; 26: 2745–55.

9. Brehaut JC, O’Connor AM, Wood TJ, et al. Validation of a decision regret scale. Med Decis Making 2003; 23: 281–92.
10. Telatar T G, Satır Özel C, Turgut A, Kınlı O. Turkish version methodological validation study of the Decision Regret Scale. Ethiopian J Health Development 2021; 35: 362–6.
11. Luukkainen T, Allonen H, Haukkamaa M, Lähteenmäki P, Nilsson CG, Toivonen J. Five years’ experience with Levonorgestrel-Releasing IUDs. Contraception 1986; 33: 139–48.
12. Xiao BL, Zhou LY, Zhang XL, Jia MC, Luukkainen T, Allonen H. Pharmacokinetic and pharmacodynamic studies of levonorgestrel-releasing intrauterine device. Contraception 1990; 41: 353–62.
13. Bahamondes L, Valeria Bahamondes M, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update 2015; 21: 640–51.
14. Silverberg SG, Haukkamaa M, Arko H, Nilsson CG, Luukkainen T. Endometrial morphology during long-term use of levonorgestrel-releasing intrauterine devices. Int J Gynecol Patholson 1986; 5: 235–41.
15. Koh SCL, Singh K. The effect of levonorgestrel‐releasing ıntrauterine system use on menstrual blood loss and the hemostatic, fibrinolytic/inhibitor systems in women with menorrhagia. J Thromb Haemost 2007; 5: 133–8.
16. Fedele L, Bianchi S, Raffaelli R, Portuese A, Dorta M. Treatment of adenomyosis-associated menorrhagia with a levonorgestrel-releasing intrauterine device. Fertil Steril 1997; 68: 426–9.
17. Endrikat J, Shapiro H, Lukkari-Lax E, Kunz M, Schmidt W, Fortier M. A Canadian, multicentre study comparing the efficacy of a levonorgestrel-releasing intrauterine system to an oral contraceptive in women with idiopathic menorrhagia. J Obstet Gynaecol Can 2009; 31: 340–7.
18. Rodriguez BM, Dias S, Jordan V, et al. Interventions for heavy menstrual bleeding; overview of Cochrane reviews and network meta-analysis. Cochrane Database of Systematic Reviews 2022.
19. Ozdegirmenci O, Kayikcioglu F, Akgul MA, et al. Comparison of levonorgestrel intrauterine system versus hysterectomy on efficacy and quality of life in patients with adenomyosis. Fertil Steril 2011; 95: 497–502.
20. Romero SA, Young K, Hickey M, Su HI. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst Rev 2020; 12: CD007245.
21. Wang Y, Yang M, Huang X, Li X, Lin E, Feng Y. Prevention of benign endometrial polyp recurrence using a Levonorgestrel-releasing Intrauterine System in premenopausal patients: a retrospective cohort study. J Minim Invasive Gynecol 2020; 27: 1281–6.
22. Kuzel D, Mara M, Zizka Z, Koliba P, Dundr P, Fanta M. Malignant endometrial polyp in woman with the levonorgestrel intrauterine system - a case report. Gynecol Endocrinol 2019; 35: 112–4.
23. Chowdary P, Maher P, Ma T, Newman M, Ellett L, Readman E. The role of the Mirena intrauterine device in the management of endometrial polyps: a pilot study. J Minim Invasive Gynecol 2019; 26: 1297–302.
24. Bulun SE. Uterine fibroids. N Engl J Med 2013; 369: 1344–55.
25. American College of Obstetricians and Gynecologists committee on Prcatice Bulletins-Gynecology, Management of symptomatic uterine leiomyomas. Obstet Gynecol 2021; 137: e100–e15.
26. Senol T, Kahramanoglu I, Dogan Y, Baktiroglu M, Karateke A, Suer N. Levonorgestrel-releasing intrauterine device use as an alternative to surgical therapy for uterine leiomyoma. Clin Exp Obstet Gynecol 2015; 42: 224–7.
27. Chen S, Liu J, Peng S, Zheng Y. LNG-IUS vs. medical treatments for women with heavy menstrual bleeding: a systematic review and meta-analysis. Front Med (Lausanne) 2022; 9: 948709.
28. Turan G, Bahat PY, Cetin BA, Peker N. The effect of a levonorgestrel-releasing intrauterine device on female sexual function. J Obstet Gynaecol (Lahore) 2021; 41: 269–74.
29. Halmesmäki K, Hurskainen R, Teperi J, et al. The effect of hysterectomy or levonorgestrel-releasing intrauterine system on sexual functioning among women with menorrhagia: a 5-year randomised controlled trial. BJOG 2007; 114: 563–8.
30. Gemzell-Danielsson K, Apter D, Hauck B, et al. The effect of age, parity and body mass index on the efficacy, safety, placement and user satisfaction associated with two low-dose Levonorgestrel Intrauterine Contraceptive Systems: subgroup analyses of data from a Phase III trial. PLoS One 2015; 10: e0135309.
31. Hurskainen R, Teperi J, Rissanen P, et al.Clinical outcomes and costs with the levonorgestrel-releasing intrauterine system or hysterectomy for treatment of menorrhagia: randomized trial 5-year follow-up. JAMA 2004; 291: 1456–63.
32. Blumenthal P D, Dawson L, Hurskainen R. Cost-effectiveness and quality of life associated with heavy menstrual bleeding among women using the levonorgestrel-releasing intrauterine system. Int J Gynaecol Obstet 2011; 112: 171–8.
33. Heliövaara-Peippo S, Hurskainen R, Teperi J et al. Quality of life and costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10-year randomized controlled trial. Am J Obstet Gynecol 2013; 209: 535.e1-535.e14.