LNG-IUD safe and effective for managing heavy menstrual bleeding in adolescents with inherited bleeding disorders: Study
One in four adolescents with heavy menstrual bleeding (HMB) since menarche may have an inherited bleeding disorder (IBD). Levonorgestrel-containing intrauterine devices (LNG-IUDs) are the preferred treatment for HMB in adolescents owing to the substantial and extended reduction in bleeding and favorable side effect profile. Medical management alone is frequently insufficient in persons with IBDs, yet several barriers impact the use of LNG-IUDs in those with IBDs, including a lack of standardized periprocedural guidelines, perceived higher bleeding risk associated with IUD insertion complications, and placement-related pain. In addition, a recent history of HMB increases the risk of IUD expulsion threefold. Moreover, first spontaneous IUD expulsion is more frequent among adolescents, potentially because of small uterine size. Expulsion risk factors include young age, history of anemia, concurrent bleeding disorder diagnosis, and abnormal uterine bleeding. While the LNG-IUD is as effective for HMB treatment in adolescents with IBDs as those without IBDs, a key barrier to securing this extended efficacy is a more frequent IUD expulsion rate within 30 days of insertion. Importantly, expulsions after 30 days are not more frequent than in adolescents without IBDs.
Cygan et al hypothesize dthat prophylactic menstrual suppression after IUD insertion may reduce early (≤30 days) device expulsion. The primary objective was to examine the rates of early IUD expulsion in adolescents with IBDs with concurrent menstrual suppression.
The Penn State Health Women and Girls Bleeding Disorder Clinic provides women's health services for patients with suspected or confirmed IBDs, including Ehlers-Danlos syndrome. This retrospective study included adolescent girls (aged 10–21 years) with known or suspected IBDs undergoing IUD insertion between November 1st, 2019 and September 7th, 2022. According to the clinic practice pattern, participants continued their prior hormonal therapy for at least 30 days after insertion. IUD insertion was within 60 days of the last depot medroxyprogesterone acetate injection to ensure adequate coverage for 30 days. Assessed data included the incidence of IUD expulsion, bleeding disorder diagnosis, mode of menstrual suppression in the first 30 days after insertion, subjective reported bleeding profiles at follow-up, and any observed complications. Bleeding patterns were categorized as amenorrheic, light, normal, or heavy.
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