Marcos Perrotti

Bleeding patterns and clinical performance of the levonorgestrel-releasing intrauterine system (Mirena) up to two years.

The objectives of this study were to evaluate the bleeding patterns and clinical performance during the first 2 years of use of an intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS, Mirena). Two-hundred-fifty-six women accepted use of Mirena from April 1998 through September 1998. The gross cumulative discontinuation rate due to pregnancy and expulsion were significantly higher in women who used the device because of heavy bleeding. There was one pregnancy at the 15th month of use after an inadvertent expulsion of the device. The continuation rate was 66.2 at the end of the second year. Forty-four percent of women reported amenorrhea at the 6th month of use. This rate maintained stability at 50% after 12 and 24 months of use. Spotting was present in 25% of the users at 6 months, decreasing to 8% and 11% at 18 and 24 months, respectively. Oligomenorrhea was described by one-quarter of women and was similar at each observation period. Removals due to menstrual bleeding problems were concentrated in the first 6 months of use and mostly due to amenorrhea or menorrhagia. In conclusion, LNG-IUS showed a high contraceptive efficacy and a good continuation rate up to 2 years. In addition, a reduction of blood loss was observed a few months after insertion.

Therapeutic use of levonorgestrel-releasing intrauterine system in women with menorrhagia: a pilot study

The objective of this study was to evaluate the efficacy and performance, for up to 1 year, of an intrauterine system releasing 20 microg/day of levonorgestrel (LNG-IUS, Mirena) in the treatment of women with menorrhagia. It was a descriptive, prospective, non-comparative study. A 20 microg/day LNG-releasing-IUS was inserted on any day during bleeding to 44 women (between 24 and 49 years of age) who presented with menorrhagia after medical therapies had failed. Menstrual patterns were assessed, and hemoglobin concentrations were measured before LNG-IUS was inserted and at 3, 6, 9, and 12 months of use. The most common bleeding pattern at 3 months after insertion was spotting, and after 6, 9, and 12 months the majority of women presented with amenorrhea or oligomenorrhea. Three women requested removal of the LNG-IUS because of spotting, and six women expelled it spontaneously. Hemoglobin levels were improved from 102 g/L to 123 and 128 g/L at 3 and 12 months, respectively, after insertion of the LNG-IUS (p < 0.01). At 12 months 79.5% of participants continued the use of LNG-IUS. In conclusion, LNG-IUS was an effective treatment for three out of four women with menorrhagia and could be an alternative treatment for women with menorrhagia who are either contraindicated for or refuse hysterectomy or endometrial ablation.

Forearm bone density in users of Depo-Provera as a contraceptive method

OBJECTIVE To determine the influence of depot medroxyprogesterone acetate (MPA) on bone mineral density when used as a contraceptive method. DESIGN Cross-sectional study. SETTING Academic tertiary-care hospital. PATIENT(S) Fifty premenopausal women who had used depot MPA as a contraceptive method for > or =1 year and 50 women who had never used hormonal contraceptive methods. INTERVENTION(S) Bone mineral density was evaluated at the midshaft and at the distal radius of the nondominant forearm using single x-ray absorptiometry. MAIN OUTCOME MEASURE(S) Bone mineral density. RESULT(S) Bone mineral density at the midshaft of the forearm was lower in depot MPA users than in women who had never used hormonal contraceptive methods, but the difference was not statistically significant. At the distal portion, bone mineral density was significantly lower in the study group. The duration of depot MPA use was not related to bone mineral density. CONCLUSION(S) Women > or =35 years of age presented with a lower bone mineral density only at the distal portion of the forearm after the use of depot MPA for > or =1 year. However, this decrease was not related to the duration of depot MPA use. It is not possible to conclude that women who use depot MPA are at risk of osteoporosis.

Forearm bone density in long-term users of oral combined contraceptives and depot medroxyprogesterone acetate.

OBJECTIVE To compare the bone mineral density of users of combined oral contraceptives (OC) or depot medroxyprogesterone acetate (depot-MPA) with women who have never used a hormonal contraceptive method. DESIGN Cross-sectional study. SETTING Academic tertiary-care hospital. PATIENT(S) A total of 189 women, aged 30 to 34 years old, were allocated to three groups: 63 who had used OC for at least 2 years; 63 who had used depot-MPA for at least 2 years; and 63 control women who had never used hormonal contraceptives. INTERVENTION(S) Each womans bone mineral density (BMD) was evaluated at the distal and ultradistal section of the radius of the nondominant forearm by the use of single x-ray absorptiometry. MAIN OUTCOME MEASURE(S) We obtained BMD measurements for each participant. RESULT(S) Independent of the period of use and the section of the forearm studied, we found no difference in BMD for OC or depot-MPA users when compared to women who had never used hormonal contraceptive methods. In addition, BMD was similar between OC users and depot-MPA users. The multiple linear regression analysis showed that the variables associated with BMD were weight, number of pregnancies, and the womans occupation. CONCLUSION(S) Women aged 30 to 34 years who have used OC or depot-MPA have similar BMD as control women. These findings suggest that the use of OC or depot-MPA does not affect the BMD of women in this age group.

Comparison of weight increase in users of depot medroxyprogesterone acetate and copper IUD up to 5 years

The objective of this study was to evaluate retrospectively the weight variation in long-term users of depot medroxyprogesterone acetate (DMPA) compared to users of the TCu380A intrauterine device (IUD). A cohort of 206 healthy women allocated in two groups of 103 women according to the contraceptive method used was evaluated through 5 years. Each user of DMPA was paired with an IUD user by age (+/- 1 year) and weight (+/- 1 kg) at the beginning of the study. Weight was evaluated yearly during 5 years. The mean age at the beginning of the study was 33.1 years in both groups, and the mean weight was 59.4 kg in the IUD users and 60.4 kg in the DMPA group. Both cohorts of women presented significant weight increase at the end of the 5 years of observation (p < 0.001). However, DMPA users presented higher weight increase when compared to IUD users from the second through the fifth year of observation. The DMPA users increased weight by 4.3 kg during the 5 years, and IUD users increased 1.8 kg. In conclusion, DMPA users had a significantly higher weight increase when compared to IUD users. In addition, this cohort of women increased weight throughout the 5 years with the use of DMPA or IUD.

Follow-up of users of intrauterine device with and without bacterial vaginosis and other cervicovaginal infections

This study aimed to assess the prevalence of bacterial vaginosis (BV) and other cervicovaginal infections, as well as the incidence of complications among new users of IUD, 1 and 6 months after its insertion, in the City of Campinas, Brazil. A total of 223 women who had a TCu-380A IUD inserted from May through November 2001, were included in the study. After the IUD insertion all women were scheduled to two additional visits: after 1 month and after 6 months, when they were interviewed and a pelvic examination was performed, along with a collection of specimens from the vagina and the endocervix for laboratory testing. The Nugents criterion was used for the BV diagnosis. They were also evaluated with regard to presence of complications possibly related to IUD insertion and use, i.e., abnormal bleeding, dysmenorrhea, expulsion and pelvic inflammatory disease. The prevalence of cervicovaginal infections was 29.1%, BV being the most frequent (19.7%). Dysmenorrhea was more frequent among women with BV than among women without BV (p = 0.03). A trend of abnormal bleeding being more frequent among women with BV was also found. In conclusion, BV after 1 month of IUD insertion was not associated with IUD complications, with the exception of dysmenorrhea.

Weight variation in a cohort of women using copper IUD for contraception

The objective of this study was to assess weight changes over time in reproductive-age women using nonhormonal contraception [copper intrauterine device (IUD) users]. Baseline variables recorded included age, parity, decade when the IUD was inserted and the presence of hypertension. A total of 1697 IUD users were followed for 7 years of use. The mean age (+/- SD) of the women at the beginning of follow-up was 27.6 +/- 5.8 years and the mean height (+/- SD) was 150 +/- 10 cm. The mean weight (+/- SD) at the time of IUD insertion was 58.5 +/- 0.30 kg. After 5 and 7 years of follow-up, the mean weight (+/- SD) was 61.2 +/- 0.33 kg and 62.4 +/- 0.51 kg, respectively. At insertion, the body mass index mean (+/- SD) was 24.5 +/- 0.12 and after 3 years it was 25 +/- 0.14, remaining above 25 up to the 7th year of observation. During the 7 years of follow-up, older women gained more weight than younger women. Parity, decade of IUD insertion and hypertension were not noted to be significant determinants of weight variation. In conclusion, this cohort of lower and middle class Brazilian copper IUD users tended to gain weight during their reproductive life, independent of other factors. These observations may improve counseling of women regarding the prevention of age-related obesity.

Users' Perspectives on Bleeding Patterns after Two Years of Levonorgestrel-Releasing Intrauterine System Use

The demand for intrauterine devices (IUDs) has increased over recent years because they represent one of the most cost-effective reversible methods of contraception.[1] However, IUD use still causes concern for women, especially those with heavy menstrual bleeding, because of the risk of anaemia.[2] Hormone-medicated IUDs, such as the 20 μg/day levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena®1, Leiras Oy, Turku, Finland), are associated with a reduction in the amount of blood loss during the menstrual period. Because of this property, the LNG-IUS has been used for the treatment of menorrhagia.[3,4] From 50–70% of women using LNG-IUS became amenorrhoeic after 1 year of use in one study.[5] However, modification of the menstrual pattern, including amenorrhoea, is one of the leading causes of discontinuation among women using the device for contraception.[6,7] The perception of what is ‘normal’ menstrual bleeding differs widely between different populations, and is influenced by sociocultural aspects and by the counselling women receive. The perception of menstrual patterns in LNG-IUS users varies among different populations. However, these differences could, in part, result from the woman’s interpretation, the service provider’s opinion regarding bleeding patterns, or the system of evaluation. Hence, when a new contraceptive method that is associated with changes in menstrual patterns, like the LNG-IUS, is introduced it is important to inform the potential user what changes she may expect to experience in her bleeding pattern. It is probable that this counselling would directly influence the continuation rate. The objective of this study was to evaluate the perspectives of users of the LNG-IUS in Campinas, Brazil, after 1 year of use, regarding bleeding patterns and their opinion on whether amenorrhoea induced by the device has health consequences.