Long-acting reversible contraceptives effects in abnormal uterine bleeding, a review of the physiology and management

Treatment of unacceptable bleeding in long-term users of 52-mg levonorgestrel intrauterine device: a prospective observational study

BACKGROUND

In the first month after the insertion of the 52-mg levonorgestrel intrauterine device, irregular vaginal bleeding often occurs. In 6% to 18% of 52-mg levonorgestrel intrauterine device users, irregular vaginal bleeding reoccurs or continues for more than 6 months after insertion of the device. This study hypothesized that the addition of estradiol may be beneficial for the regeneration of the endometrium and may consequently decrease irregular bleeding, as these basal vessels might be shielded by the regenerated endometrium.

OBJECTIVE

This prospective observational study aimed to evaluate the effectiveness of estradiol in treating irregular bleeding in patients who have had a 52-mg levonorgestrel intrauterine device in place for at least 6 months.

STUDY DESIGN

The study was conducted in 2 hospitals and in 1 general practice in the Netherlands. Patients with a 52-mg levonorgestrel intrauterine device who experienced irregular bleeding and who chose to undergo estradiol treatment were included. Treatment consisted of 2 mg of oral estradiol daily for 6 weeks. The primary outcome was the number of bleeding days a month after 3 months of estradiol treatment compared with baseline. The secondary outcomes included the number of bleeding days 12 months after the start of medication, bleeding patterns, discontinuation rate of the 52-mg levonorgestrel intrauterine device, side effects, adverse events, and patient satisfaction at 3 and 12 months of follow-up.

RESULTS

A total of 39 patients provided informed consent and completed the baseline questionnaires. The mean number of bleeding days decreased significantly from 22.5 days per month at baseline to 12.8 days per month 3 months after starting estradiol treatment. The 52-mg levonorgestrel intrauterine device was removed in 10.3% of patients at 3 months of follow-up and 33.3% of patients at 12 months of follow-up. The number of women reporting acceptable bleeding patterns and satisfaction with the 52-mg levonorgestrel intrauterine device increased substantially over 12 months of follow-up.

CONCLUSION

A decrease in the number of bleeding days was observed in long-term 52-mg levonorgestrel intrauterine device users who experienced unfavorable bleeding after the administration of estradiol for 6 weeks. In addition, satisfaction rates increased significantly.

Clinical trial registration number

NL8007.

Etonogestrel-releasing subdermal contraceptive implant: Budget impact analysis based on the Brazilian private healthcare system

High rates of unplanned pregnancies persist despite pharmacological developments and advancements in contraceptive methods. Here, we demonstrate that the etonogestrel-releasing subdermal contraceptive implant (IMP-ETN) may be an appropriate and cost-effective alternative to levonorgestrel-releasing intrauterine systems (LNG-IUSs) for women in Brazil. For our pharmacoeconomic analysis, we reviewed the literature on IMP-ETN regarding its acceptance, eligibility criteria, choice, relations with age, adverse events and, finally, the unmet need in the fee-for-service private healthcare sector. We considered qualitative observations in combination with quantitative analysis and performed a deterministic sensitivity analysis to investigate whether this technology can be self-sustainable over a period of five years. The target population for this analysis comprised 158,696 women. Compared with the continued use of LNG-IUSs, adopting the IMP-ETN can result in a cost avoidance of $ 7.640.804,02 in the first year and $ 82,455,254.43 in five years. Disseminating information among physicians will promote this change and strengthen the potential cost avoided by private health system payers. These savings can be used to improve other healthcare programs and strategies. Moreover, the principles of care can be promoted by improving and adapting healthcare systems and expanding treatment and follow-up strategies. This would also provide support to women's reproductive rights and improve their quality of life. Our results suggest that the IMP-ETN has a favorable cost-effectiveness profile. Given all its advantages and negative incremental cost impact over a period of five years, the IMP-ETN may be a more favorable alternative to LNG-IUSs. Therefore, it should be offered to beneficiaries with a private healthcare plan. This analysis overcomes previous barriers to the use of cost-benefit models, and our results may help balance decision-making by policymakers, technical consultants, and researchers.

Effect of a single dose of a combination injectable contraceptive for treatment of bothersome uterine bleeding in contraceptive implant(s) users: A randomized double-blind placebo-controlled trial

OBJECTIVES

This study aimed to determine the proportion of participants whose uterine bleeding/spotting was interrupted for at least 7 days during the month after they received a combined hormonal injection. We also evaluated bleeding at 21 days and 12 weeks after the injection.

STUDY DESIGN

We conducted a randomized, double-blind, placebo-controlled trial in 46 contraceptive implant users who presented with bothersome uterine bleeding/spotting. A single dose of a combination injectable contraceptive or placebo was administered intramuscularly at enrollment.

RESULTS

The proportions of participants whose uterine bleeding/spotting was interrupted for at least 7 days the month after they received a combined hormonal injection were higher in the combination injectable contraception group than in the placebo group (87% vs 48%, p = 0.005). Participants who reported that they were bleeding free at 21 days after treatment were 52% and 35% in the combination injectable contraception group and placebo group, respectively (p = 0.24). At 12 weeks posttreatment, 17% of participants in the combination injectable contraception group and 4% in the placebo group reported cessation of bleeding with no recurrence (p = 0.34). The median days until the first bleeding interruption was shorter in the combination injectable contraception group compared with the placebo group (1 [interquartile range, 1-2] vs 8 [interquartile range, 1-28], p = 0.007).

CONCLUSIONS

The combination injectable contraception interrupted bothersome uterine bleeding/spotting in contraceptive implant(s) users compared with placebo. However, this effect was limited only within the month when the treatment was administered.

IMPLICATIONS

Bothersome uterine bleeding/spotting is a common side effect leading to contraceptive implant(s) discontinuation. In implant users experiencing these symptoms with no estrogen contraindications, a combined injectable contraception appears to rapidly improve bleeding for the duration of injectable exposure (1 month).

Nanomaterials Solutions for Contraception: Concerns, Advances, and Prospects

Preventing unintentional pregnancy is one of the goals of a global public health policy to minimize effects on individuals, families, and society. Various contraceptive formulations with high effectiveness and acceptance, including intrauterine devices, hormonal patches for females, and condoms and vasectomy for males, have been developed and adopted over the last decades. However, distinct breakthroughs of contraceptive techniques have not yet been achieved, while the associated long-term adverse effects are insurmountable, such as endocrine system disorder along with hormone administration, invasive ligation, and slowly restored fertility after removal of intrauterine devices. Spurred by developments of nanomaterials and bionanotechnologies, advanced contraceptives could be fulfilled via nanomaterial solutions with much safer and more controllable and effective approaches to meet various and specific needs for women and men at different reproductive stages. Nanomedicine techniques have been extended to develop contraceptive methods, such as the targeted drug delivery and controlled release of hormone using nanocarriers for females and physical stimulation assisted vasectomy using functional nanomaterials via photothermal treatment or magnetic hyperthermia for males. Nanomaterial solutions for advanced contraceptives offer significantly improved biosafety, noninvasive administration, and controllable reversibility. This review summarizes the nanomaterial solutions to female and male contraceptives including the working mechanisms, clinical concerns, and their merits and demerits. This work also reviewed the nanomaterials that have been adopted in contraceptive applications. In addition, we further discuss safety considerations and future perspectives of nanomaterials in nanostrategy development for next-generation contraceptives. We expect that nanomaterials would potentially replace conventional materials for contraception in the near future.

Uterine Artery Rupture Caused by IUD Extraction: A Case Report

It’s been 100 years since the first intrauterine device (IUD) was invented in Germany in 1920. IUDS are widely favored by women of childbearing age for their efficiency, convenience, cheapness, and variety of materials. According to incomplete statistics, about 26 million people worldwide will need to have their IUDS removed from 2015 to 2025 alone. With such a large case base, we have to pay attention to the safety of IUD removal. There are few international guidelines on IUD placement and removal. Therefore, this paper will report a case of uterine artery rupture caused by ring removal, and discuss the important steps of ring removal surgery, so as to enhance the attention of physicians to the standard and safety of ring removal and improve the quality of medical treatment.