Teunissen Anna M, Merry Audrey H H, Devies Ingrid E C, Roumen Frans J M E
Department of Obstetrics and Gynecology, Zuyderland Medical Centre, Heerlen/Sittard-Geleen, The Netherlands.
Zuyderland Medical Centre, Zuyderland Academy, Heerlen/Sittard-Geleen, The Netherlands.
Eur J Contracept Reprod Health Care. 2019 Dec;24(6):449-456. doi: 10.1080/13625187.2019.1682134. Epub 2019 Nov 7.
To investigate differences in continuation rates between contraceptive and therapeutic use of the levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS) and factors associated with early removal. Study design: Retrospective consecutive cohort design. Women with the insertion of the LNG-IUS for contraceptive or therapeutic use from 1 January 2006 through 1 January 2009 at the Zuyderland Medical Centre, The Netherlands, with a follow-up of 5 years. The continuation period and reasons of early removal were noted. Univariable and multivariable analysis were performed. Follow-up was possible in 2481 women, 1855 (74.8%) in the contraception group, and 626 (25.2%) in the therapy group. Multivariable Cox proportional hazards models showed, that therapeutic use was associated with an increased risk of early removal of the LNG-IUS (HR 1.23; 95% CI 1.08-1.41), as was having one child (HR 1.20; 95% CI 1.04-1.38), and a decreased risk with advancing age (HR 0.96; 95% CI 0.95-0.97). In both groups, an unacceptable bleeding pattern and adverse events were the main reasons of early removal, resulting in very low continuation rates over the years. Therapeutic use, having one child and a younger age are independent risk factors of early removal of the LNG-IUS, in contrast with previous LNG-IUS use which is associated with a lower risk. In both the contraception group and the therapy group, the main reasons for LNG-IUS discontinuation are continuation with a new LNG-IUS, and no more need for an LNG-IUS (for contraception or therapy). An unacceptable bleeding pattern or adverse events are associated with the lowest continuation rates in both groups.
探讨左炔诺孕酮宫内节育系统52毫克（LNG-IUS）用于避孕和治疗时的续用率差异以及与早期取出相关的因素。研究设计：回顾性连续队列设计。2006年1月1日至2009年1月1日在荷兰祖德兰德医疗中心因避孕或治疗目的植入LNG-IUS的女性，随访5年。记录续用期和早期取出的原因。进行单变量和多变量分析。2481名女性可进行随访，避孕组1855名（74.8%），治疗组626名（25.2%）。多变量Cox比例风险模型显示，治疗用途与LNG-IUS早期取出风险增加相关（风险比1.23；95%置信区间1.08 - 1.41），有一个孩子也是如此（风险比1.20；95%置信区间1.04 - 1.38），而随着年龄增长风险降低（风险比0.96；95%置信区间0.95 - 0.97）。在两组中，不可接受的出血模式和不良事件是早期取出的主要原因，导致多年来续用率极低。治疗用途、有一个孩子和较年轻年龄是LNG-IUS早期取出的独立危险因素，与先前使用LNG-IUS风险较低形成对比。在避孕组和治疗组中，停用LNG-IUS的主要原因是换用新的LNG-IUS继续使用，以及不再需要LNG-IUS（用于避孕或治疗）。不可接受的出血模式或不良事件在两组中与最低续用率相关。
