Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
Gynecol Endocrinol. 2020 Dec;36(12):1086-1089. doi: 10.1080/09513590.2020.1802420. Epub 2020 Aug 4.
Current research informations fail to adequately inform about when levonorgestrel-releasing intrauterine system (LNG-IUS) 52 mg is used instead of other lower dose LNG-IUSs (13.5 and 19.5 mg) and other long-acting reversible contraceptives (LARCs) in clinical practice.
A retrospective cohort study was performed in a third-level Service for Family Planning of Modena University hospital about all the first modern contraceptives prescriptions in the whole year 2019 performed by the same group of physicians. All women included underwent a detailed transvaginal ultrasound (TVUS) at prescription and a second evaluation within 3 months when they were still using the prescribed method.
To 69/160 (43.1%) women a short-acting reversible contraceptive (SARC), while to 91/160 (56.9%) a LARC was prescribed. Women with a LARC prescription were older than them with a short-acting (SARC) ( < .0001). Women with LNG-IUS 52 mg prescription were significantly the oldest (42.9 ± 5.3), while those with intrauterine copper device and lower dose LNG-IUS were of similar age (36.5 ± 7.3 and 34.9 ± 2.3), significantly lower ( < .005). Women with implant prescription had the same age as SARC, being the youngest (30.7 ± 8.9 and 31.0 ± 9.5) ( < .0001). Women with LNG-IUS 52 mg prescription mg presented with bigger uterine volume ( = .001). In multivariate analyses, the LNG-IUS 52 mg prescription was significantly linked only to age (OR 1.24; 95% CI 1.11-1.37, < .0001) and presence of adenomyosis (OR 4.56; 95% CI 1.45-14.33, = .009).
The use of LNG-IUS 52 mg instead of other LARCs is preferred for older women, with uteri of increased volume due to adenomyosis, suggesting a possible differential use of available LNG-IUSs in the contemporary clinical practice.
目前的研究信息未能充分说明何时应使用左炔诺孕酮释放宫内节育系统（LNG-IUS）52mg 替代其他低剂量 LNG-IUS（13.5 和 19.5mg）和其他长效可逆避孕药（LARC）。
这是一项在摩德纳大学三级计划生育服务中心进行的回顾性队列研究，对同组医生在 2019 年全年开具的所有第一种现代避孕药进行了研究。所有纳入的女性在开具处方时均接受了详细的经阴道超声（TVUS）检查，并在使用规定方法的 3 个月内进行了第二次评估。
69/160（43.1%）名女性开具了短期可逆避孕药（SARC），91/160（56.9%）名女性开具了 LARC。开具 LARC 处方的女性比开具 SARC 处方的女性年龄更大（ < .0001）。开具 LNG-IUS 52mg 处方的女性年龄最大（42.9 ± 5.3），而宫内铜器和低剂量 LNG-IUS 处方的女性年龄相仿（36.5 ± 7.3 和 34.9 ± 2.3），显著更低（ < .005）。植入物处方的女性与 SARC 的年龄相同，为最年轻（30.7 ± 8.9 和 31.0 ± 9.5）（ < .0001）。开具 LNG-IUS 52mg 处方的女性子宫体积较大（ = .001）。多变量分析显示，LNG-IUS 52mg 处方仅与年龄（OR 1.24；95%CI 1.11-1.37， < .0001）和腺肌病的存在（OR 4.56；95%CI 1.45-14.33， = .009）显著相关。
对于年龄较大、因腺肌病导致子宫体积增大的女性，更倾向于使用 LNG-IUS 52mg 而不是其他 LARC，这表明在当代临床实践中可能会对现有的 LNG-IUS 进行不同的使用。
