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.