AAGL 2013: Are IUDs a Good Medical Intervention Before Surgery?

The levonorgestrel IUD is particularly helpful in patients with abnormal uterine bleeding who require an interval therapy before surgery can be performed, Harvard physicians find.

In a quest to better understand the safety and utility of long-acting reversible contraceptive methods, physicians from Beth Israel Deaconess Medical Center in Boston reviewed the medical records of 1462 women who had IUDs placed from 2006 to 2011. In their review, they learned that 158 women (10.8%) had levonorgestrel IUDs placed for reasons other than contraception.

Their findings were presented in November at the AAGL’s 42nd Global Congress on Minimally Invasive Gynecology by Lara Harvey, MD, MPH, clinical fellow in obstetrics, gynecology, and reproductive biology, Beth Israel Deaconess Medical Center, Boston.

Among this subgroup of 158 women, at least 18 months of follow-up data were available for 139 women (88.0%). The mean age of these 139 women was 42.6 years (± 7.2 years), and the median BMI was 28.4 kg/m2 (range, 25.1 - 37.8 kg/m2). Most of these women were white (38.1%), African American (39.6%), or Hispanic (12.9%).

Of these women who received a levonorgestrel IUD for medical indications, 26 (18.7%) subsequently had surgery within 18 months. The surgeries included hysterectomy (53.8%), hysteroscopy (34.6%), and ablation (15.4%); some patients underwent more than one procedure.

At least 2 years of follow-up data were available for 105 women, and among these women, 22.9% had surgery. There were no significant differences in age, ethnicity, and BMI between women who proceeded to surgery and those who did not (all P ≥ 0.53).

Our study is one of the larger reviews of levonorgestrel IUD placements for non-contraceptive indications, said Dr. Harvey. A strength of our study is the use of documented data instead of patient report, she added.

The levonorgestrel IUD may be particularly helpful for patients requiring interval therapy for less than 2 years, such as women in the perimenopausal period who experience abnormal uterine bleeding. In our study, the median time to surgery was 450 days, explained Dr. Harvey.

She also advised that counseling regarding a failure rate of 23% within 2 years may be helpful for patients anticipating a longer duration of therapy when weighing surgical and medical options.

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