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2.
Arq. ciências saúde UNIPAR ; 27(1): 73-89, Jan-Abr. 2023.
Article in Portuguese | LILACS | ID: biblio-1414725

ABSTRACT

pílula contraceptiva de emergência (CE) é chamada pelos médicos de pílula anticoncepcional pós-coito. É um método anticoncepcional de emergência e deve ser tomada até 72 horas após a relação sexual. É adequado para casos de abuso sexual, preservativos rompidos ou falha de outros métodos anticoncepcionais. Sendo assim, o objetivo do presente estudo foi avaliar o perfil da dispensação do contraceptivo de emergência (CE) em uma farmácia comercial localizada em um distrito do município de Assis Chateaubriand no oeste do estado do Paraná. Para o desenvolvimento da pesquisa, foi avaliado a quantidade do medicamento dispensado com o princípio ativo levonorgestrel no período de três meses em uma farmácia de dispensação de medicamentos no distrito de Bragantina, assim como a faixa etária da paciente que utilizou, o seu estado civil e o motivo da compra da pílula. O projeto foi aprovado pelo Comitê de ética sob o número do CAAE: 60509322.3.0000.0109. Os resultados mostraram que no período do desenvolvimento da pesquisa, 10 pacientes fizeram uso da CE, sendo 5 solteiras e 5 casadas, sendo 50%. Quando relatado a idade das pacientes que fazem uso do CE, os resultados foram entre 19 até 41 anos. Quando perguntado para as pacientes se elas faziam uso de outro método contraceptivo e se presente, qual seria este método, os resultados encontrados foram: 40% das mulheres não utilizam outro método contraceptivo e 60% fazem o uso de outro contraceptivo, destes, o percentual foi de 66% que faziam o uso de preservativo e 34% faziam o uso de anticoncepcional. Em relação ao horário pós-coito, isto é, quantas horas após o coito elas procuraram a farmácia para comprar a CE, os resultados encontrados foram de 08 horas até 52 horas. Sendo assim, conclui-se que o estudo possui relevância frente à procura da PDS, no entanto, é de suma importância não esquecer de que a PDS deve ser utilizada somente em casos de emergências e não como uso rotineiro, para isso, existem outros métodos de contraceptivos que podem ser de recurso rotineiro. Neste sentido, mais estudos são necessários para avaliar se a população tem conhecimento sobre o tema, se o farmacêutico está preparado para atendê-los e o porquê da população não se programar melhor para evitar os possíveis "acidentes".


The morning after pill (PDS) is called the post-coital birth control pill by doctors. It is an emergency contraceptive method and must be taken within 72 hours of sexual intercourse. It is suitable for cases of sexual abuse, broken condoms or failure of other contraceptive methods. Therefore, the objective of the present study will be to evaluate the profile of the dispensation of emergency contraceptives (EC) in a pharmacy in the western municipality of the state of Paraná. For the development of the research, the amount of medication dispensed in a period of three months in a drug dispensing pharmacy was evaluated, as well as the age group of the patient who will use it, her marital status and the reason for purchasing the pill. The project was approved by the Ethics Committee under CAAE number: 60509322.3.0000.0109. The results showed that during the research development period, 10 patients used PDS, 5 of them single and 5 married, being 50%. When reporting the age of patients using the morning-after pill, the results ranged from 19 to 41 years. When asked to patients if they used another contraceptive method and, if present, which method this would be, the results found were: 40% of women do not use another contraceptive method and 60% use another contraceptive, of these, the percentage 66% used condoms and 34% used contraceptives. Regarding the post-coital time, that is, how many hours after coitus they looked for the pharmacy to buy the PDS, the results found were from 08 hours to 52 hours. Therefore, it is concluded that care with medication intake becomes more important when it comes to EC, due to its potential risks to the female body, which can have consequences, especially when used excessively and without prior knowledge. Thus, more guidance on the use and its adverse effects, as more studies on the subject are necessary, in order to minimize the damage that PDS can cause in the female organism.


La píldora del día después (PDS) es llamada por los médicos píldora anticonceptiva poscoital. Es un método anticonceptivo de emergencia y debe ser tomada dentro de las 72 horas siguientes a la relación sexual. Está indicada en casos de abuso sexual, rotura del preservativo o fracaso de otros métodos anticonceptivos. Por lo tanto, el objetivo del presente estudio será evaluar el perfil de la dispensación de anticonceptivos de emergencia (AE) en una farmacia del municipio oeste del estado de Paraná. Para el desarrollo de la investigación, se evaluó la cantidad de medicación dispensada en un período de tres meses en una farmacia dispensadora de medicamentos, así como el grupo etario de la paciente que la utilizará, su estado civil y el motivo de compra de la píldora. El proyecto fue aprobado por el Comité de Ética con el número CAAE: 60509322.3.0000.0109. Los resultados mostraron que durante el período de desarrollo de la investigación, 10 pacientes utilizaron la PDS, 5 de ellas solteras y 5 casadas, siendo el 50%. Al informar sobre la edad de las pacientes que utilizaban la píldora del día después, los resultados oscilaron entre 19 y 41 años. Cuando se preguntó a las pacientes si utilizaban otro método anticonceptivo y, en caso afirmativo, cuál sería, los resultados encontrados fueron: 40% de las mujeres no utilizan otro método anticonceptivo y 60% utilizan otro anticonceptivo, de estas, el porcentaje 66% utilizó preservativo y 34% anticonceptivos. En cuanto al tiempo post-coital, es decir, cuántas horas después del coito buscaron la farmacia para comprar la PDS, los resultados encontrados fueron de 08 horas a 52 horas. Por lo tanto, se concluye que el cuidado con la ingesta de medicamentos se vuelve más importante cuando se trata de la AE, debido a sus riesgos potenciales para el organismo femenino, que pueden tener consecuencias, especialmente cuando se usa en exceso y sin conocimiento previo. Por lo tanto, son necesarias más orientaciones sobre el uso y sus efectos adversos, así como más estudios sobre el tema, con el fin de minimizar los daños que la PDS puede causar en el organismo femenino.


Subject(s)
Humans , Female , Adult , Women , Levonorgestrel , Contraceptives, Postcoital , Patients , Pharmaceutical Preparations , Cross-Sectional Studies/methods , Clinical Trial , Condoms , Pharmacy Research/organization & administration
3.
Rev. bras. ginecol. obstet ; 45(11): 654-660, 2023. tab, graf
Article in English | LILACS | ID: biblio-1529900

ABSTRACT

Abstract Objective To evaluate the continuation rates of the 52-mg levonorgestrel-releasing intrauterine system (LNG-IUS) during the first 5 years of use, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year, in adolescents and young women. Methods The present study was a 5-year prospective cohort conducted in a Family Planning Service of a tertiary hospital in Brazil. We selected 100 healthy women between 15 and 24 years old who used 52-mg LNG-IUS for contraception. The clinical follow-up of these women took place from June 2017 to December 2022. The study evaluated the continuation rates of the method, reasons for its discontinuation, bleeding patterns, and new contraceptive choice after the 5th year. Continuous data were reported as mean ± standard deviation (SD) and range (minimum-maximum). Categorical variables were described as percentages. Results The continuation rates of LNG-IUS were 89.1% (82/92), 82.9% (72/87), 75.3% (64/85), 70.5% (60/85), and 64.2% (54/84) in the 1st, 2nd, 3rd, 4th, and 5th years of use, respectively. The main reason for discontinuation was acne (11/30). Amenorrhea rates were 50, 54.1, 39, 35.7, and 51.8% at 12, 24, 36, 48, and 60 months, respectively. All patients who completed the study and needed contraception after the 5th year opted for long-acting contraceptive methods (LARC). Conclusion The LNG-IUS showed high continuation rates in adolescents and young women in the first 5 years of use. Most patients who completed the study chose a LARC method after the 5th year.


Resumo Objetivo Avaliar as taxas de continuação do sistema intrauterino liberador de levonorgestrel (SIU-LNG) 52 mg durante os primeiros 5 anos de uso, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano, em adolescentes e mulheres jovens. Métodos O estudo foi uma coorte prospectiva de 5 anos realizada em um Serviço de Planejamento Familiar de um hospital terciário no Brasil. Selecionamos 100 mulheres saudáveis entre 15 e 24 anos que usaram o SIU-LNG 52 mg para contracepção. O acompanhamento clínico dessas mulheres ocorreu de junho de 2017 a dezembro de 2022. O estudo avaliou as taxas de continuação do método, razões de sua descontinuação, padrões de sangramento e nova escolha contraceptiva após o 5° ano. Os dados contínuos foram relatados como média ± DP e intervalo (mínimo-máximo). As variáveis categóricas foram descritas como porcentagens. Resultados As taxas de continuação do SIU-LNG foram 89,1% (82/92), 82,9% (72/87), 75,3% (64/85), 70,5% (60/85) e 64,2% (54/84) no 1°, 2°, 3°, 4° e 5° anos de uso, respectivamente. O principal motivo de descontinuação foi a acne (11/30). As taxas de amenorreia foram de 50, 54,1, 39, 35,7 e 51,8% aos 12, 24, 36, 48 e 60 meses, respectivamente. Todas as pacientes que completaram o estudo e necessitaram de contracepção após o 5° ano optaram por métodos contraceptivos de longa duração (LARC). Conclusão O SIU-LNG apresentou altas taxas de continuação em adolescentes e mulheres jovens nos primeiros 5 anos de uso. A maioria das pacientes que completou o estudo escolheu um método LARC após o 5° ano.


Subject(s)
Humans , Female , Adolescent , Adult , Levonorgestrel , Amenorrhea , Long-Acting Reversible Contraception , Menstruation
4.
Chinese Journal of Obstetrics and Gynecology ; (12): 286-292, 2023.
Article in Chinese | WPRIM | ID: wpr-985653

ABSTRACT

Objective: To evaluate different methods' efficacy of controlling acute bleeding and managing long-term menstruation in patients with heavy menstrual bleeding (HMB) associated with antithrombotic therapy. Methods: The clinical data of 22 cases with HMB associated with antithrombotic therapy admitted to Peking University People's Hospital from January 2010 to August 2022 were analyzed, aged 39 years old (26-46 years). Changes in menstrual volume, hemoglobin (Hb), and quality of life were collected after control of acute bleeding and long-term menstrual management. Menstrual volume was assessed by pictorial blood assessment chart (PBAC), and quality of life was assessed by menorrhagia multi-attribute scale (MMAS). Results: (1) Treatment of acute bleeding: of the 22 cases with HMB associated with antithrombotic therapy, 16 cases were treated in our hospital and 6 in other hospital for emergency bleeding; of the 16 cases treated in our hospital, 3 underwent emergency intrauterine Foley catheter balloon compression due to severe bleeding (Hb decreased by 20 to 40 g/L within 12 hours). Of the 22 cases with antithrombotic therapy-related HMB, 15 (including 2 cases with severe bleeding) underwent emergency aspiration or endometrial resection, and intraoperative placement of levonorgestrel-releasing intrauterine system (LNG-IUS) followed by a significant reduction in bleeding volume; 3 cases had controlled acute bleeding after rivaroxaban dose reduction and continued observation; 2 cases were given gonadotropin-releasing hormone agonists to control acute bleeding in other hospital, of which 1 case was temporarily treated with periodic blood transfusion, and the other one patient underwent total hysterectomy; and 2 cases had temporary amenorrhea with oral mifepristone after intrauterine balloon compression or oral norethindrone. (2) Long-term menstrual management: of the 22 cases with antithrombotic therapy-related HMB, 15 had LNG-IUS placement and 12 had LNG-IUS placement for 6 months, and menstrual volume was significantly reduced [PBAC scores were 365.0 (272.5-460.0) vs 25.0 (12.5-37.5), respectively; Z=4.593, P<0.001], Hb was significantly increased [91.5 g/L (71.8-108.2 g/L) vs 128.5 g/L (121.2-142.5 g/L); Z=4.695, P<0.001], and quality of life was significantly improved [MMAS scores were 415.0 (327.5-472.5) vs 580.0 (570.0-580.0), respectively; Z=-3.062, P=0.002] before placement compared with 6 months after placement. Three rivaroxaban dose reduction patients' PBAC scores decreased by 20 to 35 but remained >100, and perceived quality of life did not change significantly. Two cases with temporary amenorrhea treated with oral mifepristone felt significantly improved quality of life, and the MMAS scores increased by 220 and 180, respectively. Conclusion: Intrauterine Foley catheter balloon compression, aspiration or endometrial ablation could be used to control acute bleeding in patients with antithrombotic therapy-related HMB, and LNG-IUS for long-term management could reduce menstrual volume, increase hemoglobin, and improve the quality of life of patients.


Subject(s)
Female , Humans , Adult , Menorrhagia/etiology , Fibrinolytic Agents/adverse effects , Levonorgestrel/adverse effects , Amenorrhea/drug therapy , Mifepristone/therapeutic use , Quality of Life , Rivaroxaban/therapeutic use , Hemoglobins , Intrauterine Devices, Medicated/adverse effects , Contraceptive Agents, Female
6.
Rev. bras. ginecol. obstet ; 44(4): 391-397, Apr. 2022. tab
Article in English | LILACS | ID: biblio-1387903

ABSTRACT

Abstract Objective To determine knowledge, attitude, and preventive (KAP) practices towards the SARS-CoV-2 (COVID-19) pandemic among women in reproductive age seeking to use copper or hormonal intrauterine devices (IUD/LNG-IUS). Methods We conducted a cross-sectional study in which we applied a questionnaire on 400 women about KAP practices on COVID-19 at the University of Campinas, Campinas, SP, Brazil, from May to August 2020. Results The mean (±SD) age of the women was 30.8±7.9 years, and 72.8% of them reported being pregnant at least once. Most women (95%) had heard or read about COVID-19, and their main sources of information were television (91%) and government websites (53%). However, 53% of the women had doubts about the veracity of the information accessed. Conclusion Women without a partner and with>12 years of schooling had more information about COVID-19 and on its impact on new pregnancy, and those from high socioeconomic status had a higher chance of maintaining physical distance. Safety, effectiveness, comfort, and absence of hormone in the contraceptive method (in the case of TCu380A IUD) were the main reasons for the participants to seek the service during the pandemic, and the possibility to stop menstrual bleeding was the main reason to choose the LNG-IUS.


Resumo Objetivo Determinar o conhecimento, atitude e práticas preventivas (CAP) em relação à pandemia de SARS-CoV-2 (Covid-19) entre mulheres em idade reprodutiva que buscam usar dispositivo intrauterino com cobre (DIU TCu 380) ou sistema intrauterino liberador de levonorgestrel (SIU-LNG). Métodos Foi realizado um estudo transversal e um questionário foi aplicado a 400 mulheres para conhecer o CAP sobre o COVID-19 na Universidade Estadual de Campinas, Campinas, SP, Brasil, no período de maio a agosto de 2020. Resultados A média (±DP) de idade das mulheres foi de 30,8±7,9 anos, e 72,8% delas relataram ter engravidado pelo menos uma vez. A maioria das mulheres (95%) tinha ouvido ou lido sobre a a Covid-19, e suas principais fontes de informação foram a televisão (91%) e sites do governo (53%). Porém, 53% das mulheres tinham dúvidas a respeito da veracidade das informações acessadas. Conclusão Mulheres sem companheiro e com mais de 12 anos de escolaridade tiveram mais informações sobre a COVID-19 e sobre o seu impacto em uma nova gravidez, e aquelas de nível socioeconômico alto tiveram maior chance de manter distância física. Segurança, eficácia, conforto e ausência de hormônio no método anticoncepcional (no caso do DIU TCu380A) foram os principais motivos para as participantes procurarem o serviço durante a pandemia, e a possibilidade de controlar o sangramento menstrual abundante foi o principal motivo para a escolha do SIU-LNG.


Subject(s)
Humans , Female , Health Knowledge, Attitudes, Practice , Levonorgestrel , COVID-19 , Sociodemographic Factors , Intrauterine Devices
7.
Femina ; 50(1): 51-60, 2022. ilus
Article in Portuguese | LILACS | ID: biblio-1358221

ABSTRACT

Estima-se que 40% das gestações no mundo sejam não planejadas. Em países de baixa renda, complicações no parto são a maior causa de morte entre mulheres de 15 a 19 anos. A disponibilidade de métodos contraceptivos reversíveis é necessária para o adequado planejamento reprodutivo. Entre os métodos reversíveis, os de longa ação (LARCs) são os mais efetivos. Métodos de curta ação (SARCs) são preferenciais para pacientes que desejam gestar a curto prazo e para as quais a gestação não será indesejada. O presente estudo é uma revisão narrativa da literatura, de artigos em inglês e português publicados entre 2009 e 2020, utilizando as bases de dados SciELO, Medline e Embase. O objetivo desta revisão é apresentar os LARCs e SARCs em uma tabela com dados comparativos que auxiliem na tomada de decisão do médico e da paciente e permita estabelecer estratégias para um planejamento familiar adequado.(AU)


It is estimated that 40% of pregnancies in the world are unplanned. In low-income countries, complications in childbirth are the major cause of death among women aged 15 to 19 years. The availability of reversible contraceptive methods is necessary for proper reproductive planning. Among the reversible methods, long-acting reversible contraception (LARCs) is the most effective. Short-acting reversible contraception (SARCs) methods are preferred for patients who wish to become pregnant in the short term and for whom pregnancy will not be undesirable. The present study is a narrative review of the literature, of articles in English and Portuguese published between 2009 and 2020, using the databases SciELO, Medline and Embase. The purpose of this review is to present the LARCs and SARCs in a table with comparative data that assist in the decision making of the doctor and the patient and allow to establish strategies for adequate family planning.(AU)


Subject(s)
Humans , Female , Pregnancy , Natural Family Planning Methods , Contraception/methods , Contraceptive Agents, Female , Long-Acting Reversible Contraception/methods , Databases, Bibliographic , Levonorgestrel/therapeutic use , Ethinyl Estradiol-Norgestrel Combination , Drug Implants , Eligibility Determination , Intrauterine Devices , Intrauterine Devices, Medicated
8.
Femina ; 50(9): 556-559, 2022.
Article in Portuguese | LILACS | ID: biblio-1397890

ABSTRACT

Pouco sabe-se a respeito do sistema intrauterino liberador de levonorgestrel (SIU-LNG) 52 mg em contracepção de emergência (CE). Foi realizada uma busca não sistemática em bases eletrônicas para avaliar o papel do SIU-LNG na CE e, até o momento, apenas um único trabalho que avaliou o uso isolado do SIU-LNG para uso em CE foi encontrado. Esse estudo demonstrou a não inferioridade do SIU-LNG em relação ao dispositivo intrauterino de cobre em CE. Análises secundárias desse trabalho evidenciaram baixas chances de gestação em pacientes que fizeram uso de SIU-LNG como CE, independentemente da frequência das relações sexuais desprotegidas ou do tempo em que ocorreram (até 14 dias prévios à inserção ou 7 dias após). Torna-se evidente que o SIU-LNG poderá ser uma opção viável para uso em contracepção emergencial, porém mais estudos devem ser realizados, possibilitando a validação desse método.(AU)


Little is known about the 52-mg levonorgestrel-releasing intrauterine system (LNG- -IUS) in emergency contraception (EC). A non-systematic search was carried out in electronic databases to assess the role of the LNG-IUS in EC and, to date, only a single study that evaluated the isolated use of the LNG-IUS for EC use was found. This study demonstrated the non-inferiority of the LNG-IUS in relation to the copper intrauterine device in EC. Secondary analyzes of this study showed low chances of pregnancy in patients who used LNG-IUS as EC, regardless of the frequency of unprotected sexual intercourse or the time it took place (up to 14 days prior to insertion or 7 days after). It is evident that the LNG-IUS may be a viable option for use in emergency contraception, however, more studies must be carried out, enabling the validation of this method.(AU)


Subject(s)
Humans , Female , Pregnancy , Levonorgestrel/therapeutic use , Contraception, Postcoital/methods , Intrauterine Devices, Medicated , Databases, Bibliographic
9.
Article in Portuguese | LILACS | ID: biblio-1353098

ABSTRACT

Os contraceptivos intrauterinos contendo levonorgestrel, Mirena®, amplamente utilizados na ginecologia contemporânea como método eficaz de contracepção e controle de distúrbios menstruais, mostrou reduzir as taxas de câncer de endométrio. Além disso, complicações como perfuração e migração são raras, exigindo intervenção rápida. Descrição: Dois casos atípicos acerca do uso de dispositivo intrauterino hormonal, o primeiro trata de migração do dispositivo para a cavidade abdominal, após 1 ano e 8 meses da inserção, sem perfuração, com retirada videolaparoscópica. O segundo é um caso de câncer primário de endométrio em paciente com 3 anos de uso de Mirena®. Discussão: A migração do dispositivo intrauterino é uma complicação rara, pouco relatada na literatura, a abordagem videolaparoscópica é a preferencial e foi realizada no caso em questão. O dispositivo intrauterino hormonal também está relacionado à diminuição das taxas de câncer de endométrio e, inclusive, é usado como método preventivo em mulheres de alto risco. Após revisão de literatura, apenas seis casos similares foram descritos. Conclusão: O dispositivo hormonal intrauterino, apesar de seguro, pode implicar apresentações raras, como migração e perfuração, que exigem conhecimento e agilidade da equipe profissional. O segundo caso apresentado é um evento raro, que faz atentar para mulheres com padrão hemorrágico incomum em uso do Mirena®. (AU)


Intrauterine contraceptives containing levonorgestrel, Mirena®, widely used in contemporary gynecology as an effective method of contraception and control of menstrual disorders, have shown to reduce rates of endometrial cancer. In addition, complications such as perforation and migration are rare, requiring rapid intervention. Description: Two atypical cases about the use of intrauterine hormonal device, the first deals with migration of the device to the abdominal cavity, after 1 year and 8 months of insertion, without perforation, with videolaparoscopic withdrawal. The second is a case of primary endometrial cancer in a patient with 3 years of use of Mirena®. Discussion: Migration of the intrauterine device is a rare complication, little reported in the literature, the videolaparoscopic approach is the preferred one and was performed in the case in question. The hormonal intrauterine device is also related to the decreased rates of endometrial cancer and is also used as a preventive method in high-risk women. After reviewing the literature, only six similar cases were described. Conclusion: The intrauterine hormonal device, although safe, may imply rare presentations, such as migration and perforation, which require knowledge and agility of the professional team. The second case presented is a rare event, which makes it aware for women with an unusual hemorrhagic pattern to use Mirena®. (AU)


Subject(s)
Humans , Female , Adult , Levonorgestrel , Endometrial Neoplasms , Contraception , Contraceptive Agents , Intrauterine Devices , Menstruation Disturbances
10.
Rev. Méd. Clín. Condes ; 32(4): 502-510, jul - ago. 2021. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-1525859

ABSTRACT

Los dispositivos intrauterinos hormonales de levonorgestrel son métodos anticonceptivos seguros y eficaces. Al igual que los medicamentos convencionales, una vez expirada la patente, las autoridades regulatorias de salud pueden aprobar el registro de productos similares. El objetivo de ello es disminuir los costos, considerando el elevado precio del producto original. Este tipo de productos están regulados y se aplican requisitos generales similares a los medicamentos tradicionales para demostración de seguridad y eficacia. Las propiedades mecánicas únicas del producto de referencia plantean un gran desafío a los productos similares. El presente artículo analiza de manera comparativa las características de los diversos sistemas intrauterinos hormonales de levonorgestrel, disponibles en el mercado. La autoridad sanitaria y los diversos centros clínicos deben considerar que en este tipo de productos no hay, hasta la fecha en el mundo, genéricos intercambiables y que por lo tanto, se debe decidir la intercambiabilidad de éstos sobre la base de estudios de bioequivalencia in vivo, luego de la demostración de equivalencia farmacéutica in vitro, tal y como sugiere la FDA, o en su defecto deberían ser registrados como productos nuevos, con estudios clínicos apropiados que demuestren seguridad y eficacia.


Levonorgestrel hormonal intrauterine systems are safe and effective contraceptive methods. Like conventional drugs, once the patent expires, health regulatory authorities can approve the registration of similar products. The objective of this is to reduce costs, considering the high price of the original product. These types of products are regulated as drugs and similar general requirements apply to traditional drugs for demonstration of safety and efficacy. The unique mechanical properties of the reference product pose a great challenge to similar products. This article comparatively analyzes the characteristics of the various levonorgestrel hormonal intrauterine systems available on the market. Therefore, the health authority and clinical centers must consider that up to date, there are no interchangeable generics in this type of products worldwide. Thus, their interchangeability must be decided on the basis of in vivo bioequivalence studies after the demonstration of in vitro pharmaceutical equivalence, as suggested by the FDA. Without that, they should be registered as new products, with appropriate clinical studies that demonstrate safety and efficacy.


Subject(s)
Humans , Female , Levonorgestrel/administration & dosage , Intrauterine Devices, Medicated , Safety , Efficacy
11.
Rev. bras. ginecol. obstet ; 43(4): 291-296, Apr. 2021. tab
Article in English | LILACS | ID: biblio-1280045

ABSTRACT

Abstract Objective To evaluate whether continuation rates with the 52-mg levonorgestrelreleasing intrauterine system (LNG-IUS) up to 5 years after placement differed between women using the method exclusively for contraception and those using the device for medical reasons alone. Methods A retrospective cohort study was conducted in a family planning clinic with 5,034 LNG-IUS users: 4,287 using the method exclusively for contraception and 747 for medical reasons alone. The continuation rate at 1 to 5 years of use was calculated by life table analysis. Results Initially, the continuation rate was significantly higher in the contraception group: 85.8 versus 83.4 and 77.4 versus 76.0 per 100 women-years in the 1st and 2nd years of use, respectively. There were more discontinuations due to bleeding/spotting in the medical reasons group in the first two years. The discontinuation rate according to reason for use was not significantly different from the third to the fifth year of use. No women discontinued due to amenorrhea in either group. Conclusion The continuation rate was significantly higher in the contraception group in the first two years of use. Amenorrhea was not a reason for discontinuation in either group, suggesting that counselling in this respect was adequate. Nevertheless, counselling could perhaps have been better with regards to the expected long period of bleeding and spotting in the first two years after placement.


Resumo Objetivo Avaliar a taxa de continuação até 5 anos de uso do sistema intrauterino liberador de 52-mg levonorgestrel por dia (SIU LNG) -IUS) é diferente entre mulheres que o usam exclusivamente como anticoncepcional que entre as que usam exclusivamente por razões médicas. Métodos Estudo retrospectivo realizado em uma clínica de Planejamento Familiar 5.034 usuárias de SIU LNG, 4.287 que optaram pelo método apenas como anticoncepcional e 747 que o usavamsomente por razoesmédicas. A taxa de continuação de um até cinco ano foi calculada por meio de análise de tabela de vida Resultados No início a taxa de continuação foi significativamente maior no grupo da anticoncepção: 85,8 versus 83,4 e 77,4 versus 76,0 por 100 anos-mulher no 1° e 2° ano de uso, respectivamente. Houve mais descontinuações por sangrado-manchado no grupo de razões médicas nos dos primeiros anos. A taxa de continuação não foi significativamente diferente desde o terceiro até o quinto ano de uso. Nenhuma mulher de ambos os grupos descontinuou por amenorreia. Conclusão A taxa de continuação foi significativamente maior no grupo de anticoncepção durante os dos primeiros anos de uso. Amenorreia não foi motivo de descontinuação em ambos os grupos, sugerindo que a orientação a esse respeito foi adequada. Entretanto, a orientação referente ao longo período de sangramentos irregulares nos dois primeiros anos após a inserção, precisaria ser melhorado.


Subject(s)
Humans , Female , Adult , Young Adult , Levonorgestrel/administration & dosage , Contraceptive Agents, Hormonal/administration & dosage , Intrauterine Devices, Medicated/adverse effects , Parity , Brazil , Patient Education as Topic , Regression Analysis , Retrospective Studies , Follow-Up Studies , Levonorgestrel/adverse effects , Marital Status , Counseling , Educational Status , Contraceptive Agents, Hormonal/adverse effects , Menstruation Disturbances
12.
Rev. colomb. obstet. ginecol ; 72(1): 33-42, Jan.-Mar. 2021. tab
Article in Spanish | LILACS | ID: biblio-1251611

ABSTRACT

RESUMEN Objetivo: definir la incidencia de deseo sexual hipoactivo (DSH) en mujeres que planifican con el implante subdérmico de levonorgestrel (LNG) después de 12 meses, y conocer otros efectos adversos. Materiales y métodos: estudio de cohorte, cuyas participantes fueron mujeres mayores de 18 años sin hijos ni embarazos previos y con pareja estable, a quienes se les había insertado el implante de LNG al menos tres meses previos en una clínica privada de carácter universitario en Armenia (Quindío), Colombia, entre 2014 y 2019. Se excluyeron mujeres con antecedentes de disfunción sexual, infecciones de transmisión sexual en los últimos 6 meses, peso mayor a 89 Kg y dificultades para el seguimiento. El muestreo fue consecutivo. Se describieron las características de la población estudiada, se estimó la incidencia acumulada de DSH y efectos adversos relacionados con el implante subdérmico de LNG Resultados: participaron 238 mujeres cuya edad media fue de 24,69 (DE ± 5,82) años. Se determinó una incidencia de deseo sexual hipoactivo del 18,82%. El 60,25% de las mujeres fueron diagnosticadas con DHS en los primeros 6 meses de seguimiento. Los efectos adversos se hicieron presentes desde los primeros 3 meses de la inserción del implante, el sangrado irregular (62,34%) fue el más frecuente, seguido de la amenorrea (38,91%) y el aumento de peso (33,89%). Conclusiones: es importante que los médicos y las usuarias se informen sobre la presencia del trastorno de deseo sexual hipoactivo y los efectos adversos que pueden surgir con el uso del implante subdérmico de levonorgestrel. Las futuras investigaciones deben confirmar estos hallazgos, así como su eventual base fisiológica.


ABSTRACT Objective: To determine the incidence of low libido in women using the levonorgestrel (LNG) sub-dermal implant for contraception after 12 months and to identify other adverse effects. Materials and methods: Cohort study that included women over the age of 18, with no children or prior gestations and in a stable relationship, with an LNG implant inserted at least three months before in a private teaching hospital in Armenia (Quindío), Colombia, between 2014 and 2019. Women with a history of sexual dysfunction, sexually transmitted infections in the past six months, weighing more than 89 kg and difficult to follow were excluded. Consecutive sampling was used. The characteristics of the study population were described, the cumulative incidence of low libido and the adverse effects related to the LNG sub-dermal implant after 12 months of follow-up were estimated. The tool used was the Female Sexual Dysfunction Index (FSFI). Descriptive statistics were applied. Results: The participants were 238 women with a mean age of 24.69 (SD ± 5.82) years. An 18.82% incidence of low libido was found. In 60.25% of the women were diagnosed with low libido in the first 6 months of follow-up. Adverse effects manifested as early as 3 months after the insertion of the implant, the most frequent being irregular bleeding (62.34%), followed by amenorrhea (38.91%) and weight gain (33.89%). Conclusions: It is important for practitioners and users to become aware of the presence of low libido disorder and the adverse events that may occur with the use of the levonorgestrel subdermal implant. Future research is required to confirm these findings and the underlying physiological cause.


Subject(s)
Humans , Female , Adult , Sexual Dysfunction, Physiological , Levonorgestrel , Sexual Dysfunctions, Psychological , Risk Factors , Cohort Studies , Contraception , Family Planning Services
13.
Rev. chil. obstet. ginecol. (En línea) ; 86(1): 68-75, feb. 2021. graf
Article in Spanish | LILACS | ID: biblio-1388632

ABSTRACT

INTRODUCCIÓN: La anticoncepción hormonal, a través de implantes subdérmicos, es uno de los métodos anticonceptivos reversibles de larga duración más eficaces en la actualidad que está disponible en nuestro país en forma gratuita en el sistema público. OBJETIVO: Reconocer los efectos adversos y los motivos de retiro del Implante Jadelle® en usuarias del Hospital de Clínicas, así como evaluar la información recibida por las usuarias al momento de la colocación. MATERIAL Y MÉTODOS: Un total de 160 pacientes participaron en el estudio a través de una encuesta previo consentimiento informado. Se utilizó la estadística descriptiva en números absolutos y porcentuales. Resultados: Previo al uso, recibieron información sobre los probables efectos adversos del método el 83% de ellas, y acerca de la efectividad del método el 89 %. En cuanto a efectos adversos los presentaron el 80,6% de las usuarias, siendo la irregularidad de la menstruación la causa más frecuente constituyendo un 61%. CONCLUSIONES: Es alta la frecuencia de pacientes que presentan efectos adversos y que solicitan retiro del implante antes del tiempo a causa de ello, 35% de las usuarias, siendo el principal motivo la irregularidad menstrual en un 43% de los casos. Es recomendable realizar un correcto asesoramiento previo a la colocación e incentivar a las pacientes a concurrir a los controles médicos, luego de la colocación, para brindar asesoramiento y tratamiento si se presentara algún efecto adverso, con el fin de obtener una mejor continuidad de uso del método.


INTRODUCTION: Hormonal contraception, through subdermal implants, is one of the most effective long active reversal contraceptive methods currently available in our country for free in the public system. OBJETIVE: Recognize the adverse effects and the reasons for its withdrawal in users of the Hospital de Clínicas as well as to evaluate the information received by the users at the time of placement. METHODOLOGY: A total of 160 patients participated in the work with prior informed consent through a survey. Descriptive statistics were used in absolute and percentage numbers. They received information on the probable adverse effects of the 83% pre-use method, about the effectiveness of the 89% method. RESULTS: Regarding adverse effects, they were present in 80.6% of the users; the being irregularity of menstruation is the most frequent, constituting 61%. Concluding that the frequency of patients presenting with adverse effects and requesting removal of the implant before the time is high because of it, 35% of the users who requested removal menstrual irregularities were the main reason for 43% of patients. CONCLUSIONS: It is advisable to make a correct advice prior to placement and encourage patients to attend medical controls, after placement, to provide advice and treatment if any adverse effect occurs, in order to give better use in terms of method time.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Contraceptive Agents, Female/adverse effects , Device Removal , Drug Implants/adverse effects , Progesterone/administration & dosage , Progesterone/adverse effects , Cross-Sectional Studies , Surveys and Questionnaires , Levonorgestrel/administration & dosage , Levonorgestrel/adverse effects , Contraception/methods , Contraceptive Agents, Female/administration & dosage , Motivation
15.
J. bras. econ. saúde (Impr.) ; 12(3): 264-272, Dezembro/2020.
Article in Portuguese | ECOS, LILACS | ID: biblio-1141360

ABSTRACT

Objetivo: Definir um limiar de custo para o sistema intrauterino liberador de levonorgestrel 52 mg (SIU-LNG 52 mg) para o tratamento do sangramento uterino anormal (SUA) sob a perspectiva do Sistema de Saúde Suplementar brasileiro. Métodos: Foi elaborado um modelo de custo-efetividade para definir o limiar de custo de inserção de SIU-LNG 52 mg em mulheres com SUA em comparação à histerectomia. Um modelo de Markov foi estruturado com ciclos anuais para reproduzir o tratamento do SUA em um e cinco anos, considerando custos médicos diretos e o percentual de histerectomias evitadas como desfecho. O custo da histerectomia foi variado até o valor de 10.000 reais brasileiros (BRL) com incrementos de 500 BRL a cada nova simulação para avaliar o limiar de custo do SIU-LNG 52 mg para igualar o custo total de tratamento de ambas as estratégias analisadas. Resultados: O SIU-LNG 52 mg demonstrou ser uma opção de tratamento dominante quando comparada à histerectomia, levando à redução da frequência de realização do procedimento cirúrgico em 59,62% das mulheres e redução de 2.557,91 BRL no custo total de tratamento em cinco anos. Ao considerar a histerectomia a 6.000 BRL, o custo do procedimento com SIU-LNG 52 mg poderia ser de até 6.150,35 BRL e 3.994,60 BRL para igualar o custo total de tratamento, em horizontes temporais de um e cinco anos, respectivamente. Conclusão: SIU-LNG 52 mg demonstrou ser uma opção dominante para o manejo do SUA, sendo capaz de atrelar economia para o sistema de saúde a benefícios para a mulher perante a cirurgia.


Objective: To define a cost threshold for the use of levonorgestrel-releasing intrauterine system 52 mg (LNG-IUS 52 mg) for the treatment of heavy menstrual bleeding (HMB) in the Brazilian Supplementary Health System perspective. Methods: A cost-effectiveness model was built to define the cost threshold for insertion of LNG-IUS 52 mg considering women with diagnosis of HMB as the target population and hysterectomy as the comparator. A Markov model was structured with annual cycles to reproduce HMB treatment in 1 and 5 years, considering direct medical costs and the percentage of avoided hysterectomies as the outcome. Hysterectomy cost was varied up to 10,000 Brazilian real (BRL) with increments of 500 BRL at each new simulation to define LNG-IUS 52 mg cost threshold, to provide equal total treatment costs for both strategies. Results: LNG-IUS 52 mg proved to be a cost-saving option when compared to hysterectomy, leading to a reduction in the frequency of the surgical procedure by 59.62% and a total treatment cost reduction of 2,557.91 BRL in 5 years. When considering hysterectomy at 6,000 BRL, the cost of the procedure with LNG-IUS 52 mg could be up to 6,150.35 BRL and 3,994.60 BRL to provide equal total treatment cost in 1 and 5 years time horizon, respectively. Conclusion: LNG-IUS 52 mg has proven to be a cost-saving option for the health system in the management of HMB, in addition to the known benefits for women against surgery.


Subject(s)
Levonorgestrel , Costs and Cost Analysis , Supplemental Health , Intrauterine Devices , Menorrhagia
16.
Rev. invest. clín ; 72(6): 363-371, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1289731

ABSTRACT

Abstract Background: Levonorgestrel (LNG) is a progesterone receptor agonist used in both regular and emergency hormonal contraception; however, its effects on the endometrium as a contraceptive remain widely unknown and under public debate. Objective: To analyze the effects of LNG or mifepristone (MFP), a progesterone receptor antagonist and also known as RU-486, administered at the time of follicle rupture (FR) on endometrial transcriptome during the receptive period of the menstrual cycle. Methods: Ten volunteers ovulatory women were studied during two menstrual cycles, a control cycle and a consecutively treated cycle; in this last case, women were randomly allocated to two groups of 5 women each, receiving one dose of LNG (1.5 mg) or MFP (50 mg) the day of the FR by ultrasound. Endometrial biopsies were taken 6 days after drug administration and prepared for microarray analysis. Results: Genomic functional analysis in the LNG-treated group showed as activated the bio-functions embryo implantation and decidualization, while these bio-functions in the T-MFP group were predicted as inhibited. Conclusions: The administration of LNG as a hormonal emergency contraceptive resulted in an endometrial gene expression profile associated with receptivity. These results agree on the concept that LNG does not affect endometrial receptivity and/or embryo implantation when used as an emergency contraceptive.


Subject(s)
Humans , Female , Adult , Young Adult , Embryo Implantation/drug effects , Mifepristone/pharmacology , Levonorgestrel/pharmacology , Contraceptives, Postcoital, Hormonal/pharmacology , Endometrium , Transcriptome/drug effects , Ovulation , Time Factors , Mifepristone/administration & dosage , Levonorgestrel/administration & dosage , Contraceptives, Postcoital, Hormonal/administration & dosage
17.
Femina ; 48(10): 623-630, out. 31, 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1127709

ABSTRACT

A contracepção de emergência tem como objetivo prevenir uma gravidez indesejada após uma relação sexual desprotegida, falha do método contraceptivo regular ou agressão sexual. Dentre os métodos disponíveis atualmente, destaca-se a pílula hormonal de levonorgestrel (LNG) como uma das principais estratégias utilizadas, tendo em vista o perfil de segurança desse fármaco e a facilidade de acesso e utilização dele. No entanto, embora o efeito de tal molécula seja satisfatório, pesquisas sugerem que altos índices de massa corporal implicam uma redução da eficácia contraceptiva da pílula de LNG. Nesse sentido, esse estudo visa evidenciar, mediante revisão de literatura, a relação entre esse fármaco e sua competência em mulheres com sobrepeso ou obesidade, bem como expor quais medidas devem ser tomadas para evitar a gravidez indesejada nessas pacientes. Embora existam divergências, foi observado que a maior parte dos estudos indica que a composição corporal das pacientes pode influenciar na eficácia contraceptiva da molécula de LNG, de forma sinérgica ou não com outros fatores, especialmente quando considerado o IMC > 25 kg/m² ou peso > 75 kg, uma vez que o risco de gravidez pode aumentar de 1,5 até 4,4 vezes quando comparado aos padrões de normalidade, com tendência de crescimento em relação aos parâmetros de sobrepeso/obesidade.(AU)


The main goal of the emergency contraceptive is to prevent a non-planned pregnancy after the sexual relationship without condom, after the fail of the usual contraceptive or the sexual assault. Among all the currently available methods, the hormonal pill of levonorgestrel (LNG) has its importance as one of the most used strategies, due of its safety, easy access and use. However, in spite of the fact that this molecule has a good effect, some researches suggest that a high level of the body mass reduces the efficacy of the contraceptive pill of LNG. In this context, this study objective is to clarify, by using literature review, the relation between this drug and its competence in overweight/obese women, as well to expose which other options could be taken to avoid a non-planned pregnancy in those patients. Despite of the fact that there are divergences, the most part of the studies shows that patient's body composition can influence on the contraceptive effectiveness of the LNG molecule, sinergically or not to other factors, especially when the IMC > 25 kg/m² or the body weight > 75 kg, once the pregnancy risk can be raised from 1,5 to 4,4 times when compared to regular standards, with growth tendency when related to overweigh/obesity parameters.(AU)


Subject(s)
Humans , Female , Pregnancy , Levonorgestrel/therapeutic use , Levonorgestrel/pharmacokinetics , Contraceptives, Postcoital/therapeutic use , Overweight/complications , Obesity/complications , Databases, Bibliographic , Contraception/adverse effects
18.
Rev. colomb. obstet. ginecol ; 71(3): 247-256, jul.-set. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1144387

ABSTRACT

RESUMEN Objetivo: describir la seguridad y aceptabilidad del uso del sistema intrauterino liberador de levonorgestrel de 52 mg en mujeres con hemorragia uterina anormal. Materiales y métodos: cohorte retrospectiva en la que se incluyeron mujeres de 18 años o más con diagnóstico de hemorragia uterina anormal, reporte por ultrasonido de tamaño uterino entre 6 y 10 cm de longitud y cavidad endometrial uniforme en toda su longitud, independiente de alteración estructural, a quienes se les colocó para tratamiento el sistema intrauterino liberador de levonorgestrel de 52 mg, en el periodo de 2012 hasta 2016 Se realizó un muestreo por conveniencia. Se midieron variables sociodemográficas y clínicas basales, así como la percepción de la hemorragia por parte de la paciente y la frecuencia de falla, amenorrea, necesidad de histerectomía y eventos adversos, con seguimiento a 12 meses. Se aplicó estadística descriptiva. Resultados: se evaluaron 200 pacientes, hubo una percepción de mejoría subjetiva del volumen de sangrado y de la frecuencia de incapacidad laboral o asistencia a urgencias. El 90 % de las pacientes registró amenorrea y el 6 % eventos adversos. Conclusiones: el sistema intrauterino liberador de levonorgestrel de 52 mg es una alternativa segura para el manejo de la hemorragia uterina anormal en mujeres con úteros de tamaño normal y sin alteraciones submucosas del endometrio. Se requieren estudios aleatorizados en el medio local para evaluar su efectividad y eficiencia respecto a otras alternativas de manejo.


ABSTRACT Objective: To describe safety and acceptability with the use of the 52-mg levonorgestrel-releasing intrauterine system in women with abnormal uterine bleeding. Materials and methods: Retrospective cohort of women 18 years of age and older diagnosed with abnormal uterine bleeding, ultrasound-reported uterine length between 6 and 10 cm and uniform endometrial cavity in its entire length, regardless of structural abnormality, who received treatment with 52-mg levonorgestrel-releasing intrauterine system between 2012 and 2016. Non-probabilistic convenience sampling was carried out. Sociodemographic and clinical baseline variables were measured, as well as patient perception of bleeding and the frequency of failure, amenorrhea, need for hysterectomy and adverse events, over a 12-month follow-up period. Descriptive statistics were applied. Results: Overall, 200 patients were assessed. A subjective perception of improvement in terms of bleeding volume and frequency of leave of absence or visits to the emergency department was found; 90 % of the patients had amenorrhea, and 6 % experienced adverse events. Conclusions: The 52-mg levonorgestrel-releasing intrauterine system is a safe option for the management of abnormal uterine bleeding in women with normal uterine size and no submucosal endometrial abnormalities. Local randomized studies are required to assess effectiveness and efficiency in comparison with other management options.


Subject(s)
Humans , Female , Adult , Uterine Hemorrhage , Levonorgestrel , Ambulatory Care , Intrauterine Devices , Menorrhagia
19.
Rev. argent. mastología ; 39(144): 20-38, sept. 2020. tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1150809

ABSTRACT

La creciente incidencia de cáncer de mama (CM) en mujeres jóvenes nos obliga a repensar la forma en como asesoramos sobre el método anticonceptivo (MAC) en estas mujeres, cuya fertilidad puede ser variablemente afectada por los tratamientos. Se les aconseja, post tratamiento, evitar la gestación temporalmente, sin embargo se observa un patrón de uso insuficiente de MAC con elección de métodos anticonceptivos poco efectivos. El objetivo de la presente revisión es indagar en al necesidad anticonceptiva de mujeres jóvenes con cáncer de mama evaluando la evidencia científica sobre qué métodos anticonceptivos pueden o no utilizar, analizando especialmente el rol del sistema intrauterino liberado de levonorgestrel y la salpingectomía de la oportunidad como cirugía anticonceptiva con potencial reducción de riesgo de cáncer de ovario en pacientes con riesgos genético. Además se pretende brindar estrategias para evitar embarazos no planificados en este grupo de pacientes.


The increasing incidence of breast cancer (BC) in young women forces us to rethink the way in which we counsel on the contraceptive method (CM) in these women, whose fertility can be variably affected by the treatments. They are advised, post treatment, to avoid pregnancy temporarily, however a pattern of insufficient contraception use is observed with the choice on ineffective contraceptive need of young women with breast cancer, evaluating the scientific evidencially analyzing the role of the levonorgestrel-releasin intrautrien system and oppotunistic salpingectomy as a contaceptive surgery with potential ovarian cancer risk reduction in patients with genetic risk. Is is also intended to provide strategies to avoid unplanned pregnancies in this group of patients.


Subject(s)
Contraception , Ovarian Neoplasms , Breast Neoplasms , Levonorgestrel , Contraceptive Agents , Fertility , Salpingectomy
20.
Rev. Bras. Saúde Mater. Infant. (Online) ; 20(2): 479-484, Apr.-June 2020. tab
Article in English | SES-SP, LILACS | ID: biblio-1136437

ABSTRACT

Abstract Objectives: to identify the main indications and reasons for discontinuing the use of the Levonorgestrel-Releasing Intrauterine System (LNG-IUS). Methods: a cross-sectional study was carried out from medical records of 327 women who used the LNG-IUS 52mg between January 2011 and December 2016 at a public hospital in the Northeast of Brazil. Results: the main indications for the use of the LNG-IUS were: contraception (32.7%), myoma/metrorrhagia (28.7%) and endometriosis/pelvic pain (22.3%). Of the 327 women, 68 (20.8%) had discontinued using the device. The most frequent reasons for discontinuation were: expulsion (9.2%), LNG-IUS expiration (3.7%), bleeding (2.4%) and pain (1.5%). Most patients had no difficulty in the insertion and did not require anesthesia/sedation. Among the 30 women who expelled the device, 17 (56.7%) had used it for metrorrhagia and myoma, 8 (26.7%) for contraception, and 5 (16.6%) for endometriosis/pelvic pain. Conclusions: the LNG-IUS is a well-accepted contraceptive method, with therapeutic applications for some gynecological conditions and a low expulsion rate.


Resumo Objetivos: identificar as principais indicações e razões para a descontinuação do uso do sistema intra-uterino liberador de levanogestrel (SIU-LNG). Métodos: foi realizado um estudo transversal a partir de prontuários de 327 mulheres que usaram o SIU-LNG 52mg entre janeiro de 2011 e dezembro de 2016 em um hospital público do Nordeste do Brasil. Resultados: as principais indicações para o uso do SIU-LNG foram: contracepção (32,7%), mioma / metrorragia (28,7%) e endometriose / dor pélvica (22,3%). Das 327 mulheres, 68 (20,8%) haviam descontinuado o uso do dispositivo. Os motivos mais frequentes de descontinuação foram: expulsão (9,2%), expiração de SIU-LNG (3,7%), sangramento (2,4%) e dor (1,5%). Conclusão: a maioria dos pacientes não teve dificuldade na inserção e não necessitou de anestesia / sedação. Entre as 30 mulheres que expulsaram o dispositivo, 17 (56,7%) o utilizaram para metrorragia e mioma, 8 (26,7%) para contracepção e 5 (16,6%) para endometriose / dor pélvica. O SIU-LNG é um método contraceptivo bem aceito, com aplicações terapêuticas para algumas condições ginecológicas e baixa taxa de expulsão.


Subject(s)
Female , Levonorgestrel/therapeutic use , Cost-Benefit Analysis , Long-Acting Reversible Contraception , Intrauterine Devices, Medicated/adverse effects , Intrauterine Devices, Medicated/statistics & numerical data , Brazil , Contraceptive Effectiveness
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