{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:32:33Z","timestamp":1759336353350,"version":"3.37.3"},"reference-count":19,"publisher":"Federa\u00e7\u00e3o das Associa\u00e7\u00f5es de Ginecologia e Obstetr\u00edcia","issue":"04","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ginecol Obstet"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003Changes in bleeding patterns could influence the decisions of healthcare professionals to change the levonorgestrel-releasing intrauterine system (LNG-IUS) before 7 years of use, the recommended period of extended use. We evaluated changes in the bleeding patterns of users of the 52\u2009mg LNG-IUS at the end of use of the first (IUS-1) and during the second device (IUS-2) use.<\/jats:p><jats:p>\n          Methods\u2003We performed an audit of the medical records of all women who used two consecutive LNG-IUSs at the Family Planning clinic. We evaluated the sociodemographic\/gynecological variables, the length of use, and the bleeding patterns reported in the reference periods of 90 days before removal of the IUS-1 and at the last return in use of IUS-2. We used the McNemar test to compare bleeding patterns. Statistical significance was established at p\u2009&lt;\u20090.05.<\/jats:p><jats:p>\n          Results\u2003We evaluated 301 women aged (mean\u2009\u00b1\u2009SD) 32 (\u00b16.1) years, with lengths of use of 68.9 (\u00b116.8) and 20.3 (\u00b116.7) months for the IUS-1 and IUS-2, respectively. No pregnancies were reported. Bleeding patterns varied significantly among women who used the IUS-2 for \u2265\u20097 months to 6 years when compared the bleeding patterns reported in IUS-1 use. Eighty-nine out of 221 (40%) women maintained amenorrhea and infrequent bleeding; 66 (30%) evolved to bleeding patterns with light flow, and 66 (30%) maintained or evolved to heavy flow patterns (p\u2009=\u20090.012). No differences were observed among the 80 women with \u2264 6 months of use.<\/jats:p><jats:p>\n          Conclusion\u2003Changes in bleeding patterns occur during the use of LNG-IUS and should not be decisive for the early replacement of the device.<\/jats:p>","DOI":"10.1055\/s-0040-1708092","type":"journal-article","created":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T23:31:40Z","timestamp":1587771100000},"page":"194-199","source":"Crossref","is-referenced-by-count":1,"title":["Consecutive Use of the 52\u2009mg Levonorgestrel-releasing Intrauterine System: Variations in Bleeding Patterns"],"prefix":"10.61622","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2753-1349","authenticated-orcid":false,"given":"Barbara Zantut","family":"Wittmann","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9536-0564","authenticated-orcid":false,"given":"Ilza","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3197-1195","authenticated-orcid":false,"given":"C\u00e1ssia","family":"Juliato","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5872-0017","authenticated-orcid":false,"given":"Arlete","family":"Fernandes","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"47794","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"issue":"04","key":"ref1","doi-asserted-by":"crossref","first-page":"532","DOI":"10.9745\/GHSP-D-15-00178","article-title":"The levonorgestrel intrauterine system: reasons to expand access to the public sector of Africa","volume":"3","author":"D Hubacher","year":"2015","journal-title":"Glob Health Sci Pract"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1093\/humupd\/dmv023","article-title":"Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods","volume":"21","author":"L Bahamondes","year":"2015","journal-title":"Hum Reprod Update"},{"issue":"04","key":"ref3","first-page":"608","article-title":"Advance information improves user satisfaction with the levonorgestrel intrauterine system","volume":"99","author":"T Backman","year":"2002","journal-title":"Obstet Gynecol"},{"issue":"08","key":"ref4","first-page":"716","article-title":"Health effects of long-term use of the intrauterine levonorgestrel-releasing system. A follow-up study over 12 years of continuous use","volume":"78","author":"M R\u00f6nnerdag","year":"1999","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"534","DOI":"10.9745\/GHSP-D-17-00296","article-title":"Extended effectiveness of the etonogestrel-releasing contraceptive implant and the 20 \u00b5g levonorgestrel-releasing intrauterine system for 2 years beyond U.S. Food and Drug Administration product labeling","volume":"5","author":"M Ali","year":"2017","journal-title":"Glob Health Sci Pract"},{"issue":"06","key":"ref6","doi-asserted-by":"crossref","first-page":"586.e1","DOI":"10.1016\/j.ajog.2017.01.036","article-title":"Prolonged use of the etonogestrel implant and levonorgestrel intrauterine device: 2 years beyond Food and Drug Administration-approved duration","volume":"216","author":"C McNicholas","year":"2017","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref7","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.contraception.2017.10.007","article-title":"Pregnancy outcomes associated with extended use of the 52-mg 20\u2009\u03bcg\/day levonorgestrel-releasing intrauterine system beyond 60 months: A chart review of 776 women in Brazil","volume":"97","author":"L Bahamondes","year":"2018","journal-title":"Contraception"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/0010-7824(90)90035-T","article-title":"Pharmacokinetic and pharmacodynamic studies of levonorgestrel-releasing intrauterine device","volume":"41","author":"B L Xiao","year":"1990","journal-title":"Contraception"},{"issue":"04","key":"ref9","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.contraception.2012.09.034","article-title":"Temporal changes in cervical mucus after insertion of the levonorgestrel-releasing intrauterine system","volume":"87","author":"M F Natavio","year":"2013","journal-title":"Contraception"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1080\/13625187.2016.1193139","article-title":"Assessment of the quality of cervical mucus among users of the levonorgestrel-releasing intrauterine system at different times of use","volume":"21","author":"L G Moraes","year":"2016","journal-title":"Eur J Contracept Reprod Health Care"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.contraception.2009.01.004","article-title":"Serum levonorgestrel levels and endometrial thickness during extended use of the levonorgestrel-releasing intrauterine system","volume":"80","author":"M M Hidalgo","year":"2009","journal-title":"Contraception"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1016\/j.contraception.2012.01.015","article-title":"Quantitative levonorgestrel plasma level measurements in patients with regular and prolonged use of the levonorgestrel-releasing intrauterine system","volume":"86","author":"B Seeber","year":"2012","journal-title":"Contraception"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1097\/AOG.0000000000003034","article-title":"Five-year contraceptive efficacy and safety of a levonorgestrel 52-mg intrauterine system","volume":"133","author":"S B Teal","year":"2019","journal-title":"Obstet Gynecol"},{"issue":"06","key":"ref14","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.fertnstert.2014.03.004","article-title":"Pharmacokinetics of two low-dose levonorgestrel-releasing intrauterine systems and effects on ovulation rate and cervical function: pooled analyses of phase II and III studies","volume":"101","author":"D Apter","year":"2014","journal-title":"Fertil Steril"},{"issue":"08","key":"ref15","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/17434440.2017.1350169","article-title":"Clarification of the role of the Jaydess(Skyla) LNG- IUS 13.5mg and Kyleena LNG-IUS 19.5mg as intrauterine contraceptive systems","volume":"14","author":"N D Goldstuck","year":"2017","journal-title":"Expert Rev Med Devices"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1093\/humrep\/dep426","article-title":"Bleeding pattern and safety of consecutive use of the levonorgestrel-releasing intrauterine system (LNG-IUS)--a multicentre prospective study","volume":"25","author":"K Gemzell-Danielsson","year":"2010","journal-title":"Hum Reprod"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1093\/humrep\/deu063","article-title":"Bleeding pattern and user satisfaction in second consecutive levonorgestrel-releasing intrauterine system users: results of a prospective 5-year study","volume":"29","author":"O Heikinheimo","year":"2014","journal-title":"Hum Reprod"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1016\/0010-7824(86)90006-5","article-title":"The analysis of vaginal bleeding patterns induced by fertility regulating methods. World Health Organization Special Programme of Research, Development and Research Training in Human Reproduction","volume":"34","author":"E M Belsey","year":"1986","journal-title":"Contraception"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.contraception.2016.02.024","article-title":"Safety and efficacy in parous women of a 52-mg levonorgestrel-medicated intrauterine device: a 7-year randomized comparative study with the TCu380A","volume":"93","author":"P Rowe","year":"2016","journal-title":"Contraception"}],"container-title":["Revista Brasileira de Ginecologia e Obstetr\u00edcia \/ RBGO Gynecology and Obstetrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journalrbgo.org\/article\/consecutive-use-of-the-52-mg-levonorgestrel-releasing-intrauterine-system-variations-in-bleeding-patterns\/","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1708092.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T20:57:22Z","timestamp":1721336242000},"score":1,"resource":{"primary":{"URL":"https:\/\/journalrbgo.org\/article\/consecutive-use-of-the-52-mg-levonorgestrel-releasing-intrauterine-system-variations-in-bleeding-patterns\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4]]},"references-count":19,"journal-issue":{"issue":"04","published-online":{"date-parts":[[2020,4,24]]},"published-print":{"date-parts":[[2020,4]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1708092","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0100-7203","1806-9339"],"issn-type":[{"type":"print","value":"0100-7203"},{"type":"electronic","value":"1806-9339"}],"subject":[],"published":{"date-parts":[[2020,4]]}}}