{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T07:09:23Z","timestamp":1790233763312,"version":"4.1.0"},"reference-count":14,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2016,12,23]],"date-time":"2016-12-23T00:00:00Z","timestamp":1482451200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>The objective was to assess whether patient\u2010perceived pain during the insertion of the levonorgestrel\u2010releasing intrauterine system (<jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content>) depends on the timing during the menstrual cycle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A stratified two\u2010armed non\u2010inferiority randomised controlled trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Large teaching hospital in Veldhoven, the Netherlands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Sample<\/jats:title><jats:p>From October\u00a02013 to May\u00a02014, 60 nulliparous and 60 multiparous women were randomised. Eight women withdrew after randomisation and before insertion took place: therefore, data from 112 women were collected and analysed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women were randomised to the groups \u2018during menstruation\u2019 (i.e. days\u00a01\u20137 of menstruation) or \u2018outside menstruation\u2019 (i.e. any day of the cycle after menstruation without the presence of vaginal blood loss) in a ratio of 1\u00a0:\u00a01.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>The primary outcome was pain during insertion, measured by the visual analogue scale (<jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content>, 0\u2013100\u00a0mm). Second, we analysed ease of insertion, bleeding pattern, satisfaction, pregnancy, and expulsion rate. The follow\u2010up time was 3\u00a0months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> score for nulliparous women was 74\u00a0mm (95% confidence interval, 95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a067\u201381) in the \u2018during menstruation\u2019 group, compared with 66\u00a0mm (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 59\u201374) in the \u2018outside menstruation\u2019 group (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.14). The mean <jats:styled-content style=\"fixed-case\">VAS<\/jats:styled-content> score for multiparous women was 30\u00a0mm (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 20\u201340) in the \u2018during menstruation group\u2019, compared with 43\u00a0mm (95%\u00a0<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 32\u201353) in the \u2018outside menstruation\u2019 group (<jats:italic>P\u00a0<\/jats:italic>=\u00a00.08). There was no difference between the stratified \u2018during menstruation\u2019 group and the \u2018outside menstruation\u2019 group with regards to ease of insertion, satisfaction, bleeding pattern, and median spotting and bleeding days for the use of the <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> 3\u00a0months after insertion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>As we did not find that the level of pain perceived during insertion was higher during menstruation, compared with outside menstruation, we conclude that the <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> can be inserted at any time during the menstrual cycle, especially in the case of nulliparous women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>We conducted an <jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content> on time of insertion of <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content>. We conclude that the <jats:styled-content style=\"fixed-case\">LNG<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">IUS<\/jats:styled-content> can be inserted at any time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.14445","type":"journal-article","created":{"date-parts":[[2016,12,25]],"date-time":"2016-12-25T03:32:51Z","timestamp":1482636771000},"page":"299-305","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Timing of insertion of levonorgestrel\u2010releasing intrauterine system: a randomised controlled trial"],"prefix":"10.1111","volume":"124","author":[{"given":"PAHH","family":"van der Heijden","sequence":"first","affiliation":[{"name":"Maastricht University Centre Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"PMAJ","family":"Geomini","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Centre Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MC","family":"Herman","sequence":"additional","affiliation":[{"name":"M\u00e1xima Medical Centre Veldhoven the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Veersema","sequence":"additional","affiliation":[{"name":"University Medical Centre Utrecht Utrecht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MY","family":"Bongers","sequence":"additional","affiliation":[{"name":"Maastricht University Centre Maastricht the Netherlands"},{"name":"M\u00e1xima Medical Centre Veldhoven the Netherlands"},{"name":"Grow School of Oncology and Developmental Biology Maastricht University Centre Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,12,23]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"CD001776","article-title":"Hormonally impregnated intrauterine systems (IUS's) versus other forms of reversible contraceptives as effective methods of preventing pregnancy","volume":"3","author":"French R","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2005.10.029"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1783\/1471189054483780"},{"key":"e_1_2_6_5_1","first-page":"CD002126","article-title":"Progesterone or progestogen\u2010releasing intrauterine systems for heavy menstrual bleeding","volume":"4","author":"Lethaby AE","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.addr.2009.04.022"},{"key":"e_1_2_6_7_1","first-page":"CD007373","article-title":"Interventions for pain with intrauterine device insertion","volume":"3","author":"Allen RH","year":"2009","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_6_8_1","first-page":"161","volume-title":"Family Planning Handbook","author":"John Hopkins Bloomberg school of Public Health\/Center for Communication Programs and World Health Oganization","year":"2013"},{"key":"e_1_2_6_9_1","first-page":"666","article-title":"When can a woman have a intrauterine device inserted?","volume":"87","author":"Whiteman MK","year":"2013","journal-title":"A systematic review. 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