The influence of the levonorgestrel‐releasing intrauterine system position on bleeding patterns in reproductive age women

Objective To determine whether users of the non‐fundal levonorgestrel‐releasing intrauterine system ( LNG ‐ IUS ) present with unfavorable bleeding patterns more frequently than fundal LNG ‐ IUS users. Methods A prospective cohort was conducted from June, 2016 to January, 2018 involving women aged 18–45 years who wished to use the LNG ‐ IUS as contraception and had no contraindications, endometrial polyps, submucosal myomas, irregular menstrual cycle, or anticoagulant use. Two study groups comprised women using fundal insertion and non‐fundal insertion LNG ‐ IUS . Bleeding was evaluated using a diary and pictogram chart. Results Of the 92 women who participated in the study, those with non‐fundal LNG ‐ IUS insertion sustained bleeding at rates greater than 83% (31) in the first 3 months of use, and 58% (14) at 6 months, versus 51% (22) at 3 months and 33% (19) at 6 months in those with fundal insertion ( P =0.002 at 3 months; P =0.037 at 6 months). Blood loss in the non‐fundal LNG ‐ IUS group was higher than in the fundal LNG ‐ IUS group according to pictograms drawn by participants. Conclusion Women with non‐fundal LNG ‐ IUS placement had a higher frequency of sustained bleeding and blood loss volume according to self‐reported charts than those with fundal LNG ‐ IUS placement.