目的:在青少年中使用52mg左炔诺孕酮宫内系统(LNG-IUS)治疗月经大出血(HMB),痛经,避孕增加了,然而,对预测青少年移除和不满的因素知之甚少。本研究旨在确定青少年去除LNG-IUS的预测因素。
方法:回顾性队列研究,包括2012-2021年接受LNG-IUS插入的所有青少年(9-19岁)(n=536)。病历审查整理了病史和妇科史的数据,年龄,插入指示,并发症,驱逐,和清除。使用卡方检验分析数据。
结果:517例患者(n=517)中插入LNG-IUS的适应症(n=536)包括月经管理(n=142),单独使用HMB(n=118),HMB和盆腔疼痛/痛经(n=105),仅痛经/盆腔疼痛(n=47),和避孕(n=16)。相关诊断包括智力残疾(ID)(44.29%,229/517),慢性疼痛状况(12.77%,66/517),和其他心理健康问题(24.37%,126/517)。患者对LNG-IUS的不满导致61例(11.38%)被移除,主要是疼痛或持续性出血。较高的去除率发生在那些与相关的慢性疼痛条件(46.97%,X2=55.9,p<0.05),心理健康问题(16.67%,X2=5.06,p<0.05)和出血性疾病(26.32%,X2=5.09,p<0.05)。在有身份证的队列中,去除率较低(5.7%,X2=11.2,p<0.05)。虽然不同性别青年的LNG-IUS去除率为23.07%,这没有统计学意义.年轻的年龄也与清除量的统计显着增加无关(13.72%,X2=0.73,p>0.05)。
结论:青少年对LNG-IUS的不满和去除率较低(11.38%)。慢性疼痛,出血倾向和心理健康相关性与较高的清除率相关;ID与较低的清除率相关。这些发现对于咨询患者和家庭有关LNG-IUS很有用。
OBJECTIVE: Use of 52-mg levonorgestrel intrauterine system (LNG-IUS) in adolescents for heavy menstrual bleeding (HMB), dysmenorrhea, and contraception has increased, yet little is known about the factors predicting removal and dissatisfaction in adolescents. The aim of this study was to identify factors predicting LNG-IUS removal in adolescents.
METHODS: This was a retrospective cohort study including all adolescents (9-19 years) who underwent LNG-IUS insertion between 2012 and 2021 (n = 536). A medical record review was conducted and data were collated on medical and gynecological history, age, indications for insertion, complications, expulsions, and removals. The data were analyzed using χ2 tests.
RESULTS: Indications for LNG-IUS insertions (n = 536) among 517 individual patients (n = 517) included menstrual management (n = 142), HMB alone (n = 118), HMB and pelvic pain/dysmenorrhea (n = 105), dysmenorrhea/pelvic pain alone (n = 47), and contraception (n = 16). Associated diagnoses included intellectual disability (44.29%, 229/517), chronic pain conditions (12.77%, 66/517), and additional mental health concerns (24.37%, 126/517). Patient dissatisfaction with LNG-IUS led to removal in 61 (11.38%), mostly for pain or persistent bleeding. Higher removal rates occurred in those with associated chronic pain conditions (46.97%, χ2 = 55.9, P < .05), mental health concerns (16.67%, χ2 = 5.06, P < .05), and bleeding disorders (26.32%, χ2 = 5.09, P < .05). Among the cohort with an intellectual disability, lower rates of removal occurred (5.7%, χ2 = 11.2, P < .05). Whereas the LNG-IUS removal rate among gender-diverse youth was 23.07%, this was not statistically significant. Younger age was also not associated with a statistically significant increase in removals (13.72%, χ2 = 0.73, P > .05).
CONCLUSIONS: Adolescents have a low dissatisfaction and removal rate (11.38%) of LNG-IUS. Chronic pain, bleeding tendency, and mental health concerns are associated with higher removal rates and intellectual disability with lower rates. These findings are useful in counselling patients and families about LNG-IUS.