Evaluation of the effectiveness and tolerance of long-acting reversible contraceptive methods in adolescent patients : January 2017 to December 2018.

Abstract

Objective: To evaluate adherence, the percentage of pregnancies and the profile of adverse effects reported by patients at six months and one year after placement of the levonorgestrel-releasing system or etonogestrel subdermal implant in adolescent patients of the Gynecology and Obstetrics Service of the Hospital Rafael Ángel Calderón Guardia between June 2017 and December 2018. Methods: Descriptive, cross-sectional, observational and retrospective study of medical records. It analyzes the data of adolescents (women under 20 years of age) of the Gynecobstetrics Service of the Calderón Guardia Hospital, who had any LARC placed between January 2017 and December 2018. We evaluated 114 patients with sufficient information for the analysis of contraceptive response at 6 months and 1 year after placement. A data collection sheet was used, without documenting patient identification, with information on the time of contraceptive placement, in addition to data on the variables to be studied documented in the record at 6 months and at 1 year of LARC placement. The data collected were entered into a Windows Excel analysis table, which was used to perform the statistical analysis. A descriptive analysis of the variables under study was performed, representing the number and percentage of patients. Qualitative and quantitative variables were analyzed. Tables and charts were used to describe the results obtained. Results: The effectiveness, adherence, satisfaction and adverse effects reported by the patients associated with each contraceptive method were analyzed. During the two-year study period, 48 intrauterine systems and 331 subdermal implants were inserted. Sixteen intrauterine systems and 98 subdermal implants were followed up at 6 months and 1 year. The effectiveness of the method in the patients analyzed at one year of use was 100%, with an adherence rate of 92.1%, while only 7.1% of the patients withdrew the method early. The reason for withdrawal was mostly due to adverse effects reported by the patients. Of the total number of patients, 35.4% did not report any adverse effects. Of the patients who did report some discomfort, irregular bleeding (31.5%) was most frequently documented one year after use of the method. Other adverse effects found less frequently were headache, weight gain, heavy bleeding, dizziness, pain at the implant site, acne, anxiety, depression and dysmenorrhea. Conclusion: The percentage of therapeutic failure (pregnancy) with each of the contraceptive methods at one year of use was 0%. The percentage of early withdrawal of the method was 7.1%, while 92.9% of patients continue to use the contraceptive at one year of use. The main adverse effects with the use of long-acting contraceptive methods were irregular uterine bleeding and headache at 6 months and 1 year of use, both for the subdermal implant and the intrauterine system. The main reason for abandonment of the contraceptive method was due to adverse effects, the most frequent being irregular bleeding.