INTRACERVICAL AND FUNDAL ADMINISTRATION OF LEVONORGESTREL FOR CONTRACEPTION - ENDOMETRIAL THICKNESS, PATTERNS OF BLEEDING, AND PERSISTING OVARIAN FOLLICLES

Objective(s): To study the prevalence of persisting ovarian follicles and to assess the endometrial changes and patterns of vaginal bleeding over 1 year of use of a 20 mu g/24 h levonorgestrel-releasing intrace rvical contraceptive device. Design: Prospective, randomized study. Se tting: Two family planning clinics in Helsinki, Finland. Patient(s): W omen requesting intrauterine hormonal contraception. Intervention(s): Insertion of a levonorgestrel-releasing intracervical contraceptive de vice into the cervical canal (group 1, n = 151) or fundally into the u terine cavity (group 2, n = 147) for contraception. Main Outcome Measu re(s): Transvaginal ultrasonography of the ovaries and endometrium at insertion and 3, 6, and 12 months after insertion. Data on bleeding we re collected using menstrual diary cards. Result(s): Persisting ovaria n follicles were found in <8% of women. In both groups, the amount of endometrial tissue decreased significantly in 3 months. The incidence of amenorrhea during the 1st year was higher in the fundal insertion g roup. Conclusion(s): The number of persisting follicles was low. Folli cles resolved within 6 to 8 weeks. No association was found between pe rsisting follicles and problems of bleeding. Compared with intracervic al insertion, fundal insertion resulted in more uniform endometrial su ppression and fewer days of bleeding and spotting. (C) 1997 by America n Society for Reproductive Medicine.