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Bleeding and Spotting with the LNG 13.5 mg IUS

Contraception; ePub 2019 Mar 1; Shimoni, et al

Early cycle insertion with the levonorgestrel (LNG) 13.5 mg intrauterine system (IUS) does not impact 90-day bleeding/spotting, a new study found. In the observational study, participants received a LNG 13.5 mg IUS and provided 90 days of bleeding/spotting data. Researchers dichotomized insertion timing as early (days 1‒7 from LMP) and late (reminder of menstrual cycle) and compared the 2 groups in the 90- and 30-day reference periods. They found:

  • In the 90-day dichotomous analysis (n=125), there were no differences in the number of days of bleeding/spotting, bleeding, or spotting between the early and late insertion groups.
  • Early cycle insertion and recent hormonal contraceptive use decreased 30-day bleeding.
  • Nulliparity was associated with spotting (30-day).
  • Shared decision making should determine timing of insertion.


Shimoni N, Choudhury T, Goldman A, Frondelli M, Chen P-H. Bleeding and spotting with the levonorgestrel 13.5 mg intrauterine system: The impact of insertion timing. [Published online ahead of print March 1, 2019]. Contraception. doi:10.1016/j.contraception.2019.02.004.