The Safety, Acceptability and Continuation Rate of Immediate Versus Delayed Insertion of Levonorgestrel Releasing Intrauterine System Following First Trimester Surgical Abortion: An Observational Study

Objective: To assess the safety, acceptability and six-month continuation rate of immediate versus delayed insertion of the levonorgestrel releasing intrauterine system (LNG-IUS) following surgical termination of first trimester pregnancy. Methods: This prospective observational study was conducted on 180 patients who underwent surgical abortion and opted for LNGIUS and divided into two groups; immediate group=86 and delayed group=94. Pain scores, adverse effects, acceptability and continuation rate were recorded. Results: More patients in the delayed insertion group exhibited higher perception of pain (p< 0.001) and requested additional analgesia upon LNG-IUS insertion (p< 0.05) with no significant difference between the two groups regarding other adverse effects (fainting, abnormal vaginal bleeding, expulsion and pelvic infection), request for removal and re-insertion of LNG-IUS (p>0.05). The continuation rate and patient acceptability in terms of overall satisfaction and recommendation to other women, were comparable between the two groups (p>0.05) while overall discomfort was higher in the delayed group at one, three and six months after insertion (p< 0.05) Conclusion: Although immediate insertion of LNG-IUS after first trimester surgical abortion has higher expulsion rate, yet it has lower pain intensity, request for additional analgesia and overall discomfort compared to delayed insertion of LNG-IUS with comparable continuation and acceptability rates at 6 months after insertion. Keywords: levonorgestrel releasing intrauterine system; abortion; post abortive contraceptio