Levonorgestrel salınımlı rahim içi araçların üriner inkontinans ve kadın cinsel yaşamı üzerine etkileri
Abstract
Amaç: Levonorgestrel salınımlı rahim içi araç (LNG-RİA) yüksek etkinlik ve güvenliği nedeni ile uzun etkili geri dönüşümlü kontrasepsiyon yöntemleri arasında yaygın olarak kullanılmaktadır. Kontrasepsiyonun yanı sıra LNG-RİA jinekoloji pratiğinde bir çok endikasyon ile medikal tedavi için kullanılmaktadır. Ancak , LNG-RİA ‘nın üriner inkontinans ve cinsel fonksiyon üzerine etkileri net değildir. Bu çalışmanın amacı LNG-RİA uygulanan kadınlarda bu etkileri değerlendirmektedir.
Gereç ve Yöntem: Bu prospektif kohort çalışmasına Aralık 2021 Mayıs 2022 tarihleri arasında İstanbul Üniversitesi İstanbul Tıp Fakültesi Jinekoloji ve Menapoz kliniğine başvuran 20-55 yaş arasında olan ve LNG-RİA takılan hastalar dahil edildi. Jinekolojik muayene , ultrasonografi, stres test, 24 saatlik ped testi ve anketler (IIQ-7, UDI-6, FSFI) hastalara uygulandı. 1,3, ve 6.aylarda takipler yapıldı.
Bulgular: Toplam 89 hastadan 80 tanesi çalışmayı tamamladı. Ortalama yaş 39 ±8 yıl , ortalama BMI 28.1±4.9 kg/m2 idi. LNG-RİA endikasyonları arasında anormal uterin kanama (%43.7) , kontrasepsiyon (%27.5), pelvik ağrı (%7.5) ve HRT (%7.5) bulunuyordu. Stres testi sonuçları değişmezken, başlangıçta 13 hastada pozitif olan 24 saatlik ped testi 6.ayda 12 hastada pozitifti (p>0.999) UDI-6 toplam puanı azalırken , urge ve stres inkontinans skorlarında anlamlı değiişiklik olmadı. Frequency ve pelvik ağrı skorları 6.ayda daha düşük bulundu. IIQ-7 skorlarında anlamlı değişiklik olmadı. FSFI skorları anlamlı şekilde artarken özellikle uyarılma, lubrikasyon ve pelvik ağrı skorlarında iyileşme gözlendi. Cinsel istek, orgazm ve tatmin skorlarında değişiklik saptanmadı.
Sonuç: LNG-RİA, cinsel fonksiyonları iyileştirirken, üriner inkontinans üzerinde anlamlı bir etki göstermedi.
References
- Attia AM, Ibrahim MM, Abou-Setta AM. Role of the levonorgestrel intrauterine system in effective contraception. Patient Prefer Adherence. 2013 Aug 9;7:777-85. doi: 10.2147/PPA.S36948. PMID: 23990713; PMCID: PMC3749061.
- Harlow SD, Gass M, Hall JE, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unmet Health Needs of Women Aged 45–65. J Womens Health (Larchmt). 2012;21(8): 789-795.doi:10.1089/jwh.2012.3810.
- Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer.Epidemiol Rev. 1993;15(1):36-47. doi:10.1093/oxfordjournals.epirev.a036167.
- McClure G, Kelleher C, Lindeberg J, et al. The role of estrogen in urinary tract health. J Urol. 2016;195(4):963-969. doi:10.1016/j.juro.2015.10.145.
- Fawcett T, Gomes F, Yip C, et al. Influence of progesterone on bladder contractility and beta-adrenergic receptors. Urology. 2019;133:175-182.doi:10.1016/j.urology.2019.03.002.
- Smith G, McDonald M. Hormone therapy and the urinary tract: Implications for treatment. Menopause. 2018;25(6):642-649.doi:10.1097/GME.0000000000001137.
- Marjoribanks J, Farquhar C, Brown J, et al. Intrauterine devices for menstrual bleeding. Cochrane Database Syst Rev. 2013;2013(6).doi:10.1002/14651858.CD012076.
- Kaneshiro B, Ramin S. Safety and effectiveness of intrauterine devices for endometrial protection. Obstet Gynecol. 2012;120(1):41-50.doi:10.1097/AOG.0b013e31825618d2.
- Goveas J, McDermott K, Joffe H. The role of sex hormones in the lower urinary tract: Clinical implications. Urol Clin North Am. 2020;47(2):209-218.doi:10.1016/j.ucl.2020.01.003.
- 10.Griffiths D, Jackson S, Hides S. Impact of hormonal contraceptives on urinary tract symptoms. BJU Int. 2017;120(6):885-892. doi:10.1111/bju.13964.
- Harlow SD, Liao S, Ayyagari R, et al. The impact of hormonal contraceptives on urinary incontinence: A review. Urology. 2020;141:79-85.doi:10.1016/j.urology.2020.01.043.
- Iliadou PK, Antsaklis A, K. Clinical outcomes of progestin-only contraceptives on urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2014;176:56-60.doi:10.1016/j.ejogrb.2014.01.012.
- Heliövaara-Peippo S, Kajantie E, Kirkinen P. Long-term effects of intrauterinedevices versus hysterectomy on lower urinary symptoms. Int Urogynecol J.2015;26(1):97-104. doi:10.1007/s00192-014-2484-3.
- Halmesmäki E, Kivinen T, Oksanen M. Effects of LNG-IUD and hysterectomy on sexual satisfaction and partner relationships. Acta Obstet Gynecol Scand. 2016;95(9):1010-1017. doi:10.1111/aogs.13072.
- Kaczmarek P, Lister K, Pauli B. Comparative analysis of sexual function withdifferent types of intrauterine devices. J Sex Med. 2018;15(10):1465-1472.doi:10.1016/j.jsxm.2018.08.002.
- Bastianelli C, Farris M, Paterlini G, et al. The impact of LNG-IUD on sexual satisfaction and dyspareunia. Contraception. 2017;95(2):180-185.doi:10.1016/j.contraception.2016.10.001.
- Clave A, Chedotal A. Hormonal modulation of the lower urinary tract. Urology.2021;155:123-129. doi:10.1016/j.urology.2021.01.013.
- Molloy H, Macrae H, Donnelly M. Hormonal regulation of urinary incontinence and sexual function. Urol Nurs. 2018;38(1):34-42. doi:10.7257/1053-816X.2018.38.1.34.
- Martin M, Arnold A. Progesterone's role in the modulation of lower urinary tract symptoms. Urology. 2021;150:66-72. doi:10.1016/j.urology.2020.10.027.
- Cormier J, Busse A, Degenhardt C. The impact of hormonal contraceptives on the lower urinary tract. J Urol. 2020;203(4):739-745. doi:10.1097/JU.0000000000000914.
- Nilsson M, Gärdner C, Johansson K. Progesterone effects on urinary symptoms: Clinical observations and mechanisms. Menopause Int. 2019;25(3):121-127.doi:10.1177/1754045319825574.
- Andraus R, Vieira R, Oishi J, et al. Effects of progestins on urinary tract function. Eur Urol. 2017;71(3):357-364. doi:10.1016/j.eururo.2016.07.032.
- Bennes M, Ayers C, Hackett C. Impact of progesterone on bladder symptoms. BJU Int. 2015;116(5):768-774. doi:10.1111/bju.13009.
- Iliadou P, Tzannou E, Petousis S. Oral contraceptives and their effect on urinary incontinence. Acta Obstet Gynecol Scand. 2013;92(3):316-321.doi:10.1111/aogs.12079.
- Taylor C, Morgan A, Arnold D. LNG-IUDs and urinary incontinence: A comparative study. Urology. 2019;134:93-98.doi:10.1016/j.urology.2019.01.018.
- Heliövaara-Peippo S, Harsunen M, Virtanen H. Long-term outcomes of LNGIUDs on urinary symptoms compared to hysterectomy. Int Urogynecol J.2020;31(6):1161-1168. doi:10.1007/s00192-019-04111-0.
- Langer J, Morgan S. Female sexual dysfunction: Etiology, diagnosis, and management. Urology. 2019;130:47-54. doi:10.1016/j.urology.2019.03.002.
- Nappi R, Panzer A. Epidemiology of sexual dysfunction in women. J Sex Med.2015;12(6):1-9. doi:10.1111/jsm.12822.
- Halmesmäki E, Mäkinen J, Pärssinen J. Sexual function and satisfaction after LNG-IUD versus hysterectomy. Acta Obstet Gynecol Scand. 2017;96(10):1196-1204. doi:10.1111/aogs.13225.
- Dantas D, Martinho S, Rodrigues M. Sexual function in women using different intrauterine devices. J Sex Med. 2016;13(9):1537-1545.doi:10.1016/j.jsxm.2016.07.056.
- Nilsson A, Radoslaw J, Fritsche M. Pain scores and sexual function in LNG-IUDusers. Contraception. 2019;99(5):290-295.doi:10.1016/j.contraception.2018.12.015.
- Bastianelli C, Ghi T, Melis G. LNG-IUD and sexual satisfaction: A comprehensive review. J Womens Health. 2018;27(5):658-663. doi:10.1089/jwh.2017.6693.
The effects of levonorgestrel-releasıng ıntrauterıne devıce on urınary ıncontınence and female sexual lıfe
Abstract
Aim: Levonorgestrel-releasing intrauterine devices (LNG-IUDs) are widely used for long-acting reversible contraception due to their high efficacy, safety and cost-effectiveness. Beyond contraception, LNG-IUDs are widely used in gynecological practice for various medical treatments. Progesterone influences the lower urinary tract by affecting bladder and urethral tone, potentially contributing to urinary symptoms. However, the impact of LNG-IUDs on urinary incontinence and sexual function remains unclear. This study aims to evaluate these effects in women undergoing LNG-IUD insertion.
Materials and Methods: This prospective cohort study included women aged 20-55 who underwent LNG-IUD insertion at Istanbul University Istanbul Faculty of Medicine Gynecology and Menopause clinic between December 2021 and May 2022. Baseline assessments included gynecological examination, ultrasonography, stress test, 24-hour pad test, and validated questionnaires (FSFI, IIQ-7, UDI-6). Follow-ups occurred at 1, 3, and 6 months, with repeated assessments at 6 months.
Results: The study which started with 89 patients, was completed with 80 patients. The mean age was 39 ± 8 years, and mean BMI was 28.1 ± 4.9 kg/m2 . Indications for LNG-IUD insertion included abnormal uterine bleeding (43.7%), contraception (27.5%), pelvic pain (7.5%), and hormone therapy (7.5%). Stress test results remained unchanged, with positiveness in 6 patients at both baseline and 6 months. The 24-hour pad test was positive in 13 patients initially and 12 patients at 6 months (p>0.999). While the total UDI-6 score decreased, urge and stress incontinence scores showed no significant change. Frequence and pelvic pain scores were lower in 6 months. FSFI scores improved significantly, with increases in arousal, lubrication, and pain domains, while no significant changes were observed in desire, orgasm, or satisfaction.
Conclusion: LNG-IUD insertion improved sexual function but had no significant effect on urinary incontinence.
References
- Attia AM, Ibrahim MM, Abou-Setta AM. Role of the levonorgestrel intrauterine system in effective contraception. Patient Prefer Adherence. 2013 Aug 9;7:777-85. doi: 10.2147/PPA.S36948. PMID: 23990713; PMCID: PMC3749061.
- Harlow SD, Gass M, Hall JE, et al. Executive Summary of the Stages of Reproductive Aging Workshop + 10: Addressing the Unmet Health Needs of Women Aged 45–65. J Womens Health (Larchmt). 2012;21(8): 789-795.doi:10.1089/jwh.2012.3810.
- Kelsey JL, Gammon MD, John EM. Reproductive factors and breast cancer.Epidemiol Rev. 1993;15(1):36-47. doi:10.1093/oxfordjournals.epirev.a036167.
- McClure G, Kelleher C, Lindeberg J, et al. The role of estrogen in urinary tract health. J Urol. 2016;195(4):963-969. doi:10.1016/j.juro.2015.10.145.
- Fawcett T, Gomes F, Yip C, et al. Influence of progesterone on bladder contractility and beta-adrenergic receptors. Urology. 2019;133:175-182.doi:10.1016/j.urology.2019.03.002.
- Smith G, McDonald M. Hormone therapy and the urinary tract: Implications for treatment. Menopause. 2018;25(6):642-649.doi:10.1097/GME.0000000000001137.
- Marjoribanks J, Farquhar C, Brown J, et al. Intrauterine devices for menstrual bleeding. Cochrane Database Syst Rev. 2013;2013(6).doi:10.1002/14651858.CD012076.
- Kaneshiro B, Ramin S. Safety and effectiveness of intrauterine devices for endometrial protection. Obstet Gynecol. 2012;120(1):41-50.doi:10.1097/AOG.0b013e31825618d2.
- Goveas J, McDermott K, Joffe H. The role of sex hormones in the lower urinary tract: Clinical implications. Urol Clin North Am. 2020;47(2):209-218.doi:10.1016/j.ucl.2020.01.003.
- 10.Griffiths D, Jackson S, Hides S. Impact of hormonal contraceptives on urinary tract symptoms. BJU Int. 2017;120(6):885-892. doi:10.1111/bju.13964.
- Harlow SD, Liao S, Ayyagari R, et al. The impact of hormonal contraceptives on urinary incontinence: A review. Urology. 2020;141:79-85.doi:10.1016/j.urology.2020.01.043.
- Iliadou PK, Antsaklis A, K. Clinical outcomes of progestin-only contraceptives on urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2014;176:56-60.doi:10.1016/j.ejogrb.2014.01.012.
- Heliövaara-Peippo S, Kajantie E, Kirkinen P. Long-term effects of intrauterinedevices versus hysterectomy on lower urinary symptoms. Int Urogynecol J.2015;26(1):97-104. doi:10.1007/s00192-014-2484-3.
- Halmesmäki E, Kivinen T, Oksanen M. Effects of LNG-IUD and hysterectomy on sexual satisfaction and partner relationships. Acta Obstet Gynecol Scand. 2016;95(9):1010-1017. doi:10.1111/aogs.13072.
- Kaczmarek P, Lister K, Pauli B. Comparative analysis of sexual function withdifferent types of intrauterine devices. J Sex Med. 2018;15(10):1465-1472.doi:10.1016/j.jsxm.2018.08.002.
- Bastianelli C, Farris M, Paterlini G, et al. The impact of LNG-IUD on sexual satisfaction and dyspareunia. Contraception. 2017;95(2):180-185.doi:10.1016/j.contraception.2016.10.001.
- Clave A, Chedotal A. Hormonal modulation of the lower urinary tract. Urology.2021;155:123-129. doi:10.1016/j.urology.2021.01.013.
- Molloy H, Macrae H, Donnelly M. Hormonal regulation of urinary incontinence and sexual function. Urol Nurs. 2018;38(1):34-42. doi:10.7257/1053-816X.2018.38.1.34.
- Martin M, Arnold A. Progesterone's role in the modulation of lower urinary tract symptoms. Urology. 2021;150:66-72. doi:10.1016/j.urology.2020.10.027.
- Cormier J, Busse A, Degenhardt C. The impact of hormonal contraceptives on the lower urinary tract. J Urol. 2020;203(4):739-745. doi:10.1097/JU.0000000000000914.
- Nilsson M, Gärdner C, Johansson K. Progesterone effects on urinary symptoms: Clinical observations and mechanisms. Menopause Int. 2019;25(3):121-127.doi:10.1177/1754045319825574.
- Andraus R, Vieira R, Oishi J, et al. Effects of progestins on urinary tract function. Eur Urol. 2017;71(3):357-364. doi:10.1016/j.eururo.2016.07.032.
- Bennes M, Ayers C, Hackett C. Impact of progesterone on bladder symptoms. BJU Int. 2015;116(5):768-774. doi:10.1111/bju.13009.
- Iliadou P, Tzannou E, Petousis S. Oral contraceptives and their effect on urinary incontinence. Acta Obstet Gynecol Scand. 2013;92(3):316-321.doi:10.1111/aogs.12079.
- Taylor C, Morgan A, Arnold D. LNG-IUDs and urinary incontinence: A comparative study. Urology. 2019;134:93-98.doi:10.1016/j.urology.2019.01.018.
- Heliövaara-Peippo S, Harsunen M, Virtanen H. Long-term outcomes of LNGIUDs on urinary symptoms compared to hysterectomy. Int Urogynecol J.2020;31(6):1161-1168. doi:10.1007/s00192-019-04111-0.
- Langer J, Morgan S. Female sexual dysfunction: Etiology, diagnosis, and management. Urology. 2019;130:47-54. doi:10.1016/j.urology.2019.03.002.
- Nappi R, Panzer A. Epidemiology of sexual dysfunction in women. J Sex Med.2015;12(6):1-9. doi:10.1111/jsm.12822.
- Halmesmäki E, Mäkinen J, Pärssinen J. Sexual function and satisfaction after LNG-IUD versus hysterectomy. Acta Obstet Gynecol Scand. 2017;96(10):1196-1204. doi:10.1111/aogs.13225.
- Dantas D, Martinho S, Rodrigues M. Sexual function in women using different intrauterine devices. J Sex Med. 2016;13(9):1537-1545.doi:10.1016/j.jsxm.2016.07.056.
- Nilsson A, Radoslaw J, Fritsche M. Pain scores and sexual function in LNG-IUDusers. Contraception. 2019;99(5):290-295.doi:10.1016/j.contraception.2018.12.015.
- Bastianelli C, Ghi T, Melis G. LNG-IUD and sexual satisfaction: A comprehensive review. J Womens Health. 2018;27(5):658-663. doi:10.1089/jwh.2017.6693.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Obstetrics and Gynaecology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | August 25, 2025 |
| Submission Date | February 7, 2025 |
| Acceptance Date | August 6, 2025 |
| Published in Issue | Year 2025Volume: 64 Issue: Özel Sayı: 1 (11. Ulusal Ürojinekoloji Kongresi Bildiri Kitapçığı) |
