Abstract

MIRANDA, Alexandra et al. Risk factors for anxiety and pain perception during levonorgestrel intrauterine system insertion. Acta Obstet Ginecol Port [online]. 2018, vol.12, n.4, pp.268-276. ISSN 1646-5830.

Overview and Aims: Levonorgestrel Intrauterine System (LNG-IUS) is an efficacious and cost-effective long acting reversible contraceptive, with high satisfaction rates among users. Yet, evidence shows that anxiety and fear of pain associated with LNG-IUS insertion prevent women from choosing them as their contraceptive method. We aimed to determine risk factors associated with anxiety and pain perception during LNG-IUS insertion. Methods and Population: We performed a prospective, observational, descriptive and analytical study to a sample of patients of the family planning consultation submitted to insertion of LNG-IUS between may and november 2017. Pre and post insertion questionnaires were given, one directed to the patients and other to the clinicians. Results: From a total of 161 women in analysis, 125 inserted Mirena® and 36 inserted Jaydess®. The patients submitted to the insertion of Jaydess® were significantly younger (median=34) than those who chose Mirena® (median=41) and presented higher frequency of nulliparity and absence of vaginal delivery. Higher levels of anticipated pain correlated with high levels of anxiety (p<0.001). The pain associated to the procedure was mainly referred to as mild or moderated. Higher levels of experienced pain were found in patients with less parity or absence of vaginal delivery and in more technically difficult procedures (p<0.001). After a multivariable regression analysis, only patient's anxiety and anticipated pain have remained associated with the increase of experienced pain (p<0.05). Conclusions: High levels of anxiety and anticipated pain proved to be predictors of high levels of experienced pain during LNG-IUS insertion. Future research should focus on interventions to reduce pre-procedure anxiety and anticipated pain potentially to decrease discomfort experienced with intrauterine device insertion.

Keywords : Pain; Anxiety; Contraception; LNG-IUS; Mirena®; Jaydess®.

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