Menstrual Suppression with the Levonorgestrel Intrauterine System in Girls with Developmental Delay

摘要

Study Objective: To describe the experiences of 21 girls with developmental delay accompanied by multiple other medical problems, seen over a 3-year interval, who underwent insertion of the levonorgestrel intrauterine system (LNG-IUS) for menstrual suppression. Study Design: Retrospective chart review. Setting: A referral pediatric and adolescent gynecology clinic within a tertiary care medical center with referrals from community pediatricians, pediatric subspecialists including developmental and behavioral pediatricians, community gynecologists, and adolescent medicine specialists. Participants: Adolescents and young women with developmental delay and multiple comorbid conditions who were seen for consultation with their families requesting menstrual suppression. Interventions: Participants were offered hormonal options, for menstrual suppression including the LNG-IUS. Main Outcome Measures: Satisfaction with menstrual suppression among families electing the LNG-IUS. Results: Adolescents and young women seen at CCHMC with developmental delay and multiple comorbid conditions with requests for menstrual suppression were offered hormonal options, including the LNG-IUS. Twenty-one families chose this option. Fifteen of 21 girls had previously used hormonal menstrual suppression. General anesthesia was required for 20 of 21 insertions, and 9 of 20 of these insertions were combined with other surgical procedures. There were no unsuccessful insertions or major complications. Mean duration of follow-up was 11 months, and families were satisfied with this option for menstrual suppression. There was 1 request for removal. Conclusions: LNG-IUS for menstrual suppression, in girls with developmental delay and multiple comorbid medical conditions for which amenorrhea is desirable and therapeutic, appears promising.