Assessing acceptability, benefits, and satisfaction with the levonorgestrel-containing intrauterine system as a contraceptive method for women initiating chemotherapy
Awarded 2014
Small Research Grants
Melody Hou, MD, MPH
University of California, Davis

Objectives: 1) to describe contraception counseling and bleeding complaints among women starting chemotherapy; 2) to estimate the satisfaction and bleeding patterns associated with a levonorgestrel containing intrauterine system (LNG-IUS) in women receiving chemotherapy. Methods: We performed a chart review of women 14-40 years old receiving chemotherapy from July 2008 to June 2013 at our institution. Electronic medical records were examined for contraceptive details and bleeding complaints, prophylaxis and treatment within six months of chemotherapy initiation. We also recruited for an observational pilot study of 12 women receiving the LNG-IUS, to assess satisfaction at 3, 6, and 12 months and bleeding patterns via daily diaries. Results: We identified 137 women for our retrospective study. Only 12% received contraceptive counseling prior to chemotherapy, and 63% initiated chemotherapy without contraception. By 6 months of chemotherapy, 47 (35%) women reported abnormal bleeding. Only 24 (18%) received counseling about suppressing menses prior to chemotherapy; 19 of 35 women who reported abnormal bleeding other than amenorrhea were counseled regarding treatment. The most common treatment was combined oral contraceptives. We approached 10 women for contraceptive counseling as a part of the observational pilot. Three women elected to have a LNG-IUS placed and enrolled in the study, but none completed the 3 month follow-up. We ultimately closed the pilot for recruitment futility. Conclusion: Women undergoing chemotherapy have low rates of contraception and menstrual suppression counseling. Combined oral contraceptives was the most common treatment, but is contraindicated per the Society of Family Planning. Interdisciplinary and interprofessional collaboration is important to improve women’s access to safe and effective contraceptive and gynecologic care when starting chemotherapy.