Improving 52mg LNG-IUD in daily practice

This thesis investigated that the level of pain-perceived during insertion is not higher during menstruation compared to outside menstruation, therefore the 52mg LNG-IUD can be inserted at any time during the menstrual cycle. This thesis showed that malposition rate of LNG-IUD on ultrasound six weeks after insertion is 6.3%. If patients experience unfavourable bleeding, an ultrasound should be considered to exclude malposition. Furthermore, it showed that embedment of the side arms of the LNG-IUD in the myometrium assessed by 3D ultrasound is not associated with a unfavourable bleeding pattern nor pelvic pain six weeks after insertion. Therefore, it is not recommended to perform standard 3D ultrasound. This thesis showed that evidence for the medical treatment of (ongoing) bleeding irregularities during use of the LNG-IUS is lacking and more research is needed on the topic. A decrease is described in the number of bleeding days observed in long-term 52mg LNG-IUD users experiencing bleeding after using 2mg oestradiol for six weeks.