Use Patterns of Levonorgestrel-Releasing Intrauterine System among American Women

Abstract Levonorgestrel-releasing intrauterine system (LNG-IUS) use is approved by the FDA for contraception and heavy menorrhagia. More importantly, it effectively treats endometrial hyperplasia, a precursor to endometrial cancer. Thereby, LNG-IUS use is associated with potential endometrial cancer (EC) risk reduction, but current use patterns in the U.S. are unknown. We analyzed LNG-IUS use prevalence among women aged 18-50 using a weighted statistical analysis of the 2017-2019 National Survey of Family Growth. Summary statistics were stratified by race and ethnic group, known EC sociodemographic and health risk factors, and assessed statistically with bivariate Rao-Scott chi-square tests. A multivariable logistic regression model was developed to explore LNG-IUS use predictors. Current LNG-IUS use in the US was 6.9% (95% confidence interval [CI]: 5.9-8.1%). LNG-IUS use was lower in Hispanic women compared to White women (adjusted odds ratio [AOR] 0.7, 95% CI: 0.5-1.0]. Compared to women with ≤high school education, LNG-IUS use was higher for women with ≥college degree (AOR 2.0, 95% CI: 1.3-3.1). Parous (AOR 2.6, 95% CI: 1.7-3.9) and insured (AOR 1.7. 95% CI: 1.0-3.1) women had higher odds of LNG-IUS use, whereas women with diabetes (AOR 0.3, 95% CI: 0.1-0.7) had lower odds of LNG-IUS use. No differences in LNG-IUS use were observed by EC risk factors of women’s body mass index, age of menarche, hypertension, and personal history of cancer. More research is needed to establish the potential benefits of LNG-IUS use on EC, which will further highlight potential opportunities for population-level primary prevention to address the growing incidence of EC.