Technical difficulty of levonorgestrel 52-mg intrauterine device placement and six-month clinical outcomes among women with and without isthmocele: a prospective cohort study

Objective To compare pain and difficulty during levonorgestrel 52-mg intrauterine device (LNG 52-mg IUD) insertion in women with and without isthmocele and, secondarily, to assess changes in uterine bleeding, and chronic pelvic pain six months after insertion.Materials and methods Our prospective study was conducted at the Universidade Estadual de Campinas, Brazil. Women aged 18–43 years with at least one caesarean delivery ≥6 months previously, with or without ultrasound-diagnosed isthmocele, were included. Insertion pain, menstrual pain, and chronic pelvic pain were assessed using a 100-mm visual analogue scale (VAS). We included 260 women (103 with and 157 without isthmocele), providing 80% power at α = 0.05 to detect differences in insertion outcomes. Multivariable logistic regression identified factors associated with insertion difficulty and severe pain.Results Insertion success was similar in women with and without isthmocele (99.0% vs. 98.7%; p = 1.000), as were pain intensity (p = 0.80) and insertion difficulty (p = 0.19). Of 224 women reporting at least one symptom at baseline, 89 (39.7%) had isthmocele and 135 (60.3%) did not. At six months, both groups showed significant reductions in heavy menstrual bleeding, menstrual pain, and chronic pelvic pain (all p < 0.001). Prolonged menstrual bleeding (≥8 days) decreased significantly among women with isthmocele; however, the group-by-time interaction was not significant (p = 0.21).Conclusion Isthmocele was not associated with greater insertion pain or difficulty. Six months after LNG 52-mg IUD insertion, both groups showed improvements in heavy menstrual bleeding, menstrual pain, and chronic pelvic pain.Short Condensation Isthmocele was not associated with greater insertion pain or difficulty of the LNG 52-mg IUD. Six months after IUD insertion, both groups showed improvements in heavy menstrual bleeding, menstrual pain, and chronic pelvic pain.