What are the menstrual blood flow reduction rates for Kyleena (levonorgestrel-releasing intrauterine system) and Skyla (levonorgestrel-releasing intrauterine system) IUDs in a female patient of reproductive age?

Menstrual Blood Flow Reduction with Kyleena and Skyla IUDs

Both Kyleena and Skyla levonorgestrel IUDs significantly reduce menstrual blood flow, with the levonorgestrel IUD class demonstrating marked reductions in menstrual blood loss and irregular bleeding, leading to amenorrhea in approximately 35% of women after 2 years of use. 1

Expected Bleeding Pattern Changes

General LNG-IUD Effects

• Levonorgestrel IUDs produce a marked reduction in menstrual blood loss compared to baseline or no treatment 1
• Over time, bleeding generally decreases with LNG-IUD use, and many women experience only light menstrual bleeding or amenorrhea 2
• Approximately half of LNG-IUD users are likely to experience amenorrhea or oligomenorrhea by 2 years of use 2
• Heavy or prolonged bleeding, either unscheduled or menstrual, is uncommon during LNG-IUD use 2

Initial Adjustment Period

• Unscheduled spotting or light bleeding is expected during the first 3-6 months of LNG-IUD use, is generally not harmful, and decreases with continued use 2
• These bleeding irregularities are generally not harmful and enhanced counseling about expected bleeding patterns reduces method discontinuation 2

Specific Product Considerations

Skyla (LNG-IUS 13.5mg)

• Skyla releases an average of approximately 8 μg of levonorgestrel per 24 hours during the first year 3
• In a 12-month randomized study, 60.9% of Skyla users reported being "very/somewhat satisfied" with their bleeding pattern 3
• Only 3.2% of Skyla users discontinued due to increased bleeding at 12 months 3
• Skyla is approved for 3 years of use 4

Kyleena (LNG-IUS 19.5mg)

• Kyleena contains 19.5mg total levonorgestrel, an intermediate dose between Skyla (13.5mg) and Mirena (52mg) 5
• While specific bleeding reduction percentages for Kyleena are not provided in the evidence, it follows the general LNG-IUD pattern of marked menstrual blood loss reduction 4
• The clinical research information does not adequately differentiate when Kyleena should be used in preference to other LNG-IUSs based on bleeding outcomes alone 5

Clinical Management Approach

Pre-Insertion Counseling

• Before insertion, provide counseling about potential changes in bleeding patterns during LNG-IUD use 2
• Discuss that bleeding pattern changes do not correlate with contraceptive failure, as the mechanism of contraception remains independent of bleeding patterns 4

Managing Persistent Bleeding

• If clinically indicated, consider an underlying gynecological problem such as LNG-IUD displacement, STD, pregnancy, or new pathologic uterine conditions (e.g., polyps or fibroids) 2
• Confirm device position by checking for visible strings, and obtain pelvic ultrasound if strings are not visible 4
• Provide reassurance that bleeding changes are common and do not indicate contraceptive failure if the device is properly positioned and no pathology is found 4
• Offer symptomatic management with NSAIDs for 5-7 days during bleeding episodes if the patient requests intervention 4
• If bleeding persists and the woman finds it unacceptable, counsel her on alternative contraceptive methods and offer another method if desired 2

Therapeutic Benefits Beyond Contraception

• Many women experience lighter periods or amenorrhea with levonorgestrel IUD use 4
• Levonorgestrel IUDs are particularly useful for adolescents with medical conditions requiring long-term menstrual suppression where estrogen is contraindicated 4
• Levonorgestrel IUDs provide therapeutic reduction in both bleeding and pain, with continuation rates high (75% or greater at one year) once women understand the initial bleeding pattern changes 4

Important Caveats

• The clinical differences between Skyla, Kyleena, and Mirena regarding bleeding outcomes are not adequately defined in current clinical research, with all studies being manufacturer-sponsored 5
• Individual variation exists, and some women may experience amenorrhea while others continue with light bleeding 2, 1
• Bleeding pattern changes do not indicate device failure or reduced contraceptive efficacy 4