Métodos anticonceptivos de larga duración (LARC): características de las usuarias, tasa de continuidad y efectividad / Long-Acting Reversible Contraceptive (LARC) methods: User characteristics, effectiveness, and continuation rates

Antecedentes: Los métodos anticonceptivos reversibles de larga duración (LARC) proporcionan una anticoncepción larga y reversible. Incluyen dispositivos intrauterinos (DIU) e implantes subdérmicos. Material y métodos: Estudio observacional longitudinal retrospectivo desde enero de 2017 a diciembre de 2019 incluyendo usuarias de LARC del Departamento de Salud de Elche. Se realizaron análisis descriptivos de: características de las pacientes, complicaciones postinserción, efectos no deseados y motivo de abandono, utilizando Kruskal-Wallis, ANOVA o chi-cuadrado en los análisis comparativos según la variable. Se analizaron las probabilidades de abandono tras 18meses mediante curvas Kaplan-Meier y se compararon mediante test Log-Rank. Se evaluó la razón de riesgo de las alteraciones del patrón de sangrado en las probabilidades de abandono mediante modelo de riesgos proporcionales de Cox. Resultados: Se incluyeron 605 usuarias de LARC, generalmente de raza blanca, multíparas y con pareja sexual estable. Las complicaciones más observadas fueron expulsión del DIU (4%) y hematoma cutáneo en la zona de inserción del implante (42,1%). El efecto no deseado más notificado fue el cambio del patrón de sangrado (26,8%) y su aparición aumentó el riesgo de interrupción del método (HR=1,76; IC95%: 1,15-2,68). Tras 18meses de uso, la tasa de continuidad fue del 86,9% (mayor para DIU-LNG 52mg) y la efectividad fue del 99,60% (resultado de 2embarazos con el uso de DIU-Cu). Conclusiones: Dado que los LARC son los métodos anticonceptivos reversibles más efectivos y con mayores tasas de continuación, deberían ser los métodos de primera línea ofrecidos a todas las mujeres que no presenten contraindicaciones.(AU)

Background: Long-Acting Reversible Contraceptive (LARC) methods provide long and reversible contraceptive effects. They include intrauterine devices (IUDs) —copper-containing IUD or levonorgestrel-releasing IUDs— and subdermal implant. Material and methods: A longitudinal observational retrospective study between January 2017 and December 2019 in which clinical records of users of LARC methods of the Elche Health Department were reviewed. Descriptive analyses were performed to describe user characteristics, post insertion problems, unwanted effects, and reasons for discontinuation; Kruskal-Wallis, ANOVA, and Chi-square were performed to compare these variables among different LARC methods, where appropriate. Kaplan-Meier survival curves were constructed to estimate continuation rates and the logrank test was applied for statistical comparisons. Cox proportional hazard models were used to estimate the hazard ratio (HR) for risk of contraceptive method discontinuation due to abnormal bleeding patterns. Results: Were included 605 LARC method users. These women were generally white, multiparous, and in stable relationships. The most common complications were IUD expulsion (4%) and haematoma at the implant site (42.1%). The main side effect was a change in bleeding patterns (26.8%) and was associated with premature removal (HR=1.76; 95%CI: 1.15-2.68). After 18months of use, the continuation rate was 86.9% (significantly higher for LNG-IUD 52mg) and effectiveness was 99.60% (result of 2 unintended pregnancies with use of copper-containing IUDs). Conclusions: Given that LARC methods have the highest rates of contraceptive efficacy and continuation, these methods should be the first-line contraceptive methods offered to patients without contraindications.(AU)

Apocrine carcinoma of the vulva. Case report and review of literature.

OBJECTIVES: To report a case of apocrine adenocarcinoma of the vulva and introduce the sentinel node dissection as a method to diagnose it. MATERIALS AND METHODS: Description of a case of a 77-year-old woman with histological diagnostic of apocrine adenocarcinoma of the vulva and literature review of the 16 cases published from 1954 to nowadays. RESULTS: Treatment of vulvar apocrine carcinoma is controversial given its low incidence and the small number of cases which have been reported. CONCLUSION: Selective sentinel lymph node biopsy may provide a valid option in selected patients to decrease their clinical complications.