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Routes of Administration of Progestagen-only Contraceptives and Subjective Sleep Reports on Women in Reproductive Age


Progesterone has known hypnogenic effects and the use of hormonal replacement therapy in postmenopausal women has brought improvements in their sleep quality. Previous reports have suggested that progestagen-only contraceptives may be a more adequate option for premenopausal women who complain of insomnia. However, no information regarding the route of administration has been assessed to date.


This study aimed to evaluate the impact of different route of administration of contraceptive (progestagens-only) using a sleep self-reported subjective study among premenopausal women.


This was a web-based cross-section trial. A set of questionnaires evaluating contraceptive use, sleep-related characteristics and related features was available online between July 2016 and February 2017. The tools used to assess sleep were the Epworth Sleepiness Scale (ESS) and the Insomnia Severity Index (ISI). Only women between 18 a 40 years-old were considered eligible. Considering that the route of administration of the progestagens could have a potential effect on sleep, levonorgestrel-releasing intrauterine system (LNG-IUS) users were compared with the users of oral progestagen-only contraceptives. Sleep-related comparisons were initially performed without control (raw analysis). Further analysis were performed in a controlled way in which the effects of hormonal contraceptives were corrected by potential confounding factors (age, Body Mass Index and income).


A total of 2,055 premenopausal women between 18 and 40 years-old participated in answering an online questionnaire evaluating hormonal contraceptive use, sleep-related characteristics and other important health characteristics. Of this total sample, 1,286 participants met the inclusion criteria; of which only 70 were currently taking progestagens-only contraceptives. Comparisons between users of LNG-IUS and oral pill users of progestagen-only hormonal contraceptives demonstrated a lower sleepiness score, as measured by ESS, among LNG-IUS users in both raw and corrected analysis (LNG-IUS users: 9.12±4.57; Oral pills users: 11.58±4.59).


Sleepiness was lower among LNG-IUS users when compared with oral pills progestagens-only users. LNG-IUS is a better contraceptive choice for premenopausal women who complain of sleepiness, as they seem to have smaller impacts on self-reported sleep variables.



Progesterone, Estrogen, Sexual hormones, Women, Contraceptives.


Área Clínica


Santa Casa de São Paulo School of Medical Sciences - São Paulo - Brasil, Universidade Federal de São Paulo - UNIFESP - São Paulo - Brasil


Andréia Gomes Bezerra, Monica Levy Andersen, Gabriel Natan Pires, Carolina Vicente Banzoli, Daniel Ninelo Polesel, Sergio Tufik, Helena Hachul