Continuation rates and complications of intrauterine contraception in women diagnosed with bipolar disorder

Abstract

Objective: To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing intrauterine devices (IUDs) as compared with those using depot medroxyprogesterone acetate or sterilization for birth control.

Methods: Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18-44 years with a prior diagnosis of bipolar disorder (n=849) who were using the levonorgestrel intrauterine system, a copper-containing IUD, depot medroxyprogesterone acetate, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression.

Results: Women using an IUD were more likely than those using depot medroxyprogesterone acetate to continue the method for at least 12 months (copper-containing IUD, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated depot medroxyprogesterone acetate received three more injections during the next year (P<.001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups.

Conclusion: More women with bipolar disorder continued using IUDs at one year than women using depot medroxyprogesterone acetate. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, depot medroxyprogesterone acetate, or sterilization.

Level of evidence: II.

Figure 1

Classification of women having a CuT380A or LNG-IUS inserted, receiving DMPA, or undergoing sterilization. We used the codes of International Classification of Disease, 9^th Revision, Clinical Modification (ICD-9-CM), Current Procedure Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes to identify the study subjects. The codes are described below.

1. Women with a LNG-IUS insertion were identified as those who had (a) HCPCS codes of S4981 or J7302, and any of the following CPT or ICD-9 codes: 58300, 69.7, V25.1 and V25.42. Women with a CuT380A insertion were identified as those who had HCPCS code of J7300, and any of the following: CPT code of 88300 or ICD-9-CM codes of 69.7, V25.1 and V25.42.

2. A woman was classified in the DMPA group if she received 4 injections in a 12-month period. The HCPCS code of J1055 was used to identify DMPA injection.

3. The codes for sterilization included: CPT codes of 58565, 58600, 58605, 58611, 58615, 58670, 58671, and ICD-9-CM codes of 66.2, 66.3, V25.2.

4. The diagnosis codes for bipolar disorder (BPD-I, BPD-II, BPD-Not Otherwise Specified (NOS)/subthreshold) include 296.0-296.8 except for codes 296.2 and 296.3. We included only those diagnoses by a mental health professional.

5. The diagnosis codes for women who were immunocompromised (ICP) include: 042, 043, 044, 279.0-279.3.