Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2014 Oct;124(4):718-726.
doi: 10.1097/AOG.0000000000000475.

Association of age and parity with intrauterine device expulsion

Tessa Madden  1 , Colleen McNicholas, Qiuhong Zhao, Gina M Secura, David L Eisenberg, Jeffrey F Peipert
Affiliations
Comparative Study

Association of age and parity with intrauterine device expulsion

Tessa Madden et al. Obstet Gynecol. 2014 Oct.

Abstract

Objective: To investigate whether age 14 to 19 years and nulliparity are associated with expulsion of levonorgestrel and copper intrauterine devices (IUDs).

Methods: This was a planned secondary analysis of the Contraceptive CHOICE Project. We used Kaplan-Meier survival analysis to estimate expulsion rates for the first levonorgestrel or copper IUD received during study participation. Cox proportional hazards regression models were used to investigate baseline characteristics associated with expulsion.

Results: A total of 5,403 females were included; 4,219 (78%) used the levonorgestrel IUD and 1,184 (22%) used the copper IUD. There were 432 initial expulsions reported. The 36-month cumulative expulsion rate was 10.2 per 100 IUD users and did not vary by IUD type (levonorgestrel IUD 10.1 compared with copper IUD 10.7, P=.99). In the bivariate analysis, multiple characteristics including age, nulliparity, immediate postabortion insertion, and heavy menses were associated with expulsion. The cumulative rate of expulsion was lower in nulliparous women compared with parous women (8.4 compared with 11.4; P<.001) and higher in females aged 14 to 19 compared with older women (18.8 compared with 9.3; P<.001). After adjusting for confounders and stratifying by IUD type, the hazard ratio of expulsion for females aged 14 to 19 years was 2.26 (95% confidence interval [CI] 1.68-3.06) for the levonorgestrel IUD and 3.06 (95% CI 1.75-5.33) for the copper IUD. Compared to parous levonorgestrel IUD users, expulsion was lower for nulliparous levonorgestrel IUD users (adjusted hazard ratio 0.59, 95% CI 0.44-0.78).

Conclusion: IUD expulsions were not increased in nulliparous females. More expulsions were observed in females aged 14 to 19 compared with older women regardless of parity or IUD type.

Level of evidence: : II.

PubMed Disclaimer

Conflict of interest statement

Financial Disclosure:

The other authors did not report any potential conflicts of interest.

Figures

Figure 1
Figure 1
Cumulative probability of not having an intrauterine device expulsion stratified by age.
Figure 2
Figure 2
Cumulative probability of not having an intrauterine device expulsion stratified by parity.
See this image and copyright information in PMC

References

    1. Peipert JF, Madden T, Allsworth JE, Secura GM. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol. 2012;120:1291–1297. - PMC - PubMed
    1. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998–2007. - PubMed
    1. O'Neil-Callahan M, Peipert JF, Zhao Q, Madden T, Secura G. Twenty-four-month continuation of reversible contraception. Obstet Gynecol. 2013;122:1083–1091. - PMC - PubMed
    1. Hatcher RATJ, Nelson AL, Cates W, Kowal D, Policar MS, editors. Contraceptive Technology. 20th ed. New York, NY: Ardent Media; 2011.
    1. Sivin I, el Mahgoub S, McCarthy T, et al. Long-term contraception with the levonorgestrel 20 mcg/day (LNg 20) and the copper T 380Ag intrauterine devices: a five-year randomized study. Contraception. 1990;42:361–378. - PubMed

Publication types

MeSH terms