One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception

Abstract

Objective(s): This study compares 1-year intrauterine device (IUD) continuation among women presenting for emergency contraception (EC) and initiating the copper (Cu T380A) IUD or the levonorgestrel (LNG) 52 mg IUD plus 1.5 mg oral LNG.

Study design: This cohort study enrolled 188 women who presented at a single family planning clinic in Utah between June 2013 and September 2014 and selected either the Cu T380A IUD or LNG 52 mg IUD plus oral LNG for EC. Trained personnel followed participants by phone, text or e-mail for 12 months or until discontinuation occurred. We assessed reasons for discontinuation and used Cox proportional hazard models, Kaplan-Meier estimates and log-rank tests to assess differences in continuation rates between IUDs.

Results: One hundred seventy-six women received IUDs; 66 (37%) chose the Cu T380A IUD and 110 (63%) chose the LNG 52 mg IUD plus oral LNG. At 1 year, we accounted for 147 (84%) participants, 33 (22%) had requested removals, 13 (9%) had an expulsion and declined reinsertion, 3 (2%) had a pregnancy with their IUD in place and 98 (67%) were still using their device. Continuation rates did not differ by IUD type; 60% of Cu T380A IUD users and 70% of LNG 52 mg IUD plus oral LNG users were still using their device at 12 months (adjusted hazard ratio 0.72, 95% confidence interval 0.40-1.3).

Conclusion(s): Two-thirds of women who chose IUD placement at the EC clinical encounter continued use at 1 year. Women initiating Cu T380A IUD and LNG 52 mg IUD had similar 1-year continuation rates. These findings support same-day insertion of IUDs for women who are seeking EC and would like to use a highly effective reversible method going forward.

Implications: Providing IUD options for EC users presents an opportunity to increase availability of highly effective contraception.

Keywords: Continuation; Copper IUD; Emergency contraception; Levonorgestrel IUD.

Fig. 1

Study flow diagram.

Fig. 2

Kaplan–Meier survival curve estimating IUD continuation rates by chosen method of emergency contraception. Key: Cu IUD, copper IUD;LNG IUD+, same-day 52 mg levonorgestrel IUD plus 1.5 mg oral levonorgestrel. Sensitivity analysis of (a) best and (b) worst-case scenarios and use of the drop-out event as a study end-point.

Fig. 3

Forest plot demonstrating IUD continuation rates and 95% confidence intervals for current study and comparator studies. Key: Standard, standard of care IUD start;EC, emergency contraception IUD start.