Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review

Abstract

Objective: Levonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia.

Methods: Searches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to 'Humans' and 'Females'. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice.

Results: Forty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs.

Conclusions: Bleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs.

Keywords: Contraception; Discontinuation; Intrauterine device; Menstrual bleeding; Satisfaction.

Fig. 1

PRISMA for the studies included in the systematic literature review. FTR, full-text review; IUC, intrauterine contraceptive; IUD, intrauterine device; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; SLR, systematic literature review

Fig. 2

Rates of discontinuation for any reason 12–36 months after insertion (a) and discontinuation for bleeding at any time (b) for studies reporting data for levonorgestrel-releasing intrauterine systems (LNG-IUDs) and copper intrauterine devices (Cu-IUDs). *N for LNG-IUD and Cu-IUD

Fig. 2

Rates of discontinuation for any reason 12–36 months after insertion (a) and discontinuation for bleeding at any time (b) for studies reporting data for levonorgestrel-releasing intrauterine systems (LNG-IUDs) and copper intrauterine devices (Cu-IUDs). *N for LNG-IUD and Cu-IUD