Advertisement
Original Research Gynecology| Volume 228, ISSUE 4, P438.e1-438.e10, April 2023

Download started.

Ok

One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial

Published:November 22, 2022DOI:https://doi.org/10.1016/j.ajog.2022.11.1296

      Background

      Recent evidence demonstrates the effectiveness of the levonorgestrel 52-mg intrauterine device for emergency contraception vs the copper T380A intrauterine device. Of note, 1-year pregnancy and continuation rates after intrauterine device placement for emergency contraception remain understudied.

      Objective

      This study compared 1-year pregnancy and intrauterine device continuation rates and reasons for discontinuation among emergency contraception users randomized to the levonorgestrel 52-mg intrauterine device or the copper intrauterine device.

      Study Design

      This participant-masked, randomized noninferiority trial recruited emergency contraception individuals desiring an intrauterine device from 6 Utah family planning clinics between August 2016 and December 2019. Participants were randomized 1:1 to the levonorgestrel 52-mg intrauterine device group or the copper T380A intrauterine device group. Treatment allocation was revealed to participants at the 1-month follow-up. Trained personnel followed up the participants by phone, text, or e-mail at 5 time points in 1 year and reviewed electronic health records for pregnancy and intrauterine device continuation outcomes for both confirmation and nonresponders. We assessed the reasons for the discontinuation and used Cox proportional-hazard models, Kaplan-Meier estimates, and log-rank tests to assess differences in the continuation and pregnancy rates between the groups.

      Results

      The levonorgestrel and copper intrauterine device groups included 327 and 328 participants, respectively, receiving the respective interventions. By intention-to-treat analysis at 1 year, the pregnancy rates were similar between intrauterine device types (2.8% [9/327] in levonorgestrel 52-mg intrauterine device vs 3.0% [10/328] in copper intrauterine device; risk ratio, 0.9; 95% confidence interval, 0.4–2.2; P=.82). Most pregnancies occurred in participants after intrauterine device removal, with only 1 device failure in each group. Of note, 1-year continuation rates did not differ between groups with 204 of 327 levonorgestrel 52-mg intrauterine device users (62.4%) and 183 of 328 copper T380A intrauterine device users (55.8%) continuing intrauterine device use at 1 year (risk ratio, 1.1; 95% confidence interval, 1.0–1.2; P=.09). There were differences concerning the reasons for discontinuation between intrauterine device types, with more bleeding and cramping cited among copper intrauterine device users.

      Conclusion

      The pregnancy rates were low and similar between intrauterine device types. Of note, 6 of 10 intrauterine device emergency contraception users continued use at 1 year. Moreover, 1-year continuation rates were similar between intrauterine device types.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Secura G.M.
        • Allsworth J.E.
        • Madden T.
        • Mullersman J.L.
        • Peipert J.F.
        The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraception.
        Am J Obstet Gynecol. 2010; 203: 115.e1-115.e7
        • Turok D.K.
        • Gero A.
        • Simmons R.G.
        • et al.
        Levonorgestrel vs. copper intrauterine devices for emergency contraception.
        N Engl J Med. 2021; 384: 335-344
        • Sanders J.N.
        • Turok D.K.
        • Royer P.A.
        • Thompson I.S.
        • Gawron L.M.
        • Storck K.E.
        One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception.
        Contraception. 2017; 96: 99-105
        • Peipert J.F.
        • Zhao Q.
        • Allsworth J.E.
        • et al.
        Continuation and satisfaction of reversible contraception.
        Obstet Gynecol. 2011; 117: 1105-1113
        • Achilles S.L.
        • Chen B.A.
        • Lee J.K.
        • Gariepy A.M.
        • Creinin M.D.
        Acceptability of randomization to levonorgestrel versus copper intrauterine device among women requesting IUD insertion for contraception.
        Contraception. 2015; 92: 572-574
        • Godfrey E.M.
        • Memmel L.M.
        • Neustadt A.
        • et al.
        Intrauterine contraception for adolescents aged 14-18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the Copper T 380A.
        Contraception. 2010; 81: 123-127
        • Hubacher D.
        • Spector H.
        • Monteith C.
        • Chen P.L.
        • Hart C.
        Long-acting reversible contraceptive acceptability and unintended pregnancy among women presenting for short-acting methods: a randomized patient preference trial.
        Am J Obstet Gynecol. 2017; 216: 101-109
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Bendel R.B.
        • Afifi A.A.
        Comparison of stopping rules in forward “stepwise” regression.
        J Am Stat Assoc. 1977; 72: 46-53
        • Bland J.M.
        • Altman D.G.
        Survival probabilities (the Kaplan-Meier method).
        BMJ. 1998; 317: 1572
        • Glasier A.
        • Baird D.
        The effects of self-administering emergency contraception.
        N Engl J Med. 1998; 339: 1-4
        • Raine T.R.
        • Harper C.C.
        • Rocca C.H.
        • et al.
        Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.
        JAMA. 2005; 293: 54-62
        • Walsh T.L.
        • Frezieres R.G.
        Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only.
        Contraception. 2006; 74: 110-117
        • Sander P.M.
        • Raymond E.G.
        • Weaver M.A.
        Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection.
        Am J Obstet Gynecol. 2009; 201: 146.e1-146.e6
        • Turok D.K.
        • Jacobson J.C.
        • Dermish A.I.
        • et al.
        Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates.
        Contraception. 2014; 89: 222-228