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Among women who choose IUDs or implants and then discontinue use, the most common subsequent contraceptive choice is another long-acting reversible contraceptive.
Physicians from the department of obstetrics and gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, conducted a retrospective cohort study to better understand women’s choices regarding LARC, specifically duration of use, reasons for discontinuation, and subsequent contraceptive methods. The study results were reported November 14, 2013, at the AAGL’s 42nd Global Congress on Minimally Invasive Gynecology, by Lily Wu, MD, clinical fellow in ob/gyn and reproductive biology.
Study participants included 1236 women who had a LARC device placed for contraception from 2006 through 2011. Of the 938 women with a LARC device who attended a routine 1-month follow-up exam, 93.9% chose IUDs (75.5% levonorgestrel intrauterine system, 18.4% copper intrauterine device) and 6.1% opted for implantable rods. The median patient age was 32.1 years (range, 27.1 to 37.0 years), and median BMI was 26.3 kg/m2 (range, 23.2 to 31.6 kg/m2). Nearly half of the women were white (45.7%), nearly 30% were black (29.65), and 13.6% were Hispanic.
At the 1-month follow-up, 5.3% of IUDs were expelled or discontinued and 0.0% of implants were discontinued. By 1 year, of 748 women with follow-up data, the continuation rate was 72.6% for IUDs and 66.0% for implants. At 1-year follow-up, the primary reason for discontinuation was abdominal or pelvic pain (23.6%) for IUDs and bleeding pattern (62.5%) for implants.
Of those with follow-up data at 2 years (67.4% of 938 women), continuation rates were 50.6% for IUDs and 48.7% for implants. By 4 years, 50.7% of women had follow-up, and 15.7% of IUDs were still in place.
The most common contraceptive method used after discontinuing LARC was another LARC (IUD, 20.3%; implant, 6.6%) followed by no contraception (12.7%).
When asked about the benefits of LARC, Dr. Wu said that it’s a reliable and long-acting form of contraception that requires minimal attention. Patients don’t have to remember to take daily medication or change the IUD or impant for years. For IUDs, because the effect is local, patients can use it even if they have other medical problems.
Any patient who seeks a LARC should be counseled about the possibility of abdominal/pelvic pain for IUDs and abnormal bleeding patterns for implants and the implications for discontinuing use, advised Dr. Wu.
Overall data, however, showed that more than 25% of women who discontinued a LARC method chose another LARC method, which suggests that some women are willing to try multiple types of this contraception, explained Dr. Wu.
All study findings were based on documented LARC data rather than patient reporting.