INTRODUCTION: Half of pregnancies in U.S. women are unintended. There are little data comparing reasons for intrauterine contraception discontinuation in young and adult women. Prior studies suggest an overall discontinuation rate reaching 60% by 5 years. However, specific reasons leading to early removal are less clear and may differ with age.METHODS: Retrospective comparison of levonorgestrel intrauterine system removal rates for side effects was performed for women ages 15-24 years (group 1) and ages 25-44 years (group 2) at Mayo Clinic Rochester 2006-2008. Patient characteristics, removal rates for side effects, removal reasons, and subsequent contraception were compared using x 2 , log-rank, and Cox proportional hazards regression model.
RESULTS:Of 722 women, 177 lacked follow-up. They were younger (P5.005). Of the 545 women included, 95 were in group 1 and 450 in group 2. Removal rates for side effects were 17%, 33%, and 42% (group 1) and 14%, 25%, and 30% (group 2) at 1, 3, and 5 years, respectively, and did not differ (P5.13). The most common reason for early removal across groups was bleeding (P5.53). Most common subsequent contraception was levonorgestrel intrauterine system (40%) for group 2 and no contraception (34%), combined hormonal contraception (32%), or levonorgestrel intrauterine system (28%) for group 1. Increasing age was associated with decreased removal for side effects (P5.006).CONCLUSIONS: Overall, the levonorgestrel intrauterine system was well tolerated across groups. Increasing age was related to decreasing removal for side effects. Bleeding was the most common removal reason. Understanding removal reasons is crucial in defining patient expectations during counseling.
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