Continuation of copper and levonorgestrel intrauterine devices: a retrospective cohort study

Abstract

Background Studies conflict on whether the duration of use of the copper intrauterine device is longer than that of the levonorgestrel intra-uterine device, and whether women who continue using intrauterine devices differ from those who discontinue. Objective We sought to assess continuation rates and performance of levonorgestrel intrauterine devices compared with copper intrauterine devices over a 5-year period. Study Design We performed a retrospective cohort study of 1164 individuals who underwent intrauterine device placement at an urban academic medical center. The analysis focused on a comparison of continuation rates between those using levonorgestrel intrauterine device and copper intrauterine device, factors associated with discontinuation, and intrauterine device performance. We assessed the differences in continuation at discrete time points, pregnancy, and expulsion rates using χ2 tests and calculated hazard ratios using a multivariable Cox model. Results Of 1164 women who underwent contraceptive intrauterine device insertion, 956 had follow-up data available. At 2 years, 64.9% of levonorgestrel intrauterine device users continued their device, compared with 57.7% of copper intrauterine device users (P = .11). At 4 years, continuation rates were 45.1% for levonorgestrel intrauterine device and 32.6% for copper intrauterine device (P < .01), and at 5 years continuation rates were 28.1% for levonorgestrel intrauterine device and 23.8% for copper intrauterine device (P = .33). Black race, primiparity, and age were positively associated with discontinuation; education was not. The hazard ratio for discontinuation of levonorgestrel intrauterine device compared with copper intrauterine device >4 years was 0.71 (95% confidence interval, 0.55–0.93) and >5 years was 0.82 (95% confidence interval, 0.64–1.05) after adjusting for race, age, parity, and education. Copper intrauterine device users were more likely to experience expulsion (10.2% copper intrauterine device vs 4.9% levonorgestrel intrauterine device, P < .01) over the study period and to become pregnant in the first year of use (1.6% copper intrauterine device vs 0.1% levonorgestrel intrauterine device, P < .01). Conclusion We found a difference in continuation rates between levonorgestrel and copper intrauterine device users at 4 years but not at 5 years. Copper intrauterine device users were more likely to experience expulsion and pregnancy.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

“…Philips et al found that among IUD users, 49.3% had an education level above college, while 2.8% had a below high school education level. The study also suggested that education was not associated with early discontinuation of an IUD [6]. When assessing correlations between abortion, education, and all LARCs; Steinauer et al found 69.2% of participants who chose to use LARCs following aspiration abortion had high-school level of education or higher [8].…”

“…Of copper IUD users, younger women had higher discontinuation rates, but the levonorgestrel IUD users' discontinuation rates were the same across all age groups [9]. Similarly, Phillips et al found that copper IUDs were more frequently discontinued by their younger users, but younger women were more likely to discontinue their levonorgestrel IUDs, although less so than young women with copper IUDs [6]. Two articles found that younger women were not any more likely to expel their IUDs than older women [5] [6].…”

“…Similarly, Phillips et al found that copper IUDs were more frequently discontinued by their younger users, but younger women were more likely to discontinue their levonorgestrel IUDs, although less so than young women with copper IUDs [6]. Two articles found that younger women were not any more likely to expel their IUDs than older women [5] [6]. When considering older women who use LARCS, Sanders et al reported that they were more likely to maintain their IUD use for a minimum of two years at a time [7].…”

“…Race and ethnicity did not appear to have as much of an effect on recommendations by providers when the women were of higher SES. Finally, when investigating continuation rates associated with race Black race was associated with higher discontinuation of IUD use [6]. AGE Age can be an important factor in health care: from influencing the decisions an individual makes to what their providers feel is appropriate based on their age.…”

“…White et al reported that in specific populations of Latina women, disinterest in LARC use is due to "fears and misperceptions about method insertion and removal" and "a limited understanding of reproductive physiology and hormonal methods' mode of action" [11]. Another study suggested that "continuation rates [of IUD use] may be higher in the setting of improved counseling" [6]. Steinauer et al also found that women receiving an IUD or implant were more likely to rate their counseling by providers as "helpful", reflecting a "lower awareness" of IUDs and implants [8].…”