Continuation Rates and Complications of Intrauterine Contraception in Women Diagnosed With Bipolar Disorder

Abstract

Objective To estimate continuation rates, complications, and psychiatric hospitalizations among women with bipolar disorder using levonorgestrel-releasing or copper-containing (CuT380A) intrauterine devices (IUD), as compared with those using depot medroxyprogesterone acetate (DMPA) or sterilization for birth control. Methods Data for this cohort study were obtained from a nationwide health insurance claims database on an employed, commercially insured population. Women aged 18–44 with a prior diagnosis of bipolar disorder (n = 849), who were using the levonorgestrel intrauterine system, CuT380A, DMPA, or sterilization were evaluated. Outcomes included continuation rates over a 12-month interval, infectious and noninfectious complications, and hospitalizations for bipolar disorder or depression. Results Women using an IUD were more likely than those using DMPA to continue the method for at least 12 months (CuT380A, 86%; levonorgestrel intrauterine system, 87%). In comparison, only 31% of those who initiated DMPA received three more injections during the following year (p<0.0001). No significant differences were noted in infectious or noninfectious complications by contraceptive type. Finally, no differences were observed in the number of hospitalizations for bipolar disorder or depression among the four contraceptive groups. Conclusions More women with bipolar disorder continued using IUDs at one year than women using DMPA. The rates of complications and psychiatric hospitalizations were not different among women using an IUD, DMPA, or sterilization.

<p>Impulsivity, Unplanned Pregnancies, and Contraception Among Women with Bipolar Disorder</p>

“…35 In addition, tube ligation and quarterly injection have been suggested as the most effective contraception methods in this context. 8 Rate of irregular menstruation is 25.9% in our WBD group. Research has found the rate of irregular menstruation in bipolar women to be 15.1%, with a lifetime rate of irregular menstruation being recorded as 38.7%.…”

“…Additionally, unsafe sex may cause sexually transmitted diseases, such as human immune deficiency virus infection (HIV), hepatitis, and herpes simplex virus, as well as abortions and interrupted pregnancies unless these reproductive WBD use some kind of effective contraception method. [6][7][8] An increased possibility of contracting HIV and undertaking HIV risky behavior during manic episodes as well as a relationship to impulsivity have been established in earlier studies. [9][10][11] Research on contraception use in WBD is generally very limited in the literature, 7,12,13 but the prevalence of contraception use at nominal levels has been observed in recent studies.…”

Bipolar Disorder in Women

“…Women whose symptoms interfere with consistent daily pill use or preplanning for sexual encounters may benefit from longer-acting alternatives, particularly intrauterine devices (IUDs). In a study of 849 women with bipolar disorder using four types of contraception, women using IUDs were most likely to continue the method for at least 12 months (Berenson, Asem, Tan, & Wilkinson, 2011).…”

Pharmacists and Contraception in the Inpatient Setting

“…An IUD may be a potential option for these patients if adherence is an issue and preventing pregnancy is the major concern. In a cohort including women with bipolar disorder, increased compliance rates at one year were higher among women using either a copper-containing or progestin-only IUD as contraceptives compared to women using a progestin-only injection [36]. If a patient with a psychiatric disorder is encountered while hospitalized, a clinical pharmacist can assist in several ways to select an appropriate therapy.…”