Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use

Christelle, Karen; Norhayati, Mohd Noor; Jaafar, Sharifah Halimah

doi:10.1002/14651858.cd006034.pub3

Cited by 5 publications

(1 citation statement)

References 54 publications

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“…While AUB was the most reported adverse effect in our study, AUB was not the most common reason mentioned for early discontinuation, suggesting that patients may be willing to tolerate some adverse effects in exchange for effective contraception. This may explain the increased continuation rates of the copper IUD compared to the implant reported by Moray et al [5], for example, as the copper IUD is known to cause heavy and irregular bleeding and can even double the amount of menstrual blood loss a patient experiences compared with pre-insertion levels [11,12]. Thus, although previous literature has rightfully focused on the most common adverse effects of the implant, our study suggests future research should focus on the adverse effects most intolerable to the patient and likely to cause discontinuation.…”

Section: Discussionmentioning

confidence: 99%

Continuation Rates of the Etonogestrel Implant and Factors Associated With Early Discontinuation

Hines¹,

Wang²,

Walker³

et al. 2023

Cureus

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Background: The etonogestrel implant is generally considered an effective, three-year, long-acting reversible contraceptive device. Previous research, such as the landmark CHOICE study, has reported a oneyear continuation rate of 72% to 84%, however, in a real-world setting these rates may be significantly lower.Objective: To study etonogestrel implant continuation rates and factors associated with early discontinuation in a specific clinical setting.Study design: Single-center, retrospective cohort study of patients who received the etonogestrel implant between January 1, 2015, and December 31, 2017, at several practices at an academic community hospital network. Records were reviewed up to three years after implant insertion to determine continuation rates (one to three years), early discontinuation rates (≤12 months), and reasons for early discontinuation. A sample size calculation was performed to guide a subanalysis of side effects.Results: A total of 774 patients underwent etonogestrel insertion during the study period. The one-year continuation rate was lower than that of the CHOICE study (62% vs. 83%, P <0.001). A subanalysis (n=216) revealed that a majority (82%, n=177) of patients reported side effects. Side effects were more common in patients with early discontinuation compared with patients who continued use longer than one year (93% vs. 71%, P <0.001). The most common side effect, abnormal uterine bleeding, was not significantly associated with early discontinuation. A significant association (P=0.02) was found between early discontinuation and neurologic/psychiatric complaints.Conclusions: The one-year continuation rate of the etonogestrel implant in our population is significantly lower than the value reported by CHOICE. Implant side effects are common and significantly affect rates of discontinuation. Our data suggest there is an opportunity for education and counseling for individuals opting for this method of long-acting contraception.

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Section: Discussionmentioning

confidence: 99%