Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction

Hubacher, David; Spector, Hannah; Monteith, Charles; Chen, Pai-Lien

doi:10.1016/j.contraception.2018.02.001

Cited by 27 publications

(16 citation statements)

References 17 publications

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“…This supports a qualitative study of adolescent current and former IUD users that found no difference in stated reasons for choosing the method between those who had continued versus those who had discontinued use [24]. In addition, in a study where some women seeking short-acting contraceptives were willing to be randomized to LARC method initiation, Hubacher et al found that negative baseline attitudes toward LARC among those randomized to it were not associated with discontinuation by 24 months of use [15].…”

Section: Discussionmentioning

confidence: 56%

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

Cohen

Sheeder

Teal

2019

Journal of Adolescent Health

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The purpose of the article was to describe adolescent and young women's rates of discontinuation of intrauterine devices (IUDs) and contraceptive implants, the extent to which discontinuation is predicted by baseline factors, reasons for discontinuation, and subsequent contraceptive initiation. Methods: We recruited English-speaking women, aged 13e24 years, from a family planning clinic serving clients <25 years old. Participants completed surveys before and after contraceptive initiation visits. We reviewed medical records and contacted participants who initiated use of an IUD or contraceptive implant and assessed contraceptive discontinuation before 30 months of use. We collected follow-up data on duration of use, reasons for discontinuation, and new method selected. We used multivariable regression models to ascertain factors associated with method discontinuation. Results: From 2011 to 2013, 775 young women completed surveys and initiated IUD or implant use. We determined 30-month discontinuation status of 633 women (81.7%). Among those with known outcome, fewer IUD than implant initiators had discontinued use (36.3% vs. 45.4%, p ¼ .02). Mean duration of use was 733 days (95% confidence interval 702e763 days) for the IUD and 697 days (95% confidence interval 666e728 days) for the implant. Participants who stated at baseline that it was "very important" to avoid pregnancy were about half as likely to discontinue use. The most common reasons for discontinuation were pain (IUD) and bleeding (implant). Most participants initiated alternate contraception after discontinuing their original method. Conclusions: Adolescents and young women who initiate an IUD or implant make decisions for discontinuation based on weighing high contraceptive effectiveness with other reproductive health values and preferences.

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Section: Discussionmentioning

confidence: 56%

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

Cohen

Sheeder

Teal

2019

Journal of Adolescent Health

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“…Diaphragms have a moderate failure rate (12%/year) whereas hormonal methods that rely on correct and consistent use have failure rates of between 5% and 8% per year. LARC clearly provides the best protection against pregnancy with failure rate <1% per year and satisfaction with the most effective LARC methods can be high even for women whose initial preference is for a short‐acting method …”

Section: Methodsmentioning

confidence: 99%

Contraception after pregnancy

Glasier

Bhattacharya

Evers

et al. 2019

Acta Obstet Gynecol Scand

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Whatever the outcome, pregnancy provides the opportunity to offer effective contraception to couples motivated to avoid another pregnancy. This narrative review summarizes the evidence for health providers, drawing attention to current guidelines on which contraceptive methods can be used, and when they should be started after pregnancy, whatever its outcome. Fertility returns within 1 month of the end of pregnancy unless breastfeeding occurs. Breastfeeding, which itself suppresses fertility after childbirth, influences both when contraception should start and what methods can be used. Without breastfeeding, effective contraception should be started as soon as possible if another pregnancy is to be avoided. Interpregnancy intervals of at least 6 months after miscarriage and 1‐2 years after childbirth have long been recommended by the World Health Organization in order to reduce the chance of adverse pregnancy outcome. Recent research suggests that this may not be necessary, at least for healthy women <35 years old. Most contraceptive methods can be used after pregnancy regardless of the outcome. Because of an increased risk of venous thromboembolism associated with estrogen‐containing contraceptives, initiation of these methods should be delayed until 6 weeks after childbirth. More research is required to settle the questions over the use of combined hormonal contraception during breastfeeding, the use of injectable progestin‐only contraceptives before 6 weeks after childbirth, and the use of both hormonal and intrauterine contraception after gestational trophoblastic disease. The potential impact on the risk of ectopic pregnancy of certain contraceptive methods often confuses healthcare providers. The challenges involved in providing effective, seamless service provision of contraception after pregnancy are numerous, even in industrialized countries. Nevertheless, the clear benefits demonstrate that it is worth the effort.

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“…The importance of long-acting reversible contraception (LARC; implants, intrauterine devices [IUDs] and the levonorgestrel-releasing intrauterine system [LNG-IUS]) in reducing the rate of unwanted pregnancy and abortion has recently become clear [6][7][8][9]. Better knowledge about contraception may help to promote LARC use among those most susceptible to unwanted pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Trends in use and attitudes towards contraception in Sweden: results of a nationwide survey

Hellström

Danielsson

Kallner

2019

The European Journal of Contraception & Reproductive Health

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Objective: The aim of the study was to compare the results of a 2013 nationwide survey of 1001 women representative of the Swedish female population with the results of a similar survey carried out in 2017, after new guidelines for contraceptive use were published in 2014. Methods: Women between 16 and 49 years of age took part in a telephone survey; questions covered demographics, contraceptive use, knowledge of and attitudes towards contraception, importance of monthly bleeding, and experience of unintended pregnancy. We compared the responses collected in 2013 with those collected in 2017. Results: Of all women in 2017, 717/1008 (71.1%) were currently using contraception; 291/1008 (28.9%) women were not. Long-acting reversible contraception (LARC) was used by 311/1008 (30.9%) women, which was a significant increase from 2013 (243/1001, 24.3%; p ¼ .001). The unmet need for contraception in Sweden in 2017 was estimated to be 15.2%. A total of 783 (77.7%) women had never experienced an unintended pregnancy. A significantly higher proportion of unintended pregnancies reported in 2017 were terminated compared with 2013. Conclusion: Sweden has a large unmet need for contraception. In 2017, LARC use had increased compared with 2013. A large proportion of women had experienced an unintended pregnancy. Increasing overall contraceptive use is important to reduce the rates of unintended and unwanted pregnancies.

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Not seeking yet trying long-acting reversible contraception: a 24-month randomized trial on continuation, unintended pregnancy and satisfaction

Abstract: Even women who do not necessarily view LARC as a first choice may have a highly satisfying experience and avoid unintended pregnancy if they try it.

Cited by 27 publications

References 17 publications

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

Predictors of Discontinuation of Long-Acting Reversible Contraception Before 30 Months of Use by Adolescents and Young Women

Contraception after pregnancy

Trends in use and attitudes towards contraception in Sweden: results of a nationwide survey

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