Preference for and efficacy of oral levonorgestrel for emergency contraception with concomitant placement of a levonorgestrel IUD: a prospective cohort study

Turok, David K.; Sanders, Jessica N.; Thompson, Ivana; Royer, P; Eggebroten, Jennifer; Gawron, Lori M.

doi:10.1016/j.contraception.2016.01.009

Cited by 44 publications

(32 citation statements)

References 20 publications

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“…10 The LNG IUD has been studied in combination with oral LNG EC for women seeking EC. 8 However, no IUD is currently labeled for use as EC, and women seeking EC are rarely offered the option of an IUD. 2,11 …”

Section: Introductionmentioning

confidence: 99%

“…2,11 Given their financial constraints, health care payers and decision makers must determine if the increased effectiveness of IUD EC methods are worth the additional costs. 5,6,8 Building on prior evaluations of contraceptive cost-effectiveness, this study assessed the cost-effectiveness of 4 EC methods (ie, oral LNG, UPA, Cu IUD, and oral LNG + LNG IUD) from a US payer perspective over a 1-year time horizon.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of emergency contraception options over 1 year

Bellows

Tak

Sanders

et al. 2018

American Journal of Obstetrics and Gynecology

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Over 1 year, the copper intrauterine device is currently the most cost-effective emergency contraception option. Policy makers and health care insurance companies should consider the potential for long-term savings when women seeking emergency contraception can promptly obtain whatever contraceptive best meets their personal preferences and needs; this will require removing barriers and promoting access to intrauterine devices at emergency contraception visits.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of emergency contraception options over 1 year

Bellows

Tak

Sanders

et al. 2018

American Journal of Obstetrics and Gynecology

Self Cite

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“…The first unintended pregnancy was a luteal phase pregnancy which occurred in the index EC cycle; this pregnancy is described in detail in a prior publication [13]. The second unintended pregnancy occurred without an IUD in place following an unrecognized IUD expulsion at 10 weeks post-insertion, and the third unintended pregnancy occurred with an IUD in place at 7 months post-insertion.…”

Section: Resultsmentioning

confidence: 99%

“…The details of the study design and report of the project’s primary outcomes including pregnancy rates and preference for the Cu T380A IUD or LNG 52 mg IUD in the EC setting have been previously published [13]. A brief description of the study design and the analysis for this report are described below.…”

Section: Methodsmentioning

confidence: 99%

One-year continuation of copper or levonorgestrel intrauterine devices initiated at the time of emergency contraception

et al. 2017

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Objective(s) This study compares 1-year intrauterine device (IUD) continuation among women presenting for emergency contraception (EC) and initiating the copper (Cu T380A) IUD or the levonorgestrel (LNG) 52 mg IUD plus 1.5 mg oral LNG. Study design This cohort study enrolled 188 women who presented at a single family planning clinic in Utah between June 2013 and September 2014 and selected either the Cu T380A IUD or LNG 52 mg IUD plus oral LNG for EC. Trained personnel followed participants by phone, text or e-mail for 12 months or until discontinuation occurred. We assessed reasons for discontinuation and used Cox proportional hazard models, Kaplan–Meier estimates and log-rank tests to assess differences in continuation rates between IUDs. Results One hundred seventy-six women received IUDs; 66 (37%) chose the Cu T380A IUD and 110 (63%) chose the LNG 52 mg IUD plus oral LNG. At 1 year, we accounted for 147 (84%) participants, 33 (22%) had requested removals, 13 (9%) had an expulsion and declined reinsertion, 3 (2%) had a pregnancy with their IUD in place and 98 (67%) were still using their device. Continuation rates did not differ by IUD type; 60% of Cu T380A IUD users and 70% of LNG 52 mg IUD plus oral LNG users were still using their device at 12 months (adjusted hazard ratio 0.72, 95% confidence interval 0.40–1.3). Conclusion(s) Two-thirds of women who chose IUD placement at the EC clinical encounter continued use at 1 year. Women initiating Cu T380A IUD and LNG 52 mg IUD had similar 1-year continuation rates. These findings support same-day insertion of IUDs for women who are seeking EC and would like to use a highly effective reversible method going forward. Implications Providing IUD options for EC users presents an opportunity to increase availability of highly effective contraception.

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“…Hence, it is advisable to delay initiation of hormonal contraception for at least 5 days after UPA, although some suggest that it may be more biologically correct to count the 5 days from the episode of UPSI (lifespan of spermatozoa) rather than from intake of UPA . Although UK guidelines advise that the LNG‐releasing intrauterine system should not be inserted until pregnancy has been excluded, there are some data to suggest that starting this method with LNG‐EC may be a reasonable option for some women . More research is required.…”

Section: Contraception After Ecmentioning

confidence: 99%