Abstract
Objective
We investigated the 1-year pregnancy rates for emergency contraception (EC) users
who selected the copper T380 intrauterine device (IUD) or oral levonorgestrel (LNG)
for EC.
Study Design
This prospective study followed women for 1 year after choosing either the copper
T380 IUD or oral LNG for EC. The study was powered to detect a 6% difference in pregnancy
rates within the year after presenting for EC.
Results
Of the 542 women who presented for EC, agreed to participate in the trial and met
the inclusion criteria, 215 (40%) chose the copper IUD and 327 (60%) chose oral LNG.
In the IUD group, 127 (59%) were nulligravid. IUD insertion failed in 42 women (19%).
The 1-year follow-up rate was 443/542 (82%); 64% of IUD users contacted at 1 year
still had their IUDs in place. The 1-year cumulative pregnancy rate in women choosing
the IUD was 6.5% vs. 12.2% in those choosing oral LNG [hazard ratio (HR) 0.53, 95%
confidence interval (CI): 0.29–0.97, p=.041]. By type of EC method actually received,
corresponding values were 5.2% for copper IUD users vs. 12.3% for oral LNG users (HR
0.42, 95% CI: 0.20–0.85, p=.017). A multivariable logistic regression model controlling
for demographic variables demonstrates that women who chose the IUD for EC had fewer
pregnancies in the following year than those who chose oral LNG (HR 0.50, 95% CI:
0.26–0.96, p=.037).
Conclusion
One year after presenting for EC, women choosing the copper IUD for EC were half as
likely to have a pregnancy compared to those choosing oral LNG.
Implications
Compared to EC users who choose oral levonorgestrel, those who select the copper IUD
have lower rates of pregnancy in the next year. Greater use of the copper IUD for
EC may lower rates of unintended pregnancy in high-risk women.
Keywords
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References
- Advanced provision of emergency contraception does not reduce abortion rates.Contraception. 2004; 69: 361-366
- Population effect of increased access to emergency contraceptive pills: a systematic review.Obstet Gynecol. 2007; 109: 181-188
- Post-coital contraception: an overview of published studies.Contraception. 1989; 39: 459-468
- Emergency contraception with Multiload Cu-375 SL IUD: a multicenter clinical trial.Contraception. 2001; 64: 107-112
- Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial.BJOG. 2010; 117: 1205-1210
- Interventions for emergency contraception.Cochrane Database Syst Rev. 2008; 2 (CD001324)
- Clinical management guidelines for obstetrician–gynecologists, number 69, December 2005 (replaces practice bulletin number 25, March 2001). Emergency contraception.Obstet Gynecol. 2005; 106: 1443-1452
- Emergency contraception.J Fam Plann Reprod Health Care. 2006; 32 ([quiz 8]): 121-128
- Emergency contraception: a clinical review.Clin Obstet Gynecol. 2007; 50: 927-936
- Emergency contraception: more than a morning after pill.Medscape Women's Health. 1996; 1: 1
- Emergency contraception.Best Pract Res Clin Obstet Gynaecol. 2002; 16: 181-191
- Emergency contraception.Ann Intern Med. 2002; 137: 180-189
- Emergency postcoital contraception.N Engl J Med. 1997; 337: 1058-1064
- Emergency contraception.Am Fam Physician. 2004; 70: 707-714
- Interventions for emergency contraception.Cochrane Database Syst Rev. 2012; 8 (CD001324)
- The copper IUD for emergency contraception, a neglected option.Contraception. 2012; 85: 338-339
- A survey of women obtaining emergency contraception: are they interested in using the copper IUD?.Contraception. 2011; 83: 441-446
- Interest in intrauterine contraception among seekers of emergency contraception and pregnancy testing.Obstet Gynecol. 2009; 113: 833-839
- A pilot study of the Copper T380A IUD and oral levonorgestrel for emergency contraception.Contraception. 2010; 82: 520-525
- Contraceptive technology. 20th rev. ed.New York (NY), Ardent Media2011
- The effects of self-administering emergency contraception.N Engl J Med. 1998; 339: 1-4
- Patterns of emergency contraception use by age and ethnicity from a randomized trial comparing advance provision and information only.Contraception. 2006; 74: 110-117
- Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.JAMA. 2005; 293: 54-62
- Failed IUD insertions in community practice: an under-recognized problem?.Contraception. 2013; 87: 182-186
- The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience.Hum Reprod. 2012; 27: 1994-2000
- Extending the time limit for starting the Yuzpe regimen of emergency contraception to 120 hours.Obstet Gynecol. 2003; 101: 1168-1171
- Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.Lancet. 2010; 375: 555-562
- Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomised trial.Lancet. 2002; 360: 1803-1810
Article info
Publication history
Published online: November 25, 2013
Accepted:
November 9,
2013
Received in revised form:
November 7,
2013
Received:
July 9,
2013
Footnotes
☆This project was supported by a grants from the Society of Family Planning, the Eunice Kennedy Shriver NICHD (R21HD063028) and the University of Utah Study Design and Biostatistics Center, with funding from the Public Health Services research grant: UL1-RR025764 and the National Center for Research Resources grant: C06-RR11234. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver NICHD or the NIH. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc. The copper IUDs and oral levonorgestrel (Plan B One Step) were supplied by Duramed Pharmaceuticals, Inc., the US distributor of both products at the time the study was initiated.
☆☆David Turok receives research support from Bayer Women’s Health, Teva Pharmaceuticals, Medicines 360 and Bioceptive. He has served as a consultant for Teva, Bayer and Watson Pharmaceuticals.
★Amna Dermish receives research support from Bayer Women’s Health and Teva Pharmaceuticals.
★★Clinicaltrials.gov identifier NCT00966771.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
