Abstract
Objective
To compare discontinuation rates and incidence of repeat pregnancy within 1 year among
young mothers choosing postplacental intrauterine devices (IUDs) versus postpartum
contraceptive implants.
Study Design
We enrolled a prospective cohort of postpartum adolescents and young women who chose
either postplacental IUDs or postpartum contraceptive implants prior to hospital discharge.
We used chart review and phone interviews to assess device discontinuation (by request
or expulsion) and pregnancy within 12 months.
Results
Of the 244 13–22 year-old participants, 82 chose IUDs (74 levonorgestrel IUDs and
8 copper IUDs), and 162 chose implants. Both groups had participant-requested discontinuation
rates of 14% (9/67 IUD; 19/135 implant) within 1 year. Participants choosing IUDs
had a 25% (17/67) expulsion rate. Median time to expulsion was 4.1 weeks (range: 0.4–29.3
weeks, 16/17 within 12 weeks), and participants recognized 15/17 expulsions. IUD initiators
had significantly higher pregnancy rates by 12 months (7.6% vs. 1.5%, p=0.04). Most
pregnancies occurred when women discontinued their initial device and did not start
alternative contraception.
Discussion
Participant-requested discontinuation was similar in both groups. Differences in overall
device discontinuation rates were due to IUD expulsions. Pregnancy rates by 12 months
postpartum were lower than previously reported in this age group in both implant initiators
and IUD initiators.
Implications
Young mothers who choose postplacental IUDs or postpartum contraceptive implants are
unlikely to request removal within the first year. Clinicians should counsel postplacental
IUD users that early expulsion is common (25%) and may be unrecognized (11% of expulsions).
Patients should have a plan for contraceptive management should expulsion occur.
Keywords
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Article info
Publication history
Published online: October 13, 2015
Accepted:
October 5,
2015
Received in revised form:
October 1,
2015
Received:
July 16,
2015
Footnotes
☆Potential conflicts of interest: Dr. Teal reports she has served on scientific advisory boards of Actavis, Bayer Healthcare and Microchips and serves on a Data Monitoring Board for a study funded by Merck, Inc. The Department of Obstetrics and Gynecology at the University of Colorado receives contraceptive research funding from Bayer, Agile Therapeutics and Medicines360.
☆☆Dr. Tocce reports she is an instructor for Nexplanon removal/insertion (Merck, Inc).
★All other authors report no potential conflicts of interest.
★★This work was presented as an oral abstract at the North American Forum on Family Planning, Seattle, Washington, October 6–7, 2013.
Identification
Copyright
© 2016 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
