This study assessed the timing, frequency, use of backup method and 1-month pregnancy
rates among individuals who had an intrauterine device (IUD) placed as emergency contraception
and reported intercourse within 7 days post-placement.
In this secondary analysis of a randomized control trial of IUDs for emergency contraception,
518 individuals reporting unprotected intercourse in the preceding 5 days had a 52
mg levonorgestrel intrauterine system (IUS) or 380 mm2 copper IUD placed outside the first week of their menstrual cycle. All participants
were advised to use backup contraception for 7 days. We assessed pregnancy status
1 month after placement by urine testing or, when not available, by survey responses
and electronic health record review. Participants reported whether their first sexual
activity after device placement occurred within 7 days of their placement, the frequency
of intercourse and whether they used backup contraception.
Rapid return to sexual activity was common and use of backup contraception was rare,
regardless of type of IUD placed. Of participants who resumed penile-vaginal intercourse
in the first month, most (286/446, 64.1%) participants reported intercourse within
7 days of IUD placement; only 16.4% (74/446) used condoms or withdrawal. No pregnancies
occurred among users of the levonorgestrel IUS who reported intercourse within 7 days
of placement (0/138, 0.0%, 95% CI 0.0%, 2.6%) nor among users of the 380mm2 copper IUD (0/148, 0.0%, 95% CI 0.0%, 2.5%).
Pregnancy rates are low after placement of an IUD for emergency contraception, even
among the many who resume intercourse within days following IUD placement without
use of backup contraception.
Clinical guidelines should facilitate access to contraception, including elimination
of unnecessary recommendations for backup contraception or abstinence in the 7 days
following 52 mg levonorgestrel intrauterine system.