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Switching and discontinuation of participant-masked randomization to a copper or levonorgestrel intrauterine device when presenting for emergency contraception

      Abstract

      Objectives

      Examine intrauterine device (IUD) switching or discontinuation up to 6 months after participant-masked randomization to different IUDs.

      Study design

      Participants were randomized 1:1 to the copper T380A or levonorgestrel 52 mg IUD for emergency contraception and informed they could switch IUD type without cost at any time.

      Results

      Of the 327 subjects allocated to the levonorgestrel IUD, 7 (2.1%) switched their IUD type by 6 months versus 18 (5.5%) of the 328 copper IUD users (RR: 0.4 [95% CI: 0.2, 0.9], p = 0.03). Six-month IUD discontinuation occurred in 34 (10.4%) levonorgestrel and 35 (10.7%) copper IUD users.

      Conclusion

      Individuals randomly assigned to IUD type at presentation for emergency contraception continue their assigned IUDs at high rates over 6 months.

      Implications

      While many recruited individuals declined enrollment, those who accepted randomization had high continuation rates; the high continuation and low cross-over supports using IUD randomization as a tool for future investigation. Participants’ similar rates of and reasons for switching and discontinuation by IUD type over the study period may impact clinical counseling.

      Keywords

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      References

        • Turok DK
        • Gero A
        • Simmons RG
        • Kaiser JE
        • Stoddard GJ
        • Sexsmith CD
        • et al.
        Levonorgestrel vs. copper intrauterine devices for emergency contraception.
        N Engl J Med. 2021; 384: 335-344
      1. The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions. In: Higgins J, Green S, editors. Version 5.1.0 ed. West Sussex, England: John Wiley & Sons; 2011.

        • Grunloh DS
        • Casner T
        • Secura GM
        • Peipert JF
        • Madden T.
        Characteristics associated with discontinuation of long-acting reversible contraception within the first 6 months of use.
        Obstet Gynecol. 2013; 122: 1214-1221
        • Garbers S
        • Haines-Stephan J
        • Lipton Y
        • Meserve A
        • Spieler L
        • Chiasson MA.
        Continuation of copper-containing intrauterine devices at 6 months.
        Contraception. 2013; 87: 101-106
        • Wong RC
        • Bell RJ
        • Thunuguntla K
        • McNamee K
        • Vollenhoven B.
        Implanon users are less likely to be satisfied with their contraception after 6 months than IUD users.
        Contraception. 2009; 80: 452-456
        • Godfrey EM
        • Memmel LM
        • Neustadt A
        • Shah M
        • Nicosia A
        • Moorthie M
        • et al.
        Intrauterine contraception for adolescents aged 14-18 years: a multicenter randomized pilot study of levonorgestrel-releasing intrauterine system compared to the Copper T 380A.
        Contraception. 2010; 81: 123-127
        • Achilles SL
        • Chen BA
        • Lee JK
        • Gariepy AM
        • Creinin MD.
        Acceptability of randomization to levonorgestrel versus copper intrauterine device among women requesting IUD insertion for contraception.
        Contraception. 2015; 92: 572-574
        • Kakaire O
        • Tumwesigye NM
        • Byamugisha JK
        • Gemzell-Danielsson K.
        Acceptability of intrauterine contraception among women living with human immunodeficiency virus: a randomised clinical trial.
        Eur J Contracept Reprod Health Care. 2016; 21: 220-226
        • Diedrich JT
        • Desai S
        • Zhao Q
        • Secura G
        • Madden T
        • Peipert JF.
        Association of short-term bleeding and cramping patterns with long-acting reversible contraceptive method satisfaction.
        Am J Obstet Gynecol. 2015; 212: p50.e1-p50.e8