LARC satisfaction after termination

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After terminating a pregnancy, women are more satisfied with using a levonorgestrel intrauterine device (L-IUD) for contraception and less likely to discontinue it than an etonogestrel subdermal implant (IMP), according to results of a small prospective study by Italian investigators.

In the observational study from Ferrara University Hospital, use of three long-acting reversible contraceptives (LARCs) was evaluated in a sample of women for at least 12 months after termination of pregnancy: L-IUD (n = 47), a copper intrauterine device (C-IUD) (n = 6) and an (IMP) (n = 36).

The investigators recorded baseline data about the patients and conducted phone interviews at 3, 6, and 12 months after device insertion to assess bleeding. The women were also asked about possible adverse events (AE), satisfaction and discontinuation at 12 months post-insertion.

There was a 100% satisfaction rate in the L-IUD and C-IUD groups compared to 72.2% in the IMP group.

In addition, a higher, yet not significant, percentage of patients decided to withdraw contraception in the IMP group (12.2%) versus in the two IUD groups (3.6%).

The study in the journal Gynecological Endocrinologyfound that the bleeding profile significantly favored L-IUD users versus IMP users. Irregular bleeding, heavy menstrual bleeding and spotting were more likely to occur at 6 and 12 months among IMP users than L-IUD users. Dysmenorrhea was also more frequent at 3 months in IMP users compared to L-UCD users.

However, there was no significant bleeding profile difference between the C-IUD and L-IUD groups.

The reported rate of treatment-associated AEs also did not differ significantly among the three contraceptive groups.

The authors noted that the 100% satisfaction rate among C-IUD users should be interpreted with caution, due to the small, 6-patient cohort.

Similarly, unlike in previous reports, cramps were not considered a reason for IUD discontinuation, despite a higher rate of dysmenorrheal in the IUD group at any time point.

Compared to previous reports, the current study concluded that bleeding disturbances were the main reason for treatment discontinuation in all three groups, without a significantly higher prevalence in the IMP group. The authors said this lack of variance may be due to effective counseling that anticipated a possible disturbing bleeding pattern among implant recipients.

“In keeping with existing literature, we proved that IUD (mainly L-IUD) and subdermal implant are both safe and effective” after termination of pregnancy, wrote the authors. “Moreover, the rates of satisfaction we report almost equal those detected in the general population, while the discontinuation rates are lower than previously reported in the generation population for both LARCs and even in the post-abortion setting for IUDs.”

Study results are particularly striking to prevent further unintended pregnancies among this population at risk.

Three limitations of the study, though, are the small sample size, patients lost to follow-up and its single-center nature. Patients also chose their method of contraception as opposed to being randomized to an IUD or implant.

Demographics also revealed that the two IUD groups comprised a substantially higher portion of non-Italian citizens: 72.7% vs. 27.3% Italians. Conversely, the IMP group was 48.8% non-Italian and 51.2% Italian.