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Background Studies conflict on whether the duration of use of the copper intrauterine device is longer than that of the levonorgestrel intra-uterine device, and whether women who continue using intrauterine devices differ from those who discontinue. Objective We sought to assess continuation rates and performance of levonorgestrel intrauterine devices compared with copper intrauterine devices over a 5-year period. Study Design We performed a retrospective cohort study of 1164 individuals who underwent intrauterine device placement at an urban academic medical center. The analysis focused on a comparison of continuation rates between those using levonorgestrel intrauterine device and copper intrauterine device, factors associated with discontinuation, and intrauterine device performance. We assessed the differences in continuation at discrete time points, pregnancy, and expulsion rates using χ2 tests and calculated hazard ratios using a multivariable Cox model. Results Of 1164 women who underwent contraceptive intrauterine device insertion, 956 had follow-up data available. At 2 years, 64.9% of levonorgestrel intrauterine device users continued their device, compared with 57.7% of copper intrauterine device users (P = .11). At 4 years, continuation rates were 45.1% for levonorgestrel intrauterine device and 32.6% for copper intrauterine device (P < .01), and at 5 years continuation rates were 28.1% for levonorgestrel intrauterine device and 23.8% for copper intrauterine device (P = .33). Black race, primiparity, and age were positively associated with discontinuation; education was not. The hazard ratio for discontinuation of levonorgestrel intrauterine device compared with copper intrauterine device >4 years was 0.71 (95% confidence interval, 0.55–0.93) and >5 years was 0.82 (95% confidence interval, 0.64–1.05) after adjusting for race, age, parity, and education. Copper intrauterine device users were more likely to experience expulsion (10.2% copper intrauterine device vs 4.9% levonorgestrel intrauterine device, P < .01) over the study period and to become pregnant in the first year of use (1.6% copper intrauterine device vs 0.1% levonorgestrel intrauterine device, P < .01). Conclusion We found a difference in continuation rates between levonorgestrel and copper intrauterine device users at 4 years but not at 5 years. Copper intrauterine device users were more likely to experience expulsion and pregnancy.

Objectives: We aimed to assess continuation rates and performance of levonorgestrel intrauterine devices (LNG-IUDs) compared with copper intrauterine devices (Cu-IUDs) over a 5-year period. Methods: We performed a retrospective cohort study of women who underwent IUD placement at affiliated sites of an urban academic medical center. The analysis compared continuation rates between LNG-IUD and Cu-IUD, factors associated with discontinuation and IUD performance. We assessed differences in continuation at 2, 4 and 5 years and pregnancy and expulsion rates using chi-square tests. We compared proportions using chi-square tests and calculated hazard ratios using a multivariable Cox model. Results: Of 1325 women who underwent IUD placement, 1104 had follow-up data available. At 2 years, 62% of LNG-IUD users continued using their device, compared with 57.7% of Cu-IUD users (p=.34). At 4 years, continuation rates were 40.5% for LNG-IUD users compared with 32.6% for Cu-IUD users (p=.09), and at 5 years, continuation rates were 25.2% for LNG-IUD users compared with 23.8% for Cu-IUD users (p=.74). The hazard ratio for discontinuation of LNG-IUD compared with Cu-IUD was 0.90 (95% CI, 0.70-1.14) after adjusting for race, age, parity and education. Black race and primiparity were positively associated with IUD discontinuation; age and education were not. Cu-IUD users were more likely to experience expulsion (10.2% Cu-IUD users vs. 4.1% LNG-IUD users, pb.001) and to become pregnant (first-year pregnancy rate 1.6% of Cu-IUD users vs. 0.1% LNG-IUD of users, p=.002). Conclusions: We found no difference in continuation rates between LNG-IUD users and Cu-IUD users. Women using Cu-IUDs were more likely to experience expulsion and pregnancy.

SummaryA case of recurrent intraluminal bleeding from an ulcerated gastric diverticulum is described. Difficulties in diagnosis and treatment of this rare condition are discussed. The importance of accurate preoperative diagnosis by endoscopy and barium meal is emphasized.