Duration of use of a levonorgestrel IUS amongst nulliparous and adolescent women

Abstract

Background Intrauterine devices (IUDs) are cost-effective if used for two or more years. Early discontinuation may lead to reduced cost-effectiveness of this method and unintended pregnancy if other contraceptives are not used. This study sought to examine rates and reasons for discontinuation of IUS use in adolescents versus older women and nulliparous versus parous women, as these groups may be more likely to discontinue use. Study Design Retrospective cohort study of women receiving a levonorgestrel IUS between June 2005 and April 2008. Medical records were reviewed for all visits following placement of the IUS; rates and reasons for IUS discontinuation were calculated and categorized. Data were examined under two scenarios: (1) assuming that all women not seen for follow-up continued IUS use and (2) Only including women with follow-up visits. Cox regression was used to control for age, parity, race, and marital status in comparing rates of IUS discontinuation and expulsion in nulliparous versus parous women and adolescents versus older women. Results Of the 828 women included in this analysis, 104 (12.6%) were nulliparous, and 131 (15.8%) were <=20 years of age. Nulliparous women were not more likely than parous women to have expelled their IUS [HR 1.40, 95% CI (0.57, 3.43)]. Adolescent women were more likely to experience expulsion than older women, although this did not reach statistical significance [HR 1.49 (0.76, 2.92)]. When we looked at reasons for IUS removal, we found that nulliparous women were not more likely than parous women to have their IUS removed because of dissatisfaction with the contraceptive method (6.7% vs. 11.5%, p=0.15) or desire to become pregnant (1.9% vs. 2.6%, p=0.50). Similarly, adolescents were not more likely than older women to have their IUS removed because of dissatisfaction with the contraceptive method (10.7% vs. 10.9%, p=0.94) or desire to become pregnant (3.1% vs. 2.4%, p=0.43). Conclusions Adolescents and nulliparous women are not more likely to prematurely discontinue use of their IUS than adult or parous women.

Safety and efficacy of the levonorgestrel-releasing intrauterine system: recent insights

“…In the USA, the recommended patient profile for the LNG-IUS includes 'women who have had at least one child' -however, such general restrictions regarding use in nulliparous women are not in place in the countries where the LNG-IUS is marketed the most. Adolescents and nulliparous women are not more likely to prematurely discontinue use of their IUS than adult or parous women [86]. Recent studies have confirmed that the LNG-IUS can also be used for reduction of dysmenorrhea and HMB by young and nulliparous women (Table 2).…”

“…Despite the fact that the insertion was experienced as painful by a large proportion of women, this did not negatively influence satisfaction with the LNG-IUS [80]. Compared with 'older' women or parous women, young or nulliparous women were not more likely to have their IUS removed because of dissatisfaction (Table 2) [86]. The most common reason for removing the IUS was wish for pregnancy.…”

“…Compliance Retrospective cohort study (n = 828), 104 (12.6%) nulliparous women, of which 131 (15.8%) were ≤20 years of age Nulliparous women did not have more expulsions or removals because of dissatisfaction; this was not different to parous women (6.7 vs 11.5%; p = 0.15) [86] HMB: Heavy menstrual bleeding; IUS: Intrauterine system; LNG-IUS: Levonorgestrel-releasing intrauterine system.…”

“…Due to its efficacy and additional health benefits, the use of the LNG-IUS among young nulliparous women is expanding rapidly, although there is considerable variation between countries (Table 2) [15, [79][80][81][82][83][84][85][86]. In the USA, the recommended patient profile for the LNG-IUS includes 'women who have had at least one child' -however, such general restrictions regarding use in nulliparous women are not in place in the countries where the LNG-IUS is marketed the most.…”

Clinical practice

“…The main drawback of the progestogen implant is frequent and/or prolonged breakthrough bleeding, resulting in a comparable and meaningful fraction (20-25%) of adolescents and adults requesting early removal [8]. Rapidly accumulating experience with IUCDs in adolescents shows that expulsion rates are slightly higher than the~5% incidence rate in parous women, whereas the continuation rate and satisfaction are comparable in both groups, particularly with the progestogen-containing IUCD [1]. Abnormal bleeding (frequent, prolonged and/or abundant) and pelvic pain or cramps are potential IUCD side effects yet appear to be more common with copper IUCDs.…”