Free-of-charge long-acting reversible contraception: two-year discontinuation, its risk factors, and reasons

Saloranta, Tuire; Gyllenberg, Frida; But, Anna; Gissler, Mika; Laine, Merja K.; Heikinheimo, Oskari

doi:10.1016/j.ajog.2020.06.023

Cited by 18 publications

(15 citation statements)

References 20 publications

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“…We found that women choosing using Cu-IUD had more visits for other reasons than routine checkups compared to women using LNG-IUS. This is in line with a previous study comparing LARC methods, where Cu-IUD users had higher rate of discontinuation due to increased bleeding and cramping [ 20 ]. This is likely to explain why women using Cu-IUD also had a higher need for abortion care.…”

Section: Discussionsupporting

confidence: 92%

“…Among LARC users 69% used services during follow-up. A previous study on these same LARC initiators showed high method continuation rates, over 70% at 2 years [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

“…Free-of-charge LARC initiators had more visits with the diagnosis of PID than SARC users, and women choosing IUDs had more of these visits than women choosing contraceptive implants. Clinical diagnosis of PID is a difficult one and clinicians may be prone to suspecting PIDs among IUD users as pelvic pain is a common adverse event of IUDs [ 20 , 29 , 30 ]. Thus distinguishing IUD-related pelvic pain clinically from true PID can be challenging [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Use of reproductive health services among women using long- or short-acting contraceptive methods – a register-based cohort study from Finland

et al. 2022

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Background Long-acting reversible contraceptives (LARCs) have superior contraceptive efficacy compared to short-acting reversible contraceptives (SARCs) and choosing LARCs over SARC methods reduces the need for abortion care. However, little is known how initiating these methods associates with the subsequent overall need of reproductive health services including family planning services, and visits for gynecological reasons in primary and specialized care. Methods We followed altogether 5839 non-sterilized women aged 15–44 years initiating free-of-charge LARC methods (n = 1689), initiating or switching SARC methods (n = 1524), or continuing with the same SARC method (n = 2626) at primary care family planning clinics in the City of Vantaa, Finland, 2013–2014 for 2 years using Finnish national health registers. We assessed the use of reproductive health services, namely attending public primary or specialized health care for gynecological reasons or attending the family planning clinics by applying unadjusted and adjusted negative binomial regression models on visit counts. Results A total of 11,290 visits accumulated during the two-year follow-up: 7260 (64.3%) at family planning clinics, 3385 (30.0%) for gynecological reasons in primary, and 645 (5.7%) in specialized health care. Altogether 3804 (52.4%) visits at the family planning clinics were for routine checkup, and 3456 (47.6%) for other reasons. Women initiating LARC methods used reproductive health services for reasons other than routine checkups similarly as women initiating or switching SARC methods (adjusted incidence rate ratio 0.93, 95% CI 0.82–1.05), while women continuing with SARC methods used the services less frequently (0.65, 0.59–0.72). Women initiating free-of-charge LARC and those continuing with the same SARC method used services less for abortion care than women initiating or switching SARC (adjusted incidence rate ratios 0.05, 95% CI 0.03–0.08 and 0.16, 95% CI 0.11–0.24, respectively). Conclusions While women initiating LARC methods have lower need for abortion care compared to women initiating SARC methods, women initiating both LARC and SARC methods have similar overall need for reproductive health services. In contrast, women continuing with their SARC method need reproductive health services less than women initiating LARC or a new SARC method. These service needs should be acknowledged when planning and organizing family planning services, and when promoting long-acting reversible contraception.

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Section: Discussionsupporting

confidence: 92%

“…Among LARC users 69% used services during follow-up. A previous study on these same LARC initiators showed high method continuation rates, over 70% at 2 years [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Use of reproductive health services among women using long- or short-acting contraceptive methods – a register-based cohort study from Finland

et al. 2022

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“…Similar results emerged in the following study that did not find a statistical difference in the 12-month discontinuation rate (24.9 vs. 24% for LNG-IUS 13.5 and ENG implant, respectively) [142]; a similar 2-year continuation rate between LNG-IUD and ENG implant users (77.8% vs. 75.9%) was observed [141]. More recently, a retrospective cohort study of 2026 nonsterilised women showed that at 2 years, the use of implants was more likely to be discontinued than LNG-IUD (cumulative discontinuation rate 24.2 vs. 33.3 per 100 women-years for LNG-IUD and implant, respectively) [143].…”

Section: Nexplanonmentioning

confidence: 71%

Safety and Benefits of Contraceptives Implants: A Systematic Review

et al. 2021

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Progestin-only contraceptive implants provide long-acting, highly effective reversible contraception. We searched the medical publications in PubMed, CENTRAL, and EMBASE for relevant articles on hormonal implants published in English between 1990 and 2021. Levonorgestrel (LNG) 6-capsule subdermal implants represented the first effective system approved for reversible contraception. The etonogestrel (ENG) single rod dispositive has been widely employed in clinical practice, since it is a highly effective and safe contraceptive method. Abnormal menstrual bleeding is a common ENG side effect, representing the main reason for its premature discontinuation. Emerging evidence demonstrated that it is possible to extend the use of the ENG implant beyond the three-year period for which it is approved. The ENG implant could be an effective and discrete alternative to the IUD in young girls, such as post-partum/post-abortion. Implants should be inserted by trained skilled clinicians who previously provide adequate counselling about their contraceptive effect, benefits, and any possible adverse events. More studies are needed to validate the extended use of the ENG implant for up to 5 years.

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“…Thailand's contraceptive implant discontinuation rate was 2.3/100 person-years for Bangkok [16] and 8.7-8.9% for Northeast Thailand. [17] In 2022, 36,987,900 baht was spent on providing LARC for women under 20 years. [18] Premature discontinuation of implants leads to ineffective contraception and wastage of funding.…”

Section: Introductionmentioning

confidence: 99%

A 12-month contraceptive implant(s) discontinuation rate among adolescents compared with adults at King Chulalongkorn Memorial Hospital Principal Investigator

Tarat

Uaamnuichai

Phutrakool

et al. 2022

Preprint

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Contraceptive implants are effective in preventing adolescent and unwanted pregnancies. Contraceptive implant discontinuation contributes to financial waste and contraceptive failure. We aimed to study contraceptive implant discontinuation rates in adolescents (10–19 years) compared to adults (20–49 years) and evaluate the sociodemographic and clinical factors associated with contraceptive implant discontinuation. This prospective, retrospective cohort study included 2,765 participants who initiated contraceptive implants from October 2016 to December 2021 at King Chulalongkorn Memorial Hospital. Discontinuation at 12 months was determined by medical record review and telephone interviews. The analytic sample consisted of 2,014 participants: 498 adolescents and 1,516 adults. The 12-month contraceptive implant discontinuation rates were 3.83 per 100 person-year for all age groups and 2.84 and 4.16 per 100 person-year for adolescents and adults, respectively. Adolescents had a lower risk of 12-month contraceptive implant discontinuation than adults (adjusted HR = 0.60, 95% Cl 0.31–1.15, p-value = 0.121). The risk of discontinuation was significantly lower among continuous implant users (adjusted HR = 0.29, 95% Cl 0.10–0.79, p-value = 0.016). Side effects, mainly abnormal uterine bleeding, were the most common causes of discontinuation. In conclusion, the incidence of discontinuing contraceptive implants did not differ significantly between adolescents and adults.

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Free-of-charge long-acting reversible contraception: two-year discontinuation, its risk factors, and reasons

Cited by 18 publications

References 20 publications

Use of reproductive health services among women using long- or short-acting contraceptive methods – a register-based cohort study from Finland

Use of reproductive health services among women using long- or short-acting contraceptive methods – a register-based cohort study from Finland

Safety and Benefits of Contraceptives Implants: A Systematic Review

A 12-month contraceptive implant(s) discontinuation rate among adolescents compared with adults at King Chulalongkorn Memorial Hospital Principal Investigator

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