Safety and continued use of the levonorgestrel intrauterine system as compared with the copper intrauterine device among women living with HIV in South Africa: A randomized controlled trial

Todd, Catherine S.; Jones, Heidi E.; Langwenya, Nontokozo; Hoover, Donald R.; Chen, Pai-Lien; Petro, Gregory; Myer, Landon

doi:10.1371/journal.pmed.1003110

Cited by 14 publications

(16 citation statements)

References 51 publications

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“…A study that investigated the role of two new low‐dose LNG‐IUS (8 and 13 µg/day) over 3‐year follow up reported that the risk of PID was the same in nulliparas and paras (crude incidence 0.1% vs 0.6%) and between women aged 18‐25 years and those aged 26‐35 years (crude incidence 0.2% vs 0.6%) 18 . Another study that investigated the PID incidence rates in women with HIV infection reported a rate of 1.2/100 W‐Ys (95% CI 0.3‐4.6) among LNG‐IUS users compared with a rate of 0.7/100 W‐Ys, (95% CI 0.1‐4.9) ( p = .68) among Cu‐IUD users 33 …”

Section: Use Of Copper‐bearing Iuds and The Lng‐ius Among Adolescents And Nulligravidasmentioning

confidence: 98%

“…With the two low-dose LNG-IUS (8 and 13 µg/d) nulliparous women showed the same risk as parous women (crude PID incidence: 0.1% vs 0.6%, respectively); 18 Women living with HIV users of the LNG-IUS had low incidence of PID compared with the Cu-IUD users; 33 Conception rates up to 1 y after LNG-IUS removal were similar between nulligravidas (86.8%) and parous (85.4%) women. 35…”

Section: Pidmentioning

confidence: 99%

“…Women living with HIV users of the LNG‐IUS had low incidence of PID compared with the Cu‐IUD users; 33 …”

Section: Difficult Insertions and Pain During Iud Placement In Nulligravidas And Adolescentsmentioning

confidence: 99%

“…18 Another study that investigated the PID incidence rates in women with HIV infection reported a rate of 1.2/100 W-Ys (95% CI 0.3-4.6) among LNG-IUS users compared with a rate of 0.7/100 W-Ys, (95% CI 0.1-4.9) (p = .68) among Cu-IUD users. 33 A previous study 34 that investigated the return of fertility after Cu-IUD removal in 1770 women reported that 80.1% of the women became pregnant after IUD removal and 88.0% conceived within a year. Women's age and duration of IUD use were independently associated with reduced fertility.…”

Section: Us E Of Copper-b E Aring I Uds and The Lng -I Us Among Adole Scents And N Ulli G R Avida Smentioning

confidence: 99%

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Intrauterine device use is safe among nulligravidas and adolescent girls

Bahamondes¹,

Bahamondes

2021

Acta Obstet Gynecol Scand

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The use of intrauterine devices (IUDs), including the copper‐bearing device and the levonorgestrel intrauterine system (LNG‐IUS), is safe among nulligravidas and adolescent girls. However, several misconceptions limit their use in clinical practice; health‐care providers are hesitant to prescribe IUDs, and several myths associated with their usage in nulligravidas and adolescents exist among both providers and women themselves. The high rates of unplanned pregnancies (which in many settings constitute a public health issue, primarily among adolescent females) can be attributed at least partially to lack of awareness and limited use of highly effective contraceptives such as IUDs. In this review, we discuss the role of non‐hormonal and hormonal IUDs as effective contraceptives in nulligravidas and adolescent girls. We present a literature review of data that highlight contraceptive efficacy, side effects (including reasons for discontinuation), and continuation rates with the method. We searched the PubMed/MEDLINE, Cochrane Library, Embase, and Scopus databases for all articles published in English between January 1990 through September 2020. A large body of evidence confirmed the effectiveness of IUD/IUS, independent of age and parity. Studies showed a high expulsion rate among adolescents but not among nulligravidas. Additionally, bleeding patterns among adolescents and nulligravidas were similar to those observed among adults and parous women. The high early removal rates observed in adolescents were attributable to bleeding and/or pain, which indicate that compared with adults, adolescents are less likely to accept IUD‐induced side effects. IUD placement is an excellent strategy to avoid the high rates of unplanned pregnancies in adolescents and nulligravidas. IUDs are more effective than short‐acting reversible contraceptives with failure rates that are equivalent to those observed with permanent contraception. However, few long‐term studies have investigated this category of women to definitively establish the role of IUD/IUS as effective means of contraception.

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Section: Use Of Copper‐bearing Iuds and The Lng‐ius Among Adolescents And Nulligravidasmentioning

confidence: 98%

Section: Pidmentioning

confidence: 99%

“…Women living with HIV users of the LNG‐IUS had low incidence of PID compared with the Cu‐IUD users; 33 …”

Section: Difficult Insertions and Pain During Iud Placement In Nulligravidas And Adolescentsmentioning

confidence: 99%

Section: Us E Of Copper-b E Aring I Uds and The Lng -I Us Among Adole Scents And N Ulli G R Avida Smentioning

confidence: 99%

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Intrauterine device use is safe among nulligravidas and adolescent girls

Bahamondes¹,

Bahamondes

2021

Acta Obstet Gynecol Scand

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“…Recent experience has shown that the hormonal IUD could be an important addition to the contraceptive method mix in the region. A study among postpartum women in Kenya and a trial with women living with HIV in South Africa showed high satisfaction and continuation rates with the hormonal IUD that were comparable with or superior to other LARCs [ 8 , 9 ]. Qualitative interviews in Ghana, Kenya and Nigeria revealed favorable perceptions of the hormonal IUD among key opinion leaders, providers, and early adopters [ 10 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

et al. 2022

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Background The levonorgestrel-releasing intrauterine device (IUD)—also known as the hormonal IUD—is a highly effective contraceptive method that has not been widely available in the public sector in Zambia. Early introduction efforts can provide critical insights into the characteristics of users, reasons for method choice, and experiences getting their method. Methods We conducted a survey with 710 public sector clients who received a hormonal IUD, copper IUD, implant or injectable in two provinces of Zambia, and additional in-depth interviews with 29 women. We performed descriptive analyses of survey data and fitted multivariable logistic regression models to assess factors associated with hormonal IUD use. Qualitative interviews were analyzed thematically. Results Factors associated with hormonal IUD use included full-time or self-employment (relative to both implant and copper IUD use), as well as being older, wealthier, and partner not being aware of method use (relative to implant use only). Common reasons for choosing long-acting methods were duration, perception that the method was “right for my body,” and convenience. In addition, a portion of hormonal IUD acceptors mentioned effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Between 83 and 95% of women said that they were counseled about menstrual changes and/or non-bleeding side effects; however, more hormonal IUD acceptors recalled being counseled on the possibility of experiencing reduced bleeding (88%) than amenorrhea (43%). Qualitative interviews indicate that women seek methods with minimal or tolerable side effects. While most women reported their partner was aware of method use, men may be more consistently involved in the decision to use contraception rather than in the choice of a particular method. Qualitative results show an appreciation of the lifestyle benefits of reduced bleeding (especially lighter bleeding), although amenorrhea can be cause for concern. Conclusions Initial efforts to introduce the hormonal IUD can provide valuable learnings that can inform broader method introduction to expand choice and better suit women’s needs in Zambia and elsewhere. Scale-up plans should include emphasis on high quality counseling and demand generation. Plain English Summary The government of Zambia is committed to increasing access to high-quality contraception and making more choices available to users. To date, the hormonal IUD, a highly effective, long-lasting contraceptive has not been widely available in the country. A study in pilot introduction settings provided insights into why women chose the methods, their characteristics, and their experiences getting their methods. The 710 women in the study received family planning services in public sector settings in two provinces in Zambia. Women in the study who received a hormonal IUD, copper IUD, implant, or injectable completed a quantitative survey; in-depth interviews were also conducted with 29 women. Results showed common reasons for choosing the long-acting methods (hormonal IUD, copper IUD or implants) were their duration, perception that the method was “right for my body,” and convenience. In addition, some hormonal IUD acceptors indicated that they were attracted to the method’s effectiveness, potential for discreet use, few or manageable side effects, and treatment for heavy or painful periods. Qualitative interviews with women also showed that women want contraceptive methods that lead to minimal or tolerable side effects. Male partners were typically aware of contraceptive use; however, men were less involved with decisions about the particular method women selected. Use of the hormonal IUD can lead to reduced menstrual bleeding, and in the interviews, women indicated that they liked reduced bleeding (especially lighter bleeding), although amenorrhea (paused bleeding) can be cause for concern. The results can help inform broader method introduction.

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Contraception et VIH

Plu-Bureau,

Raccah-Tebeka

2024

La Contraception en Pratique

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Safety and continued use of the levonorgestrel intrauterine system as compared with the copper intrauterine device among women living with HIV in South Africa: A randomized controlled trial

Cited by 14 publications

References 51 publications

Intrauterine device use is safe among nulligravidas and adolescent girls

Intrauterine device use is safe among nulligravidas and adolescent girls

What are the prospects for the hormonal IUD in the public sector? A mixed-method study of the user population in Zambia

Contraception et VIH

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