Twenty-Four–Month Continuation of Reversible Contraception

Abstract

Objective To estimate 24-month continuation rates of all reversible contraceptive methods for women enrolled in the Contraceptive CHOICE Project. Methods We analyzed 24-month data from the 9,256 participants enrolled in the Contraceptive CHOICE Project, a prospective observational cohort study that provides no-cost contraception to women in the St. Louis region. The project promoted the use of long-acting reversible contraception (LARC; intrauterine devices (IUDs) and implants) in an effort to reduce the rates of unintended pregnancy. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who completed a 24-month follow-up survey (n=6,153). Results Twenty-four month continuation rates for LARC and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% versus 77%), whereas the implant continuation rate was significantly lower (69%, p<0.001) compared to IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate (DMPA) 38%, p=0.72). Participants who chose a LARC method at enrollment were at significantly lower risk of contraceptive method discontinuation (adjusted hazard ratio=0.29, 95% confidence interval 0.26, 0.32) compared with women who selected a non-LARC method. Conclusion IUDs and the implant have the highest rates of continuation at 24-months. Given their effectiveness and high continuation rates, IUDs and implants should be first-line contraceptive options and shorter-acting methods such as OCPs, patch, ring, and DMPA should be second tier.

Prophylactic ibuprofen does not improve pain with IUD insertion: a randomized trial

“…Smaller inserters may reduce discomfort but it is not likely that these will alter our conclusion of a lack of benefit of ibuprofen. Women choosing an IUD for contraception have the highest continuation and satisfaction rates compared to other contraceptive methods [26]. In recent years, IUD use has risen predominately among parous women [27], and as our study confirmed low pain levels with IUD insertion among parous women, likely no additional pain intervention is necessary for this group.…”

New Zealand women’s experience during their first year of Jadelle® contraceptive implant

“…Age has been shown to impact on implant continuation with younger women having higher rates of discontinuation. 8,14,18 This study found that known removals were less likely for younger women than older women. However, the higher loss to follow up rate of younger women may signal more Jadelle® removals in this group.…”

“…Earlier studies have shown Jadelle® continuation rates to be 88-94% at one year. 14,15 A study of women using Norplant® found a 14% discontinuation at two years of use for bleeding problems. 5 At five years, 55% of women were still using the Jadelle® implant, giving a cumulative 5-year life table discontinuation rates for menstrual problems of 16.4/100.…”

Provision of No-Cost, Long-Acting Contraception and Teenage Pregnancy

“…12 Furthermore, teens in our cohort continued to use LARC methods longer than short- er-acting methods such as the oral contraceptive pill and DMPA injection; two thirds of teens in CHOICE were still using their LARC method at 24 months of follow-up, as compared with only one third of teens using a non-LARC method. 8 The limitations of our study must be considered. First, information about pregnancy was self-reported by participants, and thus it is possible that the number of teenage pregnancies was underestimated in the CHOICE cohort.…”

“…8,9 LARC methods reduce the likelihood of pregnancy and of repeat pregnancy among adolescents, 10,11 yet less than 5% of U.S. teens report using LARC methods. 12 Lack of information about effective contraception, limited access, and cost remain barriers to the use of LARC methods by teens.…”