Unintended pregnancy is currently a major public health problem in the US; approximately 3 million unplanned or mistimed pregnancies occur each year in the nation. Worldwide, the problem has decreased in recent years; however, unintended pregnancy rates have not decreased in the US. A new study noted that increasing access to effective contraception may prevent the negative health and economic consequences associated with unplanned pregnancy. Therefore, they conducted a study to determine how well tolerated long-acting reversible contraception was among young women and teens. The study was published in the December 2013 edition of the journal Obstetrics & Gynecology by researchers at Washington University in St. Louis School of Medicine, St. Louis, Missouri.
The investigators measured the rate of discontinuation within six months among users of the levonorgestrel intrauterine system, copper intrauterine device (IUD), and etonogestrel implant. In addition, they analyzed the factors associated with early discontinuation. The researchers accessed data from the Contraceptive CHOICE Project, which was a study of 9,256 women who had received no-cost contraception; the women were followed-up with telephone interviews at three and six months. They subjected the data to statistical analysis to determine factors associated with early discontinuation of the two IUDs and implant; in addition, they described reasons for discontinuation.
Eligible for inclusion in the study were 6,167 women. Follow-up data were available for 5,928 women; 5,495 (93%) were using their method at 6 months and 433 (7%) had discontinued. Discontinuation rates were 7.3% for the levonorgestrel intrauterine system, 8.0% for the copper IUD, and 6.9% for the implant, respectively. The data were adjusting for age, race, marital status, low socioeconomic status, and history of sexually transmitted infection. The researchers found that, compared to married women, unmarried women were slightly more likely to discontinue. No other factors, including younger age (14–19 years), were associated with early discontinuation. The most common reason given for discontinuation among IUD users was cramping; irregular or frequent bleeding were the most common reasons for discontinuation among implant users.
The authors concluded that the discontinuation rates of long-acting reversible contraception at six months is low; furthermore, they are not increased in teens or young women. They recommended that IUDs and the implant should be considered as first-line contraceptive options among all women to reduce unintended pregnancy.