Long-Acting Contraceptives Safe and Effective, Yet Underused

Diedtra Henderson

January 09, 2015

Two long-acting reversible contraceptive devices, the levonorgestrel intrauterine system (LNG-IUS) and etonogestrel (ENG) subdermal implants, are well-tolerated and are associated with few serious adverse effects, according to a retrospective cohort study published online December 30, 2014, in the American Journal of Obstetrics and Gynecology. The study also found that 88% of the teenagers who used either contraceptive continued to use it for at least 12 months.

Despite the study's high reliability, Abbey B. Berenson, MD, PhD, professor, obstetrics and gynecology, and director, Center for Interdisciplinary Research in Women's Health, University of Texas Medical Branch at Galveston, and coauthors found that relatively few US women use long-acting reversible contraception, with less than 1% of women who were using contraceptives using ENG implants in 2009, 2 years after their introduction. To compare the use and complications of two such contraceptive methods, the researchers reviewed health insurance claims from 2007 to 2011, identifying 79,920 women who had LNG-IUS and 7374 who had the ENG implants and who retained their insurance for a year thereafter.

The women were aged 15 to 44 years, with a mean age 31.6 years for women using LNG-IUS and 24.1 years for the ENG implant users.

Some 83% to 88% of the women used the contraceptive device for at least 12 months. Obstetrician-gynecologists were the providers who most frequently inserted the devices. The frequency of ENG implants increased fivefold in the first 4 years of their availability compared with stable IUD insertion rates over the same period, a trend the authors say "highlight[s] the need to offer further education to both physicians and patients on the safety of prescribing modern IUDs to nulliparous women."

ENG implants, which have a failure rate of roughly 0%, were more popular among younger women, with 60% being placed in women aged 24 years or younger. The implants were more likely to be removed early by women aged 20 to 44 years. Women aged 25 to 44 years with these implants were more likely to experience excessive menstruation, uterine hemorrhage, or cervicitis. Women were more likely to have the implant removed within 30 days of visiting a clinician after reporting abnormal bleeding, the researchers report.

The LNG-IUS were used more frequently by women aged 25 to 44 years, and women aged 24 years or younger were more likely to opt for this method within 8 weeks of childbirth. Early removal occurred more often for women whose LNG-IUS had been inserted at a clinic (18.7%) compared with an insertion performed by a specialist (16.3%), an obstetrician-gynecologist (11.3%), or a general practitioner (11.2%).

Serious complications were rare with either method, with less than 1% of women experiencing pelvic inflammatory disease. According to the authors, the most frequent complication was abnormal menstruation, such as metrorrhagia or irregular menstrual cycles. Dr Berenson and colleagues suggest that before implantation, clinicians should counsel their patients about the likelihood of abnormal bleeding and offer treatment such as tranexamic acid, mifepristone combined with an estrogen, and doxycycline, as needed.

"We found that both methods were well tolerated among women of all ages with few side effects and that continuation rates exceeded those observed with other contraceptive methods," Dr Berenson and colleagues conclude. "Results from this direct comparison will help healthcare providers better counsel their patients about the benefits of both types of [long-acting reversible contraception] as well as help patients choose which method best fulfills their needs."

Support for the study was provided by the Institute for Translational Sciences at the University of Texas Medical Branch. The authors have disclosed no relevant financial relationships.

Am J Obstet Gynecol. Published online December 30, 2014. Abstract

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