IUDs, Implants May Be Effective Beyond Recommended Time

Jenni Laidman

February 09, 2015

Etonogestrel implants and levonorgestrel intrauterine devices (IUDs) used longer than recommended showed no increase in failure rate, according to a study published online February 4 and in the March issue of Obstetrics & Gynecology.

There were no pregnancies among 237 implant users at 1 and 2 years beyond the recommended 3-year use. Those users contributed 229.4 women-years to follow-up. One hundred twenty-three of the women used the etonogestrel implant for 4 years, which is 1 year longer than recommended, and 34 used the implant for 5 years, for a failure rate of 0 per 100 women years (97.5% confidence interval [CI], 0 - 1.61).

Among the 263 users of the 52-mg levonorgestrel IUDs, who contributed 197.7 women-years to follow-up, 108 women used the IUD at least 1 year longer than recommended. There was one confirmed pregnancy in this group, for a failure rate of 0.51 per 100 women years (95% CI, 0.01 - 2.82).

The failure rate in this postrecommendation period is identical to the failure rate for IUDs and implants during the recommended use period, author Colleen P. McNicholas, DO, instructor, obstetrics and gynecology, Washington University, St. Louis, Missouri, told Medscape Medical News. "The data really supports the fourth year use for implants and the sixth year for IUDs," she said. The single pregnancy in the study occurred within weeks of the 5-year use period termination and appeared to be caused by a partial expulsion of the IUD.

"If the final data continue to look this reassuring, this is great news from the patient's perspective," Sarah Pickle, MD, wrote in an email to Medscape Medical News. Dr Pickle, assistant professor in the Department of Family Medicine and Community Health at Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, is the director of the Rutgers Reproductive Health Education in Family Medicine Program. She is not associated with the current study.

"The potential benefits to [a patient] include cost savings, avoidance of another insertion procedure, and prolongation of any noncontraceptive benefits (eg, decrease in heavy menstrual bleeding associated with the levonorgestrel IUD). And of course, she will benefit from continuous, uninterrupted pregnancy prevention. Each patient should talk to her own provider about whether this option is appropriate for her. "

Dr Pickle told Medscape Medical News that the study answers some of the questions raised by previous research. "Prior smaller studies have reported zero pregnancy rates associated with use of the levonorgestrel 52-mg IUD beyond 5 years and up to 7 years postinsertion. However, the generalizability of these studies was limited by the fact that they were conducted in non-US settings, excluded nulliparous women, and included very few young women. This current study is a well-conducted, prospective observational study that addresses these gaps in the literature." Dr Pickle is a coauthor of a 2014 literature review examining extended use of IUDs published in Contraception.

The current study further showed that etonogestrel levels in women using long-acting reversible contraception did not differ by body mass index at 3 years (P = .79) or 4 years (P = .47). The study included a range of body mass indexes, with 29% (n = 27) of participants being in the normal body mass index range, 25% (n = 23) being overweight, and 46% (n = 42) being obese or morbidly obese.

One coauthor receives funding from Bayer, Teva, and Merck and has served on advisory boards for Teva, Bayer, and Watson/Actavis. The other authors and Dr. Pickle have disclosed no relevant financial relationships.

Obstet Gynecol. 2015;599-604. Abstract

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