COMMENTARY

Emergency Contraception With the Progestin IUD

Andrew M. Kaunitz, MD

Disclosures

February 22, 2021

This transcript has been edited for clarity.

Hello. I'm Andrew Kaunitz, professor and associate chair in the ob/gyn department at the University of Florida College of Medicine in Jacksonville. Today I'd like to discuss the use of progestin intrauterine devices (IUDs) for emergency contraception

Due to their convenience and high efficacy, a growing number of US women are using intrauterine contraception. More women are choosing progestin-releasing IUDs over the copper IUD. Although the copper IUD is known to provide highly effective emergency contraception, little data address use of progestin-releasing IUDs for this indication.

In an NIH-funded clinical trial, investigators based in family planning clinics in Utah randomly assigned women who presented for emergency contraception following one or more episodes of unprotected sex in the prior 5 days to a levonorgestrel or a copper IUD.

At baseline, all participants had a negative urine pregnancy test. The progestin IUDs used in this trial contained 52 mg of levonorgestrel. Brand names for such IUDs are Liletta or Mirena. The primary outcome was having a positive urine pregnancy test 1 month after IUD placement.

One-month outcome data were available for almost 650 participants. One pregnancy occurred in the levonorgestrel IUD group, resulting in a pregnancy rate of 0.3% or 3 per 1000. No pregnancies occurred in the copper IUD group. The single pregnancy resulted in a miscarriage.

The difference between the pregnancy rates for the two IUDs met prespecified criteria that the progestin IUD was comparable to the copper IUD when used for emergency contraception.

As the authors point out, the effectiveness of the progestin IUDs for emergency contraception compares favorably with that of oral emergency contraception. However, unlike oral methods, the efficacy of IUDs when used for emergency contraception does not decline when used in women with higher weight or body mass index.

This trial was conducted in US family planning clinics. Unfortunately, the use of IUDs for emergency contraception is limited in many private-practice settings due to the need for insurance authorization, which can cause delays in IUD access.

In conclusion, this landmark trial changes our standard of care by clarifying that 52 mg levonorgestrel IUDs as well as the copper IUD are highly effective when used for emergency contraception.

Thank you for the honor of your time. I am Andrew Kaunitz.

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