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Twenty-Four–Month Continuation of Reversible Contraception

O'Neil-Callahan, Micaela MD; Peipert, Jeffrey F. MD, PhD; Zhao, Qiuhong MS; Madden, Tessa MD, MPH; Secura, Gina PhD, MPH

doi: 10.1097/AOG.0b013e3182a91f45
Original Research

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 long-acting reversible contraception and non-LARC methods were 77% and 41%, respectively. Continuation rates for the levonorgestrel and the copper IUDs were similar (79% compared with 77%), whereas the implant continuation rate was significantly lower (69%, P<.001) compared with IUDs at 24 months. There was no statistically significant difference in 24-month continuation rates among the four non-LARC methods (oral contraceptive pill [OCP] 43%, patch 40%, ring 41%, depot medroxyprogesterone acetate [DMPA] 38%; P=.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: Intrauterine devices 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.

LEVEL OF EVIDENCE: II

At 24 months, 77% of adolescents and women using long-acting reversible contraceptive methods continued their method, whereas only 41% continued use of non–long-acting reversible contraceptive methods.

Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.

Corresponding author: Jeffrey F. Peipert, MD, PhD, Vice Chair of Clinical Research, Division of Clinical Research, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, Campus Box 8219, 4533 Clayton Avenue, St. Louis, MO 63110; e-mail: peipertj@wudosis.wustl.edu.

The Contraceptive CHOICE Project is funded by the Susan T. Buffett Foundation. This research was also supported in part by a Midcareer Investigator Award in Women's Health Research (K24 HD01298), by a Clinical and Translational Science Award (UL1RR024992), by award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD); and by Grant No. KL2RR024994 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.

Financial Disclosure Dr. Peipert receives research funding from Bayer and Merck and is on advisory boards for Teva and Watson. Dr. Madden receives research funding from Merck & Co, Inc and honoraria for serving on an advisory board for Bayer Healthcare Pharmaceuticals. The other authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.