Characteristics Associated With Discontinuation of Long-Acting Reversible Contraception Within the First 6 Months of Use

Grunloh, Danielle S. BS; Casner, Teya MPH; Secura, Gina M. PhD, MPH; Peipert, Jeffrey F. MD, PhD; Madden, Tessa MD, MPH

doi: 10.1097/01.AOG.0000435452.86108.59
Contents: Original Research

OBJECTIVE: To measure discontinuation within 6 months among users of the levonorgestrel intrauterine system, copper intrauterine device (IUD), and etonogestrel implant and identify baseline characteristics associated with early discontinuation.

METHODS: This was an analysis of the Contraceptive CHOICE Project, a cohort study of 9,256 participants provided with no-cost contraception and followed with telephone interviews at 3 and 6 months. We used logistic regression to investigate characteristics associated with early discontinuation of the two IUDs and implant and described reasons for discontinuation.

RESULTS: A total of 6,167 participants were eligible for this analysis. Follow-up data were available for 5,928 participants; 5,495 (93%) were using their method at 6 months and 433 (7%) had discontinued. Discontinuation rates were 7.3%, 8.0%, and 6.9% for the levonorgestrel intrauterine system, copper IUD, and implant, respectively. After adjusting for age, race, marital status, low socioeconomic status, and history of sexually transmitted infection, we found that unmarried women were slightly more likely to discontinue compared with married women (adjusted odds ratio [OR] 1.26, 95% confidence interval [CI] 1.01–1.59 and adjusted OR 1.62, 95% CI 1.11–2.37, respectively). No other baseline characteristics, including younger age (14–19 years), were associated with early discontinuation. The most common reason given for discontinuation was cramping among IUD users and irregular or frequent bleeding among implant users.

CONCLUSION: Rates of discontinuation of long-acting reversible contraception at 6 months is low and not increased in adolescents and young women. Intrauterine devices and the implant should be considered as first-line contraceptive options among all women to reduce unintended pregnancy.

LEVEL OF EVIDENCE: II

Six-month discontinuation rates of intrauterine devices and implants are low, and adolescents and young women are not more likely to discontinue these methods early.

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

Corresponding author: Tessa Madden, MD, MPH, Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, 4533 Clayton Avenue, Campus Box 8219, St. Louis, MO 63110; e-mail: maddent@wustl.edu.

Supported in part by The Susan Thompson Buffett Foundation; Award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD); and Grant number UL1 TR000448 from the National Institutes of Health (NIH)–National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NICHD or NIH.

Financial Disclosure Dr. Peipert receives research funding from Bayer Healthcare Pharmaceuticals and Merck & Co, Inc and honorarium for serving on an advisory board for TEVA Pharmaceuticals and Watson/Activis. Dr. Madden receives research funding from Merck & Co, Inc and honorarium 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.