Copper Intrauterine Device Users Research Articles

Does the shape of the copper intrauterine device play a role in expulsion? Results from the ongoing European Active Surveillance Study on LCS12

ObjectiveTo compare the incidence of expulsion for different copper intrauterine device (IUD) shapes. Study designWe conducted a secondary analysis of the ongoing, prospective, non-interventional European Active Surveillance Study on LCS12 (EURAS-LCS12). Users of newly inserted IUDs were recruited in 10 European countries via a network of approximately 1200 clinicians. We restricted the analysis to copper IUD users. In the main analysis, we classified copper IUDs by shape [Nova-T frame, Tatum-T frame, Multiload frame, frameless IUDs and intrauterine balls], without differentiation of size. We calculated the cumulative incidence, crude, and adjusted hazard ratios for expulsion. Covariates included in the adjusted analyses were age, BMI, parity, education, income, IUD user status, marital status, length of device, heavy menstrual bleeding, and clinician’s experience. ResultsWe included 26,381 copper IUD users from the EURAS-LCS12 dataset for this study. The most frequently used IUD shape was the Nova-T frame (14,724 [55.8%]) followed by the Tatum-T frame (4276 [16.2%]), frameless IUDs (3374 [12.8%]), Multiload frame (2962 [11.2%]), and intrauterine balls (IUBs) (1045 [4.0%]). Cox regression analysis regarding expulsions yielded an adjusted hazard ratio of 0.8 (95% CI, 0.7–1.0), 1.3 (95% CI, 1.0–1.8), 1.6 (95% CI, 1.2–2.1) and 3.6 (95% CI, 2.7–4.9) for Nova-T frame IUD, frameless IUDs, Multiload frame IUDs and IUBs versus Tatum-T frame IUD, respectively. ConclusionThe risk of expulsion following placement of a copper IUD is related to IUD shape, with Nova-T frame and Tatum-T frame IUDs demonstrating the lowest risk. ImplicationsOur finding of a higher risk of expulsion observed with Multiload frame, frameless, and intrauterine ball copper IUDs compared to Tatum-T frame and Nova-T frame devices during real world use has clinical importance. Clinicians may choose to use these data when counseling patients.

Copper levels in cervical mucus of copper intrauterine device users versus non-users.

SynopsisWe found higher copper levels in the cervical mucus of Cu‐IUD users compared with non‐users.

TEMPORARILY WITHDRAWN: Does the shape of the copper intrauterine device play a role in expulsion? Results from the ongoing European Active Surveillance Study on LCS12

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Is long‐acting reversible contraceptive method use associated with HIV testing frequency in KwaZulu‐Natal, South Africa and Lusaka, Zambia? Findings from the CUBE study

ObjectivesTo assess differences in HIV testing at 6-months intervals over 24 months among intramuscular depot medroxyprogesterone acetate (DMPA-IM) injectable, levonorgestrel implant, or copper intrauterine devices (IUD) users in KwaZulu-Natal, South Africa, and Lusaka, Zambia. Testing at recommended intervals has not been previously assessed in long-acting reversible contraceptive (LARC) users (implant and IUD users) compared to those using effective but shorter-acting methods (such as DMPA-IM) in sub-Saharan Africa. Study designAs part of the longitudinal contraceptive use beyond ECHO (CUBE) study, we measured HIV testing over 24 months. Participants were considered continuous users of DMPA-IM, levonorgestrel implant, or copper IUD if they used the same method across all months of their study participation, or not continuous users of their baseline CUBE method if they switched or discontinued their method. We used multivariable logistic regression models with generalized estimating equations and robust standard errors, stratified by country, to assess differences in HIV testing. ResultsAmong the 498 participants, HIV testing rates were higher in Zambia for all methods compared to South Africa. In bivariate analyses, continuous implant or IUD users (the LARC users) were significantly less likely to report having received HIV testing at the 6-months and 24-months surveys, compared to continuous DMPA-IM users. In adjusted longitudinal models, continuous IUD users (adjusted odds ratio: 0.42, 95% CI: 0.24, 0.74), continuous implant users (adjusted odds ratio: 0.23, 95% CI: 0.12, 0.42) in South Africa had significantly lower odds of HIV testing compared to continuous DMPA-IM users. There were no significant differences in Zambia in the adjusted models. ConclusionLARC use may reduce opportunities for HIV testing and users should be counseled on regular HIV testing and the option of HIV self-testing. ImplicationsDue to infrequent clinical contacts which may lead to lower rates of HIV testing at recommended intervals, LARC users should be provided opportunities to test for HIV at home or when seeking other health services.

One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial

Recent evidence demonstrates the effectiveness of the levonorgestrel 52-mg intrauterine device for emergency contraception vs the copper T380A intrauterine device. Of note, 1-year pregnancy and continuation rates after intrauterine device placement for emergency contraception remain understudied. This study compared 1-year pregnancy and intrauterine device continuation rates and reasons for discontinuation among emergency contraception users randomized to the levonorgestrel 52-mg intrauterine device or the copper intrauterine device. This participant-masked, randomized noninferiority trial recruited emergency contraception individuals desiring an intrauterine device from 6 Utah family planning clinics between August 2016 and December 2019. Participants were randomized 1:1 to the levonorgestrel 52-mg intrauterine device group or the copper T380A intrauterine device group. Treatment allocation was revealed to participants at the 1-month follow-up. Trained personnel followed up the participants by phone, text, or e-mail at 5 time points in 1 year and reviewed electronic health records for pregnancy and intrauterine device continuation outcomes for both confirmation and nonresponders. We assessed the reasons for the discontinuation and used Cox proportional-hazard models, Kaplan-Meier estimates, and log-rank tests to assess differences in the continuation and pregnancy rates between the groups. The levonorgestrel and copper intrauterine device groups included 327 and 328 participants, respectively, receiving the respective interventions. By intention-to-treat analysis at 1 year, the pregnancy rates were similar between intrauterine device types (2.8% [9/327] in levonorgestrel 52-mg intrauterine device vs 3.0% [10/328] in copper intrauterine device; risk ratio, 0.9; 95% confidence interval, 0.4-2.2; P=.82). Most pregnancies occurred in participants after intrauterine device removal, with only 1 device failure in each group. Of note, 1-year continuation rates did not differ between groups with 204 of 327 levonorgestrel 52-mg intrauterine device users (62.4%) and 183 of 328 copper T380A intrauterine device users (55.8%) continuing intrauterine device use at 1 year (risk ratio, 1.1; 95% confidence interval, 1.0-1.2; P=.09). There were differences concerning the reasons for discontinuation between intrauterine device types, with more bleeding and cramping cited among copper intrauterine device users. The pregnancy rates were low and similar between intrauterine device types. Of note, 6 of 10 intrauterine device emergency contraception users continued use at 1 year. Moreover, 1-year continuation rates were similar between intrauterine device types.

P060Utilization of larc methods at the time of emergency contraception visit: A prospective observational study

<h3>Objectives</h3> To compare long-acting reversible contraceptive (LARC) method initiation by device at time of emergency contraception (EC) request. <h3>Methods</h3> All clients who presented to four Planned Parenthood Association of Utah clinics for EC from February 2021 to April 2022 received printed information about three LARC options for EC in addition to oral options. LARC options included the copper T380A intrauterine device (IUD), 52 mg levonorgestrel (LNG) IUD, and the guideline-supported option for oral LNG with same-day etonogestrel (ENG) implant. Participants were aged 18–35, who reported unprotected intercourse within five days with negative pregnancy testing. We assessed demographic variables associated with method selection and reasons for method choice. LARC methods were available at no cost. <h3>Results</h3> A total of 194 EC clients (18% of 1,086 approached) requested LARC and 187 qualified: 24% (n=44) selected a copper IUD, 23% (n=43) a 52 mg LNG IUD, and 54% (n=100) an ENG implant and oral LNG. ENG implant users were younger (22.9) than those selecting the LNG IUD (25.4) or copper IUD (25.9, p<0.01). Copper IUD users had a lower mean BMI (24.0) than those selecting an LNG IUD (27.0) or ENG implant and oral LNG (27.1, p=0.01). Commonly cited reasons for choosing ENG implant and oral LNG included having friends using the same method (30.0%), wanting fewer side effects (20.0%), and wanting lighter or no bleeding (18.0%). <h3>Conclusions</h3> In this observational study of EC clients desiring LARC, participants more frequently selected the ENG implant with oral LNG over either IUD, despite a lack of EC efficacy data for the ENG implant with oral LNG.

Switching and discontinuation of participant-masked randomization to a copper or levonorgestrel intrauterine device when presenting for emergency contraception

ObjectivesExamine intrauterine device (IUD) switching or discontinuation up to 6 months after participant-masked randomization to different IUDs. Study designParticipants were randomized 1:1 to the copper T380A or levonorgestrel 52 mg IUD for emergency contraception and informed they could switch IUD type without cost at any time. ResultsOf the 327 subjects allocated to the levonorgestrel IUD, 7 (2.1%) switched their IUD type by 6 months versus 18 (5.5%) of the 328 copper IUD users (RR: 0.4 [95% CI: 0.2, 0.9], p = 0.03). Six-month IUD discontinuation occurred in 34 (10.4%) levonorgestrel and 35 (10.7%) copper IUD users. ConclusionIndividuals randomly assigned to IUD type at presentation for emergency contraception continue their assigned IUDs at high rates over 6 months. ImplicationsWhile many recruited individuals declined enrollment, those who accepted randomization had high continuation rates; the high continuation and low cross-over supports using IUD randomization as a tool for future investigation. Participants’ similar rates of and reasons for switching and discontinuation by IUD type over the study period may impact clinical counseling.

Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use.

Interventions to prevent or treat heavy menstrual bleeding or pain associated with intrauterine-device use.

P-713 Prescription determinants of intrauterine devices in different European countries - Results from the real-world safety study EURAS-LCS12

Abstract Study question What are the reasons for intrauterine devices (IUD) use beyond contraception for various IUD types in routine clinical practice across Europe? Summary answer Beyond contraception, high- and low-dose levonorgestrel (LNG)-releasing IUDs are frequently used for heavy menstrual bleeding, especially in Mediterranean countries. What is known already All IUDs are approved for the use of contraception, but additional indications differ by IUD type (i.e., LNG- and copper-containing). The higher, 52 mg LNG, dose IUD (e.g., Mirena) is also approved for the treatment of menorrhagia and endometrium protection during hormone replacement therapy. There is a documented off-label indication to use copper IUD as emergency contraception within 5 days of unprotected intercourse. The only approved indication for LNG-intrauterine devices containing less than 52 mg LNG (e.g., LCS12, Kyleena) is contraception. Study design, size, duration EURAS-LCS12 is an ongoing prospective, non-interventional cohort study with active surveillance in ten European countries (Austria, Czech Republic, Spain, Sweden, Finland, Poland, Germany, United Kingdom, Italy, and France). Participants/materials, setting, methods Women (N = 77,088) with a newly inserted hormonal or copper IUD (i.e., LCS12, Kyleena, Mirena, copper IUD) were enrolled between 2014 and 2021 (planned interim stage). Information on reasons for IUD use was collected from the inserting health care professional, and multiple answers were possible. In 2016 the inclusion criteria were restricted to women below the age of 40 years. Main results and the role of chance The most common reason for IUD use was birth control in all four cohorts (98.3% of LCS12, 98.4% of Kyleena, 93.4% of Mirena and 98.9% of copper IUD users). For LCS12, Kyleena and Mirena, heavy menstrual bleeding was reported as most frequent additional reason (9.0%, 11.6%, and 24.9%, respectively). Of all Mirena users, 5.5% received the prescription solely for the treatment of heavy menstrual bleeding without a need for contraception. For copper IUDs, emergency contraception was the most frequently reported additional reason in 2.2% of the women. There were differences with respect to country: In Italy, Austria, Spain, and France LCS12 and Kyleena were also prescribed for heavy menstrual bleeding with frequencies between 20% and 33%. The overall proportion for menorrhagia indication in Mirena users were in the ranges from 10% (Germany) to 58% (Italy). Copper IUDs were primarily used for contraception indications (98% to 100% across all countries). The rates for heavy menstrual bleeding as a reason for copper IUD use remained below 1% across all countries. The United Kingdom revealed the highest rate for emergency contraception usage in copper IUD users among all countries (i.e., 7%), followed by Germany with 2%. Limitations, reasons for caution The cohort is mainly limited to women below the age of 40 years. Frequencies of reasons for IUD use beyond contraception, especially with respect to heavy menstrual bleeding might differ in women of higher age. Wider implications of the findings Mirena is frequently used for its additional approved indication (i.e., menorrhagia). LCS12 and Kyleena are used for menorrhagia in addition to contraception, especially in Italy, Spain and Austria. It remains to be evaluated whether also low-dose LNG-IUDs are effective in treating idiopathic menorrhagia. Trial registration number NCT02146950

Expanding long-acting contraceptive options: a prospective cohort study of the hormonal intrauterine device, copper intrauterine device, and implants in Nigeria and Zambia

SummaryBackground30 years after the introduction of the levonorgestrel-releasing intrauterine device in Europe, several sub-Saharan African countries are seeking to broaden access to this contraceptive method. In this study, we aimed to assess 12-month continuation of the hormonal intrauterine device, copper intrauterine device, and implants, as well as to assess women's experiences and satisfaction using these methods in the private sector in Nigeria and the public sector in Zambia.MethodsWe did a prospective cohort study of long-acting reversible contraceptive users across 40 private sector clinics in Nigeria and 21 public sector clinics in Zambia. Eligible women were aged 18–49 years in Nigeria and 16–49 years in Zambia, had chosen to receive the hormonal intrauterine device, copper intrauterine device, or implant (either a 5-year levonorgestrel-releasing subdermal implant or a 3-year etonogestrel-releasing subdermal implant), and, in Nigeria only, had access to a telephone. Women were interviewed within 100 days of receiving their contraceptive method either via telephone in Nigeria or in person in Zambia, with follow-up surveys at 6 months and 12 months. The primary outcomes were method-specific, 12-month continuation rates—ie, continuation rates of the hormonal intrauterine device, copper intrauterine device, and implant across Nigeria and Zambia. We used Kaplan-Meier methods to estimate the cumulative probabilities of method-specific continuation and a log-rank test to compare contraceptive methods. We analysed self-reported satisfaction and experiences as a secondary outcome.FindingsBetween June 25 and Nov 22, 2018, we enrolled a total of 1542 women (n=860 in Nigeria and n=682 in Zambia) receiving a long-acting reversible contraceptive. In total, 835 women (266 [32%] hormonal intrauterine device users, 274 [33%] copper intrauterine device users, and 295 [35%] implant users) in Nigeria and 367 (140 [38%] hormonal intrauterine device users, 149 [40%] copper intrauterine device users, and 78 [21%] implant users) in Zambia were included in the study analysis. The 12-month cumulative continuation rates were 86·8% (95% CI 82·1–90·4) for the hormonal intrauterine device, 86·9% (82·1–90·4) for the copper intrauterine device, and 85·0% (80·2–88·7) for implants in Nigeria. In Zambia, the 12-month cumulative continuation rates were 94·7% (89·2–97·4) for the hormonal intrauterine device, 89·1% (82·3–93·4) for the copper intrauterine device, and 83·1% (72·2–90·1) for implants. At least 71% of respondents across the timepoints were very satisfied with their method, and at least 55 (79%) of 70 reported having recommended their contraceptive method to someone else. Across the methods, the most commonly self-reported positive aspect of long-acting reversible contraceptive use at 12 months was effectiveness in Nigeria (range 93–94%) and long-lasting duration in Zambia (48–60%). Between 124 (50%) of 248 and 136 (59%) of 230 Nigerian participants and 26 (42%) of 62 and 66 (57%) of 117 Zambian participants reported nothing negative about their contraceptive method.InterpretationOur study showed high continuation rates and satisfaction across long-acting reversible contraceptives, including the hormonal intrauterine device, a method that has been largely underused in sub-Saharan Africa. This finding supports the inclusion of the hormonal intrauterine device as a valuable addition to the mix of contraceptive methods in Nigeria and Zambia.FundingBill & Melinda Gates Foundation.

Rates of pregnancy among levonorgestrel and copper intrauterine emergency contraception initiators: Implications for backup contraception recommendations

ObjectiveThis study assessed the timing, frequency, use of backup method and 1-month pregnancy rates among individuals who had an intrauterine device (IUD) placed as emergency contraception and reported intercourse within 7 days post-placement. Study DesignIn this secondary analysis of a randomized control trial of IUDs for emergency contraception, 518 individuals reporting unprotected intercourse in the preceding 5 days had a 52 mg levonorgestrel intrauterine system (IUS) or 380 mm2 copper IUD placed outside the first week of their menstrual cycle. All participants were advised to use backup contraception for 7 days. We assessed pregnancy status 1 month after placement by urine testing or, when not available, by survey responses and electronic health record review. Participants reported whether their first sexual activity after device placement occurred within 7 days of their placement, the frequency of intercourse and whether they used backup contraception. ResultsRapid return to sexual activity was common and use of backup contraception was rare, regardless of type of IUD placed. Of participants who resumed penile-vaginal intercourse in the first month, most (286/446, 64.1%) participants reported intercourse within 7 days of IUD placement; only 16.4% (74/446) used condoms or withdrawal. No pregnancies occurred among users of the levonorgestrel IUS who reported intercourse within 7 days of placement (0/138, 0.0%, 95% CI 0.0%, 2.6%) nor among users of the 380mm2 copper IUD (0/148, 0.0%, 95% CI 0.0%, 2.5%). ConclusionPregnancy rates are low after placement of an IUD for emergency contraception, even among the many who resume intercourse within days following IUD placement without use of backup contraception. ImplicationsClinical guidelines should facilitate access to contraception, including elimination of unnecessary recommendations for backup contraception or abstinence in the 7 days following 52 mg levonorgestrel intrauterine system.

Copper IUD continuation, unwanted effects and cost consequences at 1 year in users aged under 30 – a secondary analysis of the EURAS-IUD study

Objective To conduct a secondary analysis of continuation, unwanted effects and cost consequences at 1 year in copper intrauterine device (IUD) users aged under 30 in the European Active Surveillance Study for Intrauterine Devices (EURAS-IUD study) based on IUD type. Methods Descriptive and comparative analyses of copper IUD continuation, unwanted effects and estimated cost consequences at 1 year were performed in users aged under 30 based on IUD copper surface area, shape or design, width and arms’ flexibility. Results 5796 copper IUD users were identified to have been aged under 30 at EURAS-IUD study recruitment and data for 5762 users (99.4%) was analysed. Higher IUD continuation, fewer unwanted effects and lower costs were observed with IUDs of the lowest copper content (<300mm2), horse-shoe frame design, widths 18 mm to <30mm and flexible IUD arms. Discontinuation, unwanted effects and costs were greater with frameless IUDs and framed, ≥30mm width IUDs with 380mm2 of copper and copper bands on their rigid transverse IUD arms. Conclusions Significant differences in continuation, reported unwanted effects and estimated costs at 1 year between IUD types were observed in users aged under 30. Although further research is needed, clinicians should consider these findings when counselling and choosing IUD types for younger women.

Does last contraceptive method used impact the return of normal fertility?

Yes, according to a prospective observational study of more than 17,000 women that evaluated fecundability after stopping contraception. The authors found hormonal intrauterine device (IUD) users had slightly increased fecundability compared with users of barrier methods. There was no difference in fecundability for users of copper IUDs, implant, oral contraception, patches, rings, or natural methods compared with barrier methods. Users of injectable contraceptives experienced the longest delay in return of normal fertility, about 5 to 8 menstrual cycles.

Free-of-charge long-acting reversible contraception: two-year discontinuation, its risk factors, and reasons

Since 2013, the residents of the city of Vantaa, Finland, have been offered their first long-acting reversible contraceptive method (levonorgestrel-releasing intrauterine system, implant, and copper intrauterine device) free of charge. The primary aim of this study was to assess the 2-year cumulative discontinuation rates of long-acting reversible contraceptive methods when provided free of charge for first-time users in a real-world setting. Additional aims were to describe factors associated with discontinuation and to evaluate the reasons for discontinuation. This is a retrospective register-based cohort study of 2026 nonsterilized women aged 15 to 44 years, who initiated a free-of-charge long-acting contraceptive method in 2013-2014 in the city of Vantaa. Removals within 2 years after method initiation and reasons for discontinuation were obtained from electronic health records and from national registers. We calculated the 2-year cumulative incidence rates of discontinuation with 95% confidence intervals for each method. Furthermore, we assessed crude and adjusted incidence rate ratios of discontinuation with 95% confidence interval by Poisson regression models comparing implants and copper intrauterine device with levonorgestrel-releasing intrauterine systems. During the 2 -year follow-up, 514 women discontinued, yielding a cumulative discontinuation rate of 28.3 per 100 women-years (95% confidence interval, 26.2-30.4). Among the 1199 women who initiated the levonorgestrel-releasing intrauterine system, the cumulative discontinuation rate was 24.2 per 100 women-years (95% confidence interval, 21.7-26.9); among the 642 implant users, 33.3 per 100 women-years (95% confidence interval, 29.5-37.4); and among the 185 copper intrauterine device users, 37.8 per 100 women-years (95% confidence interval, 31.0-45.7). Compared with women aged 30 to 44 years, women aged 15 to 19 years (adjusted incidence rate ratio, 1.58; 95% confidence interval, 1.17-2.14) and 20 to 29 years (adjusted incidence rate ratio, 1.35; 95% confidence interval, 1.11-1.63) were more likely to discontinue. We observed a higher discontinuation rate in women who had given birth within the previous year (adjusted incidence rate ratio, 1.36; 95% confidence interval, 1.13-1.65), spoke a native language other than Finnish or Swedish (adjusted incidence rate ratio, 1.31; 95% confidence interval, 1.06-1.63), and had a history of a sexually transmitted infection (adjusted incidence rate ratio, 1.62; 95% confidence interval, 1.07-2.46). No association was found in marital status, overall parity, history of induced abortion, socioeconomic status, education level, or smoking status. The most common reason for discontinuation was bleeding disturbances, reported by 21% of women who discontinued the levonorgestrel-releasing intrauterine system, by 71% who discontinued the implant, and by 41% who discontinued the copper intrauterine device. One in 4 women who discontinued the copper intrauterine device reported heavy menstrual bleeding, whereas only 1% who discontinued the levonorgestrel-releasing intrauterine system and none who discontinued implants reported this reason. Abdominal pain was the reported reason for discontinuation in 20% of both intrauterine device users and in only 2% who discontinued implants. At 2 years, the use of implants and copper intrauterine devices was more likely to be discontinued than that of the levonorgestrel-releasing intrauterine system. Women younger than 30 years and those who gave birth in the preceding year, spoke a native language other than Finnish or Swedish, or had a history of sexually transmitted infections were more likely to discontinue. The levonorgestrel-releasing intrauterine system was least likely to be removed owing to bleeding disturbances.

Menstrual Cup Use and Intrauterine Device Expulsion in a Copper Intrauterine Device Contraceptive Efficacy Trial [OP01-1B

INTRODUCTION: Menstrual cup use for menstrual hygiene is increasingly popular. We evaluated relationship of menstrual cup use and intrauterine device (IUD) expulsion in a prospective trial of two copper IUDs. METHODS: An ongoing 3-year contraceptive efficacy trial randomized women to one of two copper IUDs, with successful placement in 1,092 women. Institutional Review Board approval was obtained, and all subjects provided informed consent. Follow-up visits in the first year occurred at 6 weeks, and then 3, 6, and 12 months after insertion. At nine months after initiating enrollment, we modified the protocol to advise subjects against concurrent menstrual cup use with the IUD. We evaluated the association of menstrual cup use and expulsion risk over the first 24 months of study conduct. RESULTS: Overall, 266 (24.4%) women reported menstrual cup use. At 24 months after initiating enrollment, 46 (17.3%) cup users and 43 (5.2%) non-users experienced expulsion (odds ratio 3.81 [95% CI 2.45-5.92]). Fourteen (30.4%) menstrual cup users with expulsion reported the event occurred during menstrual cup removal. At Year 1 of the study, expulsion rates among menstrual cup users and non-users were 14.3% and 4.7%, respectively (P&lt;.001). By the end of Year 2, these rates were 23.2% and 6.5% (P&lt;.001). CONCLUSION: We found higher than expected IUD expulsion rates in menstrual cup users amongst participants in a prospective trial of two copper IUDs. Copper IUD users should be cautioned that concurrent menstrual cup use increases the risk of IUD expulsion and expulsion risk continues with ongoing menstrual cup use.

Relative Risk of Cervical Neoplasms Among Copper and Levonorgestrel-Releasing Intrauterine System Users.

To evaluate the relative risk of cervical neoplasms among copper intrauterine device (Cu IUD) and levonorgestrel-releasing intrauterine system (LNG-IUS) users. We performed a retrospective cohort analysis of 10,674 patients who received IUDs at Columbia University Medical Center. Our data were transformed to a common data model and are part of the Observational Health Data Sciences and Informatics network. The cohort patients and outcomes were identified by a combination of procedure codes, condition codes, and medication exposures in billing and claims data. We adjusted for confounding with propensity score stratification and propensity score 1:1 matching. Before propensity score adjustment, the Cu IUD cohort included 8,274 patients and the LNG-IUS cohort included 2,400 patients. The median age for both cohorts was 29 years at IUD placement. More than 95% of the LNG-IUS cohort used a device with 52 mg LNG. Before propensity score adjustment, we identified 114 cervical neoplasm outcomes. Seventy-seven (0.9%) cervical neoplasms were in the Cu IUD cohort and 37 (1.5%) were in the LNG-IUS cohort. The propensity score matching analysis identified 7,114 Cu IUD and 2,174 LNG-IUS users, with covariate balance achieved over 16,827 covariates. The diagnosis of high-grade cervical neoplasia was 0.7% in the Cu IUD cohort and 1.8% in the LNG-IUS cohort (2.4 [95% CI 1.5-4.0] cases/1,000 person-years and 5.2 [95% CI 3.7-7.1] cases/1,000 person-years, respectively). The relative risk of high-grade cervical neoplasms among Cu IUD users was 0.38 (95% CI 0.16-0.78, P<.02) compared with LNG-IUS users. By inspection, the Kaplan-Meier curves for each cohort diverged over time. Copper IUD users have a lower risk of high-grade cervical neoplasms compared with LNG-IUS users. The relative risk of cervical neoplasms of LNG-IUS users compared with the general population is unknown.

Elevated risk of bacterial vaginosis among copper intrauterine device users: a prospective cohort analysis

Elevated risk of bacterial vaginosis among copper intrauterine device users: a prospective cohort analysis

A prospective cohort study comparing expulsion after postplacental insertion: the levonorgestrel versus the copper intrauterine device

ObjectivesTo compare the expulsion rate at 6 months after postplacental insertion by intrauterine device (IUD) type. Study designThis prospective cohort included participants with a postplacental IUD inserted after vaginal or cesarean delivery, aged 18–45 and ≥24 weeks’ gestation. Study enrollment took place after IUD selection and insertion. Participants returned for a postpartum visit and received a short message service survey regarding IUD expulsion, removal, vaginal bleeding and breastfeeding weekly from weeks 0 to 5 and on weeks 12 and 24 postpartum. Multivariable logistic regression examined 6-month expulsion rate by IUD type adjusting for variables that differed between the groups at baseline and in the bivariate analyses. ResultsOf 114 participants, 75 (65.8%) chose a levonorgestrel 52-mg IUD and 39 (34.2%) chose a copper IUD; 58 (50.9%) had a vaginal delivery, and 56 (49.1%) had a cesarean delivery. Groups were similar except that copper IUD users had a higher median parity (3 vs. 2, p=.03) and a higher proportion of senior residents compared to junior residents had performed insertion (46.2% vs. 22.7%, p=.02). The expulsion rate at 6 months was similar between the levonorgestrel and copper groups (26.7% and 20.5%, respectively; p=.38). Multivariable logistic regression also demonstrated that the odds of expulsion did not differ by IUD type (adjusted odds ratio 0.98, 95% confidence interval 0.22–4.48). ConclusionThe expulsion rate at 6 months after postplacental insertion did not differ between the levonorgestrel and copper IUD type. ImplicationsPrior studies demonstrate a wide range of expulsion after postplacental insertion, and recent data suggest a higher expulsion rate for the levonorgestrel compared to the copper intrauterine device. However, many studies did not control for patient-level factors or delivery route. We found that when controlling for these confounding variables, the expulsion rate at 6 months postpartum did not differ by intrauterine device type.

Acquisition of Sexually Transmitted Infections among Women Using a Variety of Contraceptive Options: A prospective Study among High-risk African Women.

IntroductionIn many African settings, women concurrently face substantial risk of human immunodeficiency virus type 1 (HIV‐1) infection, sexually transmitted infections (STIs) and unintended pregnancies. Few studies have evaluated STI risk among users of hormonal implants and copper intrauterine devices (IUDs) although these long‐acting reversible contraceptive methods are being promoted widely because of their benefits. Within a prospective study of women at risk for HIV‐1, we compared the risk of acquisition of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis among women using different contraceptive methods.Methods MTN‐020/ASPIRE was a randomized trial of the dapivirine vaginal ring for HIV‐1 prevention among 2629 women aged 18 to 45 years from Malawi, South Africa, Uganda and Zimbabwe, of whom 2264 used copper IUDs or progestin‐based injectables or implants during follow‐up. Screening for the above STIs occurred semi‐annually.ResultsOver 3440 person‐years of follow‐up, 408 cases of C. trachomatis (incidence 11.86/100 person‐years), 196 of N. gonorrhoeae (5.70/100 person‐years) and 213 cases of T. vaginalis (6.19/100 person‐years) were detected. C. trachomatis and N. gonorrhoeae incidence were not significantly different across contraceptive methods. T. vaginalis incidence was significantly higher for copper IUD users compared to depot medroxyprogesterone acetate (DMPA), implant and norethisterone enanthate users.ConclusionAmong African women at high HIV‐1 risk, STIs were common. Risk of cervical infections did not differ across contraceptive methods. Significantly higher rates of T. vaginalis were observed among progestin‐based methods compared to copper IUD users. Overall, these findings call for more intensive routine screening for STIs, and they support current World Health Organization guidance that women should have a wide range of contraceptive options.

Discontinuation Rates among Copper Intrauterine Device Users in Primary Healthcare Unit and University Clinic. Is There a Difference?

Background: in Egypt, despite the high percentage of women using IUD according to Demographic and Health Surveys (DHS) 2014 (52.9%) of total women using contraceptive methods, the discontinuation rates among Cu-IUD users (within 12 months of use) reaches 14.3% in 2014. Aim of the Work: the aim of the study was to compare between primary health care unit and university family planning clinic in discontinuation rate among copper IUD users. Patients and Method: study design: prospective analytical observational study. Study setting: This study was conducted at Family planning Outpatient clinic of Ain Shams Maternity Hospital and El-Zahraa primary health care unit for a year. This study included 260 women whom attending family planning clinic for Cu- IUD insertion. Total 100 subjects was enrolled from each clinic. Rest of subjects was lost on follow up either after 6 months or 12 months. Some others refused to participate or gave wrong personal contacts. Results: preliminary results of the study revealed that there is no statistically significant difference between discontinuation rate among Copper IUD users in university clinic and primary healthcare clinic (p-value = 0.095). Conclusion: in our Study, analysis of data revealed that age, parity and previous usage of IUD may affect discontinuation rate after 12 months of IUD use. The mean cause of IUD discontinuation was bleeding and Anemia was present in 66.6% of patients complaining from bleeding.