Cu-IUD Users Research Articles

Female genital tract host factors and tenofovir and lamivudine active metabolites.

We previously reported the effect of contraception on cervical tenofovir concentrations in Ugandan women living with HIV. Here we explored the role of cervicovaginal cytokines and drug metabolizing enzymes and transporters (DMETs) to elucidate FGT drug disposition in a Ugandan cohort. Cervicovaginal fluid and cervical biopsies were collected from Ugandan women living with HIV receiving tenofovir/lamivudine-based therapy and intramuscular depot medroxyprogesterone acetate (DMPA-IM; n=25), copper IUD (cuIUD; n=12), or condoms (n=13) as contraception. Cytokines were measured in cervicovaginal fluid (CVF). Ectocervical tenofovir diphosphate (TFVdp) and lamivudine triphosphate (3TCtp), dATP/dCTP concentrations, and immune marker/DMETs gene expression were measured in cervical biopsies. Cervical 3TCtp was not correlated with any CVF cytokines. Cervical TFVdp was correlated with IL-10, IL-7, and IL-17 in CVF. CCR5 mRNA expression in cervical biopsies was higher in cuIUD-users versus condoms-users. Using multivariable linear regression, CVF IL-17, tissue dATP, plasma estradiol, and plasma tenofovir were all significant predictors of cervical TFVdp. Tissue dCTP and plasma lamivudine were significant predictors of cervical 3TCtp. TFVdp concentrations in cervix appear to be influenced by local inflammation. In contrast, 3TCtp FGT exposure was not affected by genital inflammation or DMETS. CuIUD users have more immune cells present, which may in turn influence local TFVdp disposition.

Effects of intrauterine device use on attack frequency and severity ın woman of reproductive age with familial Mediterranean fever.

Familial Mediterranean fever (FMF) is the most common inherited autoinflammatory disease in the world. There are known triggers to initiate an FMF attack, yet potential effects of intrauterine devices (IUD) in women of reproductive age have not been evaluated before. Consecutive female patients with FMF who ever used IUD over the age of 18 were enrolled. Female patients with FMF were sub grouped according to the type of IUD they use. FMF attack frequency, severity, duration, presence of dysmenorrhea, severity of dysmenorrhea, having attacks during menstruation before and after IUD use were questioned. Demographic and clinical data were collected from hospital database. When all patients with IUD use were evaluated, it was found that the frequency of attacks increased after IUD insertion at 3rd and 12th months (median [min-max] attack frequency at 3rd month, 1 (0-3) vs 1 (0-6), p = 0.002, median [min-max] attack frequency at 12th month, 2 (0-12) vs 3.5 (0-18), p = 0.028). Attack severity measured by VAS pain was also significantly increased. Attack duration and menstrual pain was similar before and after IUD use. Attack frequency at 3rd and 12th months, attack severity and menstrual pain was all increased significantly in Cu-IUD users, whereas none of these parameters deteriorated in LNG-IUD group. IUD use, especially Cu-IUD, may increase the frequency and severity of attacks in female patients with FMF. Clinicians may benefit from considering LGN-IUD if IUDs are preferred as contraception in women of childbearing age with FMF.

Effects of intrauterine devices on female sexual function: a cross-sectional study

Objectives: To examine the differences in sexual functions between women using copper intrauterine device (Cu-IUD) and levonorgestrel intrauterine system (LND-IUS). Methods: A total of 125 women between the ages of 20 and 40 were included in the study. The demographic data of all participants were recorded. Female Sexual Function Index (FSFI) was performed to all participants. Study participants were divided into 3 groups; 42 Cu-IUD users, 42 LND-IUS users, and 41 control (not use contraceptive) group, then compared. Women with a total score lower than ≤ 26.5 were considered as having sexual dysfunction. Results: The prevalence of female sexual dysfunction (FSD) was 56.8% among the participants. The total FSFI scores of Cu-IUD and LNG-IUS groups were similar. Moreover, the FSFI score of both IUD users was lower than the control group, and the difference was statistically significant (p < 0.001). The presence of Cu-IUD affected arousal more than pain, satisfaction, lubrication and orgasm scores (p = 0.016). Pain score was similar among IUD groups and significantly lower than controls (p < 0.001). Moreover, orgasm and satisfaction scores were found to be significantly higher in the control group than in the both IUD groups (p < 0.001). All of three groups were also similar about desire and lubrication domains of FSFI. Conclusions: In conclusion, this study found that Cu-IUD and LNG-IUS users did not differ in terms of sexual function according to scores calculated by FSFI.

Discontinuation rates of intrauterine contraception due to unfavourable bleeding: a systematic review

ObjectiveLevonorgestrel-releasing intrauterine devices (LNG-IUDs) and copper intrauterine devices (Cu-IUDs) offer long-acting contraception; however, some women may discontinue use within the first year due to bleeding pattern changes, limiting their potential. This systematic literature review investigated whether differences in bleeding profiles influence continuation rates in women in America, Europe and Australia.MethodsSearches performed in PubMed and Embase were screened to identify publications describing bleeding patterns and rates of early IUC removal/discontinuation or continuation, descriptions of bleeding patterns, reasons for discontinuation, and patient satisfaction, acceptability and tolerability for LNG-IUDs and Cu-IUDs published between January 2010 and December 2019. The results were further restricted to capture citations related to ‘Humans’ and ‘Females’. The review was limited to studies published from 2010 onwards, as changing attitudes over time mean that results of studies performed before this date may not be generalizable to current practice.ResultsForty-eight publications describing 41 studies performed principally in the USA (n = 17) and Europe (n = 13) were identified. Publications describing bleeding patterns in LNG-IUD users (n = 11) consistently observed a reduction in bleeding in most women, whereas two of three studies in Cu-IUD users reported heavy bleeding in approximately 40% of patients. Rates of discontinuation for both devices ranged widely and may be as high as 50% but were lower for LNG-IUDs versus Cu-IUDs. Discontinuation rates due to bleeding were consistently higher for Cu-IUDs versus LNG-IUDs.ConclusionsBleeding is a common reason for discontinuation of Cu-IUDs and LNG-IUDs. The more favourable bleeding pattern observed in LNG-IUD users may be associated with a lower rate of early discontinuation of LNG-IUDs versus Cu-IUDs.

Associations of MCM8 rs3761873 and rs16991617 variants with abnormal uterine bleeding induced by copper intrauterine device.

Intrauterine device (IUD) is a commonly used contraceptive method worldwide. Abnormal uterine bleeding (AUB) is one of the most common side effects of Cu-IUDs. Since AUB varies among Cu-IUD users, changes in the bleeding-related genetic factors may contribute to AUB. This study aimed to determine the genetic risk factors of AUB after Cu-IUD insertion. We conducted a case-control study on women who experienced AUB after Cu-IUD insertion (case:control=62:59). Six candidate variants were genotyped using the Sequenom MassARRAY. Genotype and allele frequencies were analyzed using SHEsisPlus. We performed Pearson's Chi-squared test to analyze categorical data, and ESEfinder to predict the impact on splicing regulation. MCM8 coding sequence variants: rs3761873-A>C was in Exon 7 and rs16991617 A>G was in Exon 12 of all 19 exons, both of which were significantly different between cases and controls (pallele =0.039 and pgenotype =0.092). rs6022 and rs6029 in F5 gene and rs3761873 and rs16991617 in the MCM8 gene showed strong linkage disequilibrium (R2 > 0.8). ESEfinder indicated that the variants of MCM8 may affect the splicing regulation. MCM8 rs376187 and rs16991617 were associated with AUB in Cu-IUDs users. MCM8 may play a role in AUB by regulating functions of reproductive organs and primary ovarian insufficiency. Our findings may improve the understanding of the genetic basis of AUB caused by Cu-IUDs.

Does Obesity Influence Body Mass Index Changes in Nulliparous Adolescent Users of Long-Acting Reversible Contraceptives?

To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), specifically, the etonogestrel subdermal implant (ENG-implant), levonorgestrel intrauterine device (LNG-IUD), and copper IUD (Cu-IUD), by initial BMI category from the time of LARC insertion to within 6-18 months after insertion. This was a single-center retrospective cohort study. We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth. BMI change from LARC insertion to first BMI documented after 6-18 months RESULTS: Mean age was 17.2 ± 0.2 years; 59% of the cohort was Hispanic and 29% Black. Mean BMI was 26.4 ± 7.1 kg/m2. Of the total cohort of adolescents, 51% were underweight/normal, 24% overweight, and 25% obese. Mean time to first BMI documented after LARC insertion was 10.1 ± 3.2 months. Mean BMI change for the total cohort was +0.73 ± 1.8 kg/m2, indicating weight gain. Mean BMI change for the ENG-implant+LNG-IUD users (n=127) was larger than for Cu-IUD users (n=69) (+0.92 ± 1.9 kg/m2 vs +0.37 ± 1.6 kg/m2, respectively, P < .05). Two-way analysis of variance showed that both initial BMI category (P=.001) and type of LARC (P=.011) had an independent significant main effect on BMI change. A significant interaction effect (P=.017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC, either ENG-implant or LNG-IUD, as compared to a Cu-IUD (P < .05). Adolescents using progestin-releasing LARCs had a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs was primarily contributed by obese users.

Female sexual function in women using LARC methods

Objective This study aims to assess sexual function (SF) and quality of life (QoL) among women using copper intrauterine devices (Cu-IUD), levonorgestrel-releasing intrauterine system (LNG-IUS) or etonogestrel(ENG)-releasing subdermal implant. Methods This is a cross-sectional study involving 213 women who are sexually active, using Cu-IUD, LNG-IUS or ENG implant for at least one year. SF assessment was carried out through the Female Sexual Function Index (FSFI) and QoL was made through The Short Form Health Research. Results Frequency of sexual dysfunction score in Cu-IUD users was 33.8%; 47.2% in LNG-IUS users and 47.8% in ENG-implant users, without difference between groups. Desire domain had higher score in Cu-IUD users (Cu-IUD:4.20 ± 1.15 × LNG-IUS:3.76 ± 1.17 × ENG-implant:3.63 ± 1.15; p = .009). Between Cu-IUD and LNG-IUS users there was no difference in FSFI score. Total FSFI score was higher in Cu-IUD group when compared only to ENG-implant (Cu-IUD:27.48 ± 6.14 × Implant:25.07 ± 6.89; p = .029). Regarding the QoL score, difference was found only in general health domain (Cu-IUD:65.22 ± 14.91 × LNG-IUS:62.61 ± 19.04 × Implant:58.33 ± 16.46; p = .034), with lower score for implant group. Conclusion There was no difference in the SF total score between the users of Cu-IUD, LNG-IUS and ENG implant. However, the score of the FSFI desire domain and general health status were higher among users of the Cu-IUD.

POSTER ABSTRACTS: P51 COPPER LEVELS IN CERVICAL MUCUS OF COPPER INTRAUTERINE DEVICE USERS VERSUS NONUSERS

Objectives: Current approaches rely on imaging studies or invasive exploratory exams to confirm a copper intrauterine device (Cu-IUD) when strings are missing. However, Cu-IUD devices release measurable copper (Cu) into the reproductive tract. Our study objective was to determine whether Cu levels in cervical mucus could be used to discriminate between Cu-IUD users and nonusers.

Weight change among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception did not influence early discontinuation.

A recent study published in EClinicalMedicine by Mags Beksinska and colleagues reported findings from a large randomised trial conducted in four Sub-Saharan African countries to assess weight variations among users of levonorgestrel-contraceptive implant [LNG-implant], depot medroxyprogesterone acetate [DMPA] injection, both contraceptives without estrogen, and the copper-intrauterine device [Cu-IUD]. Follow up was from baseline to 18 months after initiation of use. The results evidenced that DMPA injection and LNG-implant users gained 3.5 and 2.4 kg, respectively, compared to 1.5 kg among Cu-IUD users [1].

Zim CHIC: A cohort study of immune changes in the female genital tract associated with initiation and use of contraceptives.

ProblemContraceptive hormones are systemically active, potent, and likely to invoke biological responses other than known fertility regulation impacts. We hypothesized that initiation of depot medroxyprogesterone acetate (DMPA) would increase genital HIV‐target‐cells and soluble immune mediators compared with baseline and initiation of other contraceptive methods.Method of StudyWe collected cervical cytobrushes and cervicovaginal fluid from healthy Zimbabwean women aged 18‐34 to assess immune cell populations, cytokines, and innate anti‐HIV activity at baseline and after 30, 90, and 180 days use of DMPA (n = 38), norethisterone enanthate (n = 41), medroxyprogesterone acetate/estradiol cypionate (n = 36), levonorgestrel implant (n = 43), etonogestrel implant (n = 47), or copper intrauterine device (Cu‐IUD) (n = 45). Cells were quantified by flow cytometry, cytokines were detected by multiplex assays, and innate anti‐HIV activity was assessed by in vitro HIV challenge.ResultsCompared to baseline, the number of cervical HIV target cells (#CD4 cells P < .04 and #CD11c cells P < .04), the concentration of the inflammatory cytokine IL‐1β (P < .01), and the innate in vitro anti‐HIV activity (P < .001) significantly decreased following DMPA initiation. In Cu‐IUD users, genital HIV target cells increased (#CD4 cells P < .001, #CD4CCR5 cells P = .02, #CD4CD69 cells P < .001, #CD8CD69 P = .01, and #CD11c cells P = .003) at day 30 and resolved by day 180. IFN‐γ (P < .001), IL‐1β (P < .001), IL‐6 (P < .001), IL‐8 (P < .001), IL‐10 (P < .01), and RANTES (P < .001) were also significantly increased at day 30. Minimal alterations were observed following initiation of subdermal implantable contraceptives.ConclusionsThis head‐to‐head study compared six contraceptives and found increased HIV target cells and cervical inflammation temporally associated with Cu‐IUD initiation. Use of hormonal contraception, including DMPA, did not increase cervical HIV target cells or inflammation.Clinical Trial Number: NCT02038335

Elevated Risk of Bacterial Vaginosis Among Users of the Copper Intrauterine Device: A Prospective Longitudinal Cohort Study.

Limited evidence suggests that the nonhormonal contraceptive copper intrauterine device (Cu-IUD) may increase bacterial vaginosis (BV) risk, possibly due to increased volume and duration of menses, a common side effect of Cu-IUD use. Although increases in bleeding typically resolve within 6-12 months following initiation, evaluations of the association between Cu-IUD and BV have not included more than 6 months of follow-up. This secondary analysis of a human immunodeficiency virus type 1 prevention trial included 2585 African women ages 18-45 followed for up to 33 months. Women reported contraceptive use each month. BV was evaluated by Nugent score in 6-monthly intervals and, if clinically indicated, by Amsel criteria. Andersen-Gill proportional hazards models were used to (1) evaluate BV risk among Cu-IUD users relative to women using no/another nonhormonal contraceptive and (2) test changes in BV frequency before, while using, and following Cu-IUD discontinuation. BV frequency was highest among Cu-IUD users at 153.6 episodes per 100 person-years (95% confidence interval [CI]: 145.2, 162.4). In adjusted models, Cu-IUD users experienced 1.28-fold (95% CI: 1.12, 1.46) higher BV risk relative to women using no/another nonhormonal contraception. Compared to the 6 months prior to initiation, BV risk was 1.52-fold (95% CI: 1.16, 2.00) higher in the first 6 months of Cu-IUD use and remained elevated over 18 months of use (P < .05). Among women who discontinued Cu-IUD, BV frequency was similar to pre-initiation rates within 1 year. Cu-IUD users experienced elevated BV risk that persisted throughout use. Women and their providers may wish to consider BV risk when discussing contraceptive options.

Differential Effects of the Hormonal and Copper Intrauterine Device on the Endometrial Transcriptome

The contraceptive effectiveness of intrauterine devices (IUDs) has been attributed in part to a foreign body reaction in the endometrium. We performed this study to better understand mechanisms of action of contraceptives of by studying their effects on endometrial and cervical transcriptomes. We collected endometrial and cervical biopsies from women using the levonorgestrel-releasing intrauterine system (LNG-IUS, n = 11), copper intrauterine device (cu-IUD, n = 13) or levonorgestrel-containing combined oral contraceptives (COC, n = 12), and from women not using contraceptives (control group, n = 11). Transcriptional profiling was performed with Affymetrix arrays, Principal Component Analysis and the bioconductor package limma. In endometrial samples from cu-IUD users, there were no genes with statistically significant differential expression compared to controls. In LNG-IUS users, 2509 genes were differentially expressed and mapped predominantly onto immune and inflammatory pathways. The cervical samples showed no statistically significant differential gene expression compared to controls. Hormonal and copper IUDs have significantly different effects on the endometrial transcriptome, with the LNG-IUS transcriptome showing pronounced inflammation and immune activation compared to controls whereas the cu-IUD transcriptome was indistinguishable from luteal phase endometrium. These findings argue against a foreign body reaction as a common mechanism of action of IUDs.

Depot medroxyprogesterone acetate and norethisterone enanthate differentially impact T-cell responses and expression of immunosuppressive markers.

Injectable contraceptive use may impact immune cell responsiveness and susceptibility to infection. We measured responsiveness of T-cells from women before and after initiating depot medroxyprogesterone acetate (DMPA) or norethisterone enanthate (Net-En). Peripheral blood mononuclear cells collected from women aged 18-34years prior to, at steady state, and nadir concentrations after initiating DMPA (n=30) or Net-En (n=36) and from women initiating copper intrauterine device (CU-IUD; n=32) were stimulated with phorbol myristate acetate and analyzed using flow cytometry. We evaluated percentage change in T-cells expressing programmed cell death-1 (PD-1) and cytotoxic T-lymphocyte associated protein-4 (CTLA-4). Compared to baseline, there were decreased numbers of CD4+CTLA4+ (P<.001) and CD8+CTLA4+ (P<.01) T-cells following ex vivo stimulation challenge at steady state DMPA concentrations and no differences at nadir concentrations (P=.781 and P=.463, respectively). In Net-En users, no differences in CD4+CTLA4+ T-cells at steady state (P=.087) and nadir concentrations (P=.217) were observed. DMPA users had fewer CD4+PD-1+ (P<.001) and CD8+PD-1+ (P<.001) T-cells at nadir concentrations. Number of CD4+PD-1+ and CD8+PD-1+ T-cells decreased at steady state concentration (P=.002 and P=.001, respectively) and at nadir concentrations after Net-En initiation (P<.001 and P<.001). In CU-IUD users, there were no changes in number of CD4+CTLA4+ (P=.426) and CD8+CTLA4+ (P=.169) and no changes in CD4+PD-1+ (P=.083) and CD8+PD-1+ (P=.936) compared to baseline. Activation of T-cells in response to ex vivo stimulation is suppressed at steady state DMPA concentration and resolves at nadir concentration, suggesting DMPA immunosuppressive effects may be transient.

A survey of young women’s perceptions of the influence of the Levonorgestrel-Intrauterine System or copper-intrauterine device on sexual desire

ObjectivesFew studies, with contradictory results, evaluate intrauterine contraceptives (IUC) and sexual function specifically. This study compares perception of sexual desire related to IUC use and aspects of sexual function in women who use the Lng-IUS with those using the Cu-IUD. Study designA secondary analysis regarding IUC use based on a larger cross-sectional survey of contraceptive use in Sweden, conducted in 2013. In total, 153 IUC users (103 Cu-IUD and 50 Lng-IUS users) answered the questionnaire. The only inclusion criterion was intrauterine contraceptive use. Main outcome measuresWere self-reported sexual desire changes related to contraceptive method. We also analysed aspects of sexual functioning; sexual desire level, sexual activity, orgasm frequency, satisfaction with sex life and satisfaction of desire level. ResultsA negative effect on sexual desire due to contraceptive method was reported by 28% of the Lng-IUS users and by 10.1% of the Cu-IUD users (p < 0.05). Results were more marked after adjusting for age, body mass index, depression, parity, switching behaviour, and partnership (OR 5.0; CI: 1.8–13.8).The adjusted odds of reporting low sexual desire level (never or almost never feeling sexual desire) (OR 3.5; CI: 1.1–11.2) as well as low satisfaction with sex life (OR 2.7; CI: 1.2–6.3) was higher in the Lng-IUS group (adjusted for same confounders as above). ConclusionsThe women in this study using the Lng-IUS more often report negative sexual desire effects of their contraception as well as lower sexual desire level compared with women using the Cu-IUD.

Effects of a levonorgestrel intrauterine system versus acopper intrauterine device on menstrual changes and uterine arteryDoppler.

To compare the effects of a levonorgestrel-releasing intrauterine system (LNG-IUS) and a copper intrauterine device (Cu-IUD) on menstrual changes and uterine artery Doppler indices. A randomized clinical trial was conducted at Menoufia University Hospital, Egypt, between December 2016 and August 2017. 306 multiparous women desiring intrauterine contraception were randomly assigned to LNG-IUS (n=152) or Cu-IUD (n=154). Uterine artery pulsatility index (PI) and resistant index (RI) were measured before use, and 3 and 6months after insertion, and associations with abnormal bleeding were evaluated. Irregular bleeding was initially reported by 31 (74%) of 42 women in the LNG-IUS group, and heavy menstrual bleeding by 53 (67%) of 79 women in the Cu-IUD group. Incidence of abnormal bleeding decreased over the 6-month study period. Uterine artery PI was significantly correlated with abnormal bleeding at a cutoff of 1.35 with area under the curve (AUC) 0.93, sensitivity 88%, and specificity 100%, whereas uterine artery RI was significantly correlated with abnormal bleeding at a cutoff of 0.62 with AUC 0.1, sensitivity 96%, and specificity 100%. LNG-IUS-related abnormal bleeding was associated with changes in uterine artery blood flow that were not evident among Cu-IUD users. Pan African Clinical Trials Registry: PACTR201701001900640.

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.

Bleeding pattern difference between levonorgestrel intrauterine system and copper intrauterine devices inserted immediately post-abortion: a multicenter, prospective, observational cohort study in Chinese women

Background: To describe the bleeding pattern (primary outcome), side effects, treatment satisfaction and 6 month continuity rates associated with the 52 mg levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (Cu-IUD) inserted immediately after abortion.Methods: This multicenter, prospective, observational cohort study enrolled healthy women (aged ≥18 years) inserted with LNG-IUS or Cu-IUD immediately after first-trimester surgical abortion and followed up to 6 months. Bleeding pattern was obtained through daily patient bleeding diaries.Results: From 2013 to 2014, we enrolled 512 women (LNG-IUS = 312 [median age: 32.0 years] and Cu-IUD = 200 [median age: 30.0 years]) from nine Chinese centers. LNG-IUS resulted in a significantly lower number of bleeding/spotting days in the second 90 day reference period compared with Cu-IUD (median 14.5 vs. 18.0 days, p < .0001). Amenorrhea rate (no bleeding/spotting day in the second 90 day reference period) and no menstrual bleeding rate (absence of bleeding days in the second 90 day reference period) were significantly higher in LNG-IUS compared to Cu-IUD (13.9% vs. 0% and 39.5% vs. 0%; p < .001 for all). No dysmenorrhea was higher at the last follow-up in LNG-IUS users than Cu-IUD users (81.2% vs. 76%; p = .0047). Both treatments had a high satisfaction rate among women at both the follow-up visits, and the majority of them continued with the treatment. The rates of adverse events (e.g. oligomenorrhea, amenorrhea) in the LNG-IUS and Cu-IUD groups were 77.2% and 44.5% (p < .0001), respectively.Conclusion: LNG-IUS post-abortion shows better bleeding patterns, and reduced dysmenorrhea and bleeding amount, but with a similar safety profile compared with Cu-IUD.ClinicalTrials.gov identifier: NCT01958684

User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women.

Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception. To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation. Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation. Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred. Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.

Breastfeeding and infant growth parameters among a prospective cohort of Malawian women who underwent immediate postpartum implant or copper intrauterine device insertion

Objectives: We aimed to compare 3-month postdelivery breastfeeding and infant growth parameters between women who underwent immediate postpartum implant or copper intrauterine device (Cu-IUD) insertion. Methods: This is a secondary analysis of a prospective cohort study of 171 Malawian women who underwent immediate postpartum insertion of the implant or Cu-IUD between September 2014 and March 2015. The study's primary objective was to compare contraceptive continuation rates between implant and Cu-IUD users 1 year postdelivery. For this secondary analysis, we used Fisher's Exact Test and t tests to compare the breastfeeding and infant growth parameters of women with a singleton pregnancy and live infant at their 3-month postdelivery survey. Results: Some 122 women (71%) completed the 3-month postdelivery survey, and 108 women (61%) were eligible for this secondary analysis: 10 Cu-IUD and 98 implant users. All women (100%) reported that they were breastfeeding, with no significant difference in exclusive breastfeeding (90% for Cu-IUD vs. 93% for implant, p=.55). There were also no significant differences in infant weight (6.3 kg for Cu-IUD vs. 6.2 kg for implant, p=.69), length (60.8 cm for Cu-IUD vs. 59.6 cm for implant, p=.42) or head circumference (40.9 cm for Cu-IUD vs. 41.2 cm for implant, p=.74). Conclusions: Almost all women were still exclusively breastfeeding at 3 months postdelivery, with no differences in infant growth between implant and Cu-IUD users, although sample size limited our power. The high rate of exclusive breastfeeding at 3 months in both groups suggests that both options should be offered to postpartum women who want to prevent short interpregnancy intervals.

Three-year continuation of long-acting reversible contraceptive methods in a mixed-payer health care setting: a retrospective review

Objectives: As long-acting reversible contraceptive (LARC) method use increases, accurate data on duration of use in clinical practice are needed. We aimed to estimate 3-year continuation for the levonorgestrel (LNG) IUD, copper (Cu) IUD and etonogestrel contraceptive implant in an academic health care system with mixed-payer reimbursement. Methods: This retrospective review assessed University of Utah Healthcare system patients who had an IUD or implant inserted between January 1, 2004 and December 31, 2011. IUD and implant users were identified by ICD-9 and CPT codes. We fitted a multivariable Poisson regression with robust variance estimates to relate patient characteristics to continuation beyond 3 years. Results: We obtained data on 7053 LARC device insertions to assess 3-year continuation. Three-year continuation incidences were 70.6%, 67.3% and 56.2% for the LNG-IUD, Cu-IUD and implant, respectively. Cu-IUD and LNG-IUD continuation did not differ significantly; however, both LNG-IUD and Cu-IUD users had a significantly higher 3-year continuation incidence than implant users (IRR, 1.19; 95% CI, 1.00–1.41; and IRR, 1.25; 95% CI, 1.09–1.43, respectively). Being older than 30 at insertion increased the incidence of 3-year continuation regardless of device (IRR, 1.10; 95% CI, 1.02–1.18), as did payment out of pocket (IRR, 1.22; 95% CI, 1.04–1.43). White women continued use beyond 3 years more often than non-White women (IRR, 1.12; 95% CI, 1.02–1.23). Ethnicity, parity and year of insertion were not associated with 3-year continuation. Conclusions: Two thirds of both LNG- and Cu-IUD users continued use for 3 years, which is a significantly longer duration than for implant users. Payer type, race and age were associated with 3-year continuation incidences in this population.