Intrauterine Device For Emergency Contraception Research Articles

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.

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.

Emergency contraception from historical myth to modern reality: a historical timeline and updated interpretation

Introduction: Emergency contraception is the use of a birth control method after coitus has taken place and there is a fear that it may lead to a pregnancy. Historical attempts were more likely to be harmful rather than effective. Oral estrogens, progestins, anti-progesterone, and partial agonist/antagonists of progesterone have all been used with varying degrees of efficacy. Currently ethinyl estradiol/levonorgestrel combinations, levonorgestrel alone, ulipristal acetate, and mifepristone are the usual oral methods depending on availability. Copper carrying and more recently levonorgestrel releasing intrauterine devices have also been used successfully. The intrauterine devices appear to be more effective than the oral methods and are also regular contraceptive methods and in addition have therapeutic properties. Background: The evolution from longer duration oral treatments with side effects to the current single tablet of levonorgestrel, ulipristal acetate, or mifepristone with low side effects and reasonable efficacy is described. The role of the highly effective copper intrauterine device and now also the levonorgestrel intrauterine device for emergency contraception is examined. Conclusion: Oral emergency contraception is a short term solution. Expanding emergency contraception to include the levonorgestrel releasing intrauterine device may provide long term contraception and health benefits as well as providing emergency contraception.

O4 The levonorgestrel vs. copper intrauterine device for emergency contraception: A non-inferiority randomized controlled trial

O4 The levonorgestrel vs. copper intrauterine device for emergency contraception: A non-inferiority randomized controlled trial

Copper T380 intrauterine device for emergency contraception: highly effective at any time in the menstrual cycle

Does the efficacy of placing a copper intrauterine device (IUD) for emergency contraception (EC) to prevent pregnancy depend on menstrual cycle timing and timing of unprotected intercourse (UPI)? If the urine pregnancy test is negative prior to IUD placement, the copper IUD is highly effective for EC at any point in the menstrual cycle. The use of the Copper T380A for EC has been encouraged by the failure of oral EC methods to decrease rates of unintended pregnancy and the documented success of the IUD in reducing unintended pregnancies. However scant data exist regarding the efficacy and safety of IUD insertion for EC when accounting for menstrual cycle timing and time since UPI. This is a secondary analysis of data obtained from a previously published prospective cohort study of women who received the Copper T380A IUD for EC between July 1997 and January 2000. We included 1840 participants according to the study inclusion criteria of a known last menstrual period (LMP) and cycle lengths of 25-35 days. The original study included women aged between 18 and 44 years who presented for EC at 18 sites throughout China and who had regular menstrual cycles between 24 and 42 days, a known LMP, UPI within 120 h (5 days) and a negative urine pregnancy test (cutoff <25 IU/ml). Women with uncertain LMP dates were excluded. This study included only participants with cycle lengths of 25-35 days. Among the 1840 participants with usual cycle lengths of 25-35 days, 850 (46.2%) had their IUD inserted following UPI in the expected fertile window and 84 (4.6%) had the insertion >5 days after the predicted ovulation day and 52 (2.8%) had the insertion >5 days after UPI. There were no pregnancies in the first month among the 1771 women who had information available regarding their 1-month follow-up pregnancy test. This was a secondary analysis of an observational study, and thus participants were not randomized to an alternative postcoital method. There were a small number of women who had UPI >5 days after their predicted ovulation day thus limiting the confidence of assuring a low risk of pregnancy in this situation. The ovulation day was calculated based on the LMP prior to IUD insertion and not on the subsequent first day of menses following IUD insertion. If the urine pregnancy test is negative prior to IUD placement, the copper IUD is likely to be effective for EC at almost any point in the menstrual cycle. The original study was funded by the UNDP/UNPFA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The donors and sponsors of the study had no role in the study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the paper for publication.

The copper intrauterine device for emergency contraception: an opportunity to provide the optimal emergency contraception method and transition to highly effective contraception

Worldwide, 40% of all pregnancies are unintended. Widespread, over-the-counter availability of oral emergency contraception (EC) has not reduced unintended pregnancy rates. The EC visit presents an opportunity to initiate a highly effective method of contraception in a population at high risk of unintended pregnancy who are actively seeking to avoid pregnancy. The copper intrauterine device (IUD), the most effective method of EC, continues to provide contraception as effective as sterilization for up to 12 years, and it should be offered as the first-line method of EC wherever possible. Increased demand for and supply of the copper IUD for EC may have an important role in reducing rates of unintended pregnancy. The EC visit should include access to the copper IUD as optimal care but should ideally include access to all highly effective methods of contraception.

Improving uptake of the copper intrauterine device for emergency contraception by educating pharmacists in the community

ObjectivesThe copper intrauterine device (Cu-IUD) is the most effective method of emergency contraception (EC) and provides ongoing contraception, yet few women choose this option. This study evaluates the impact of...

Criterion‐based Screening for Sexually Transmitted Infection: Sensitivity, Specificity, and Predictive Values of Commonly Used Questions

Practice protocols that mandate prescreening for sexually transmitted infection prior to insertion of an intrauterine device for contraception can pose obstacles for women seeking this highly effective method of birth control. Some practices screen for presumed risk factors for sexually transmitted infection in order to identify those who may be infected or those in whom laboratory testing should be obtained. The value of such criterion-based screening is unclear. Data from a prospective observational trial of offering the copper intrauterine device for emergency contraception were used to assess the value of several screening questions in predicting the presence of sexually transmitted infection. Criteria evaluated were age under 25 years, history of a sexually transmitted infection, and having 2 or more sexual partners in the previous 3 months. The sensitivity, specificity, and likelihood ratio of both positive and negative test results and positive and negative predictive values were calculated for 3 separate questions as well as for combinations of these 3 questions. There were 197 women who received a copper intrauterine device for emergency contraception at the same time they were tested for sexually transmitted infection. In this sample, there were 8 cases of Chlamydia trachomatis identified and no cases of Neisseria gonorrhoeae. The sensitivity of individual and combined questions in identifying those who were infected ranged from 0% to 88%; specificity ranged from 37% to 97%. The positive predictive values for single or combined screening questions were in the range of 4% to 6%. Likelihood ratios for both positive and negative test results did not change posttest likelihood of disease in any appreciable way. Standard screening questions used to identify sexually transmitted infection risk could presume infection in large numbers of uninfected women and are of little value in identifying the women who are truly infected.

Failed IUD insertions in community practice: an under-recognized problem?

BackgroundThe data analysis was conducted to describe the rate of unsuccessful copper T380A intrauterine device (IUD) insertions among women using the IUD for emergency contraception (EC) at community family planning clinics in Utah. MethodsThese data were obtained from a prospective observational trial of women choosing the copper T380A IUD for EC. Insertions were performed by nurse practitioners at two family planning clinics in order to generalize findings to the type of service setting most likely to employ this intervention. Adjuvant measures to facilitate difficult IUD insertions (cervical anesthesia, dilation, pain medication, and use of ultrasound guidance) were not utilized. The effect of parity on IUD insertion success was determined using exact logistic regression models adjusted for individual practitioner failure rates. ResultsSix providers performed 197 IUD insertion attempts. These providers had a mean of 14.1 years of experience (range 1–27, S.D. ±12.5). Among nulliparous women, 27 of 138 (19.6%) IUD insertions were unsuccessful. In parous women, 8 of 59 IUD insertions were unsuccessful (13.6%). The adjusted odds ratio (aOR) showed that IUD insertion failure was more likely in nulliparous women compared to parous women (aOR=2.31, 95% CI 0.90–6.52, p=.09). ConclusionThe high rate of unsuccessful IUD insertions reported here, particularly for nulliparous women, suggests that the true insertion failure rate of providers who are not employing additional tools for difficult insertions may be much higher than reported in clinical trials. Further investigation is necessary to determine if this is a common problem and, if so, to assess if the use of adjuvant measures will reduce the number of unsuccessful IUD insertions.

Ongoing contraception after use of emergency contraception from a specialist contraceptive service

Background A consultation for emergency contraception (EC) gives way to an opportunity to provide women with an ongoing effective method of contraception. Study Design A review of the case notes of women seeking EC from a large family planning clinic in Edinburgh, Scotland, was conducted to determine what percentage of women were provided with an effective method of ongoing contraception. Results Case notes of 460 women presenting for EC over a 2-year period were reviewed. Women were of mean age 26 years (range 15–49 years) and presented because they had used no contraception (47%), experienced condom failure (42%) or missed oral contraceptive pills (9%). Only 2% ( n=11) were given an intrauterine device for EC. All women who had missed contraceptive pills prior to taking EC opted to continue this method. Only 23% ( n=89) of women using no method or condoms at EC received supplies of an effective contraceptive method (pills, patch, injectable). Two thirds ( n=263) of the women chose condoms for ongoing contraception. Conclusion Research is required to develop strategies to improve the uptake of effective contraception after EC.

Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial

Please cite this paper as: Wu S, Godfrey E, Wojdyla D, Dong J, Cong J, Wang C, von Hertzen H. Copper T380A intrauterine device for emergency contraception: a prospective, multicentre, cohort clinical trial. BJOG 2010;117:1205–1210.Objective To determine the effectiveness of the Copper T380A (CuT380A) intrauterine device (IUD) as an emergency contraceptive in women.Design Prospective, multicentre, cohort clinical trial.Setting Eighteen family planning clinics in China.Sample A cohort of 1963 women, aged 18–44 years, requesting emergency contraception within 120 hours of unprotected sexual intercourse.Methods Women requesting emergency contraception were followed at 1, 3 and 12 months after the insertion of CuT380A.Main outcome measures Efficacy of CuT380A as emergency contraception and for up to 12 months of postinsertion use. Insertion complication rates, reported side‐effects and continuation rates at 12 months were also recorded.Results No pregnancies occurred prior to or at the first follow‐up visit, making CuT380A 100% effective as emergency contraception in this study. The pregnancy rate over the 12‐month period was 0.23 per 100 women. In all, 29 (1.5%) women experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics. No uterine perforations occurred. The main side‐effects were increased menstrual bleeding and menstrual disturbances. The 12‐month postinsertion continuation rate was 94.0 per 100 woman‐years.Conclusions CuT380A is a safe and effective method for emergency contraception. The advantages of CuT380A include its ability to provide effective, long‐term contraception.