The following is a summary of “One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial,” published in the APRIL 2023 issue of Obstetrics and Gynecology by Kaiser, et al.
Recent research has shown the effectiveness of the levonorgestrel 52-mg intrauterine device (IUD) compared to the copper T380A IUD for emergency contraception. However, there is limited information on the 1-year pregnancy and continuation rates after IUD placement for emergency contraception. Therefore, for a study, researchers aimed to compare the 1-year pregnancy and IUD continuation rates, as well as reasons for discontinuation, among individuals who used emergency contraception and were randomized to receive either the levonorgestrel 52-mg IUD or the copper T380A IUD.
It was a participant-masked, randomized noninferiority trial conducted at six family planning clinics in Utah between August 2016 and December 2019. Participants who desired an IUD for emergency contraception were randomly assigned in a 1:1 ratio to either the levonorgestrel 52-mg IUD group or the copper T380A IUD group. Treatment allocation was revealed to participants at the 1-month follow-up. Trained personnel followed up with the participants at five-time points over one year through phone, text, or email, and electronic health records were reviewed for pregnancy and IUD continuation outcomes. Reasons for discontinuation were assessed, and Cox proportional-hazard models, Kaplan-Meier estimates, and log-rank tests were used to analyze differences in continuation and pregnancy rates between the two groups.
The study included 327 participants in the levonorgestrel IUD group and 328 participants in the copper IUD group. Intention-to-treat analysis at one year showed similar pregnancy rates between the two groups (2.8% [9/327] in the levonorgestrel IUD group vs. 3.0% [10/328] in the copper IUD group; risk ratio, 0.9; 95% CI, 0.4–2.2; P = 0.82). Most pregnancies occurred after IUD removal, with only one device failure reported in each group. Furthermore, the 1-year continuation rates did not significantly differ between the two groups, with 62.4% (204/327) of levonorgestrel IUD users and 55.8% (183/328) of copper IUD users continuing IUD use at one year (risk ratio, 1.1; 95% CI, 1.0–1.2; P = 0.09). However, there were differences in reasons for discontinuation between the two IUD types, with more bleeding and cramping reported among copper IUD users.
The pregnancy rates were low and comparable between the levonorgestrel 52-mg IUD and the copper T380A IUD for emergency contraception. Notably, a significant proportion of individuals continued IUD use for one year, and the continuation rates were similar between the two IUD types.