IUDs and the implant should be 1st line contraceptives – new study

The Contraceptive CHOICE study, which provides women with free and accessible contraception of choice, has now provided us with great longer term data on contraception continuation. A new study using this data (O’Neil-Callahan Obstet Gynecol November 2013) tells us what women are likely to be using for birth control two years later. This information is key because switching methods is a time where user error is more likely or gaps in coverage resulting in unplanned pregnancy. It is best to try and hit a satisfaction bullseye with the first choice.

The clear winner is the intrauterine device (both the Mirena and Copper) with the etonorgestrel implant (Implanon) a close second (these 2 methods are considered long acting reversible contraception or LARC). Pills, the ring, depo-provera, and the patch are all considered short acting reversible methods.

At 12 months 87% of LARC users were still using there initial method of contraception compared with 57% of non-LARC users. At 2 years 77% of women who chose a LARC were still using that method compared with a relatively dismal 41% for non-LARC. There was essential no difference between types of IUD, with 79% still using the Mirena and 77% the Copper although slightly fewer women (69%) were still using the Implanon. There was minimal difference between the short-acting hormonal methods (see the table below detailing the breakdown by method).

Adults were more likely to stick with their method if contraception compared with adolescents (no surprise), but at 2 years 66% of adolescents were still using their long acting method versus 37% who were still using their short-acting contraception.

While the study doesn’t tell us why some women chose a particular method, they do tell us that when women are free to choose they are most likely to stay with an IUD or Implanon than any other method. This study also doesn’t tell us what happened to women who switched, did they intentionally get pregnant, have an unplanned pregnancy, or successfully switch methods?

What is the take home message? If you choose an IUD you are most likely to still be using this method at 2 years than if you choose any other method. Don’t like the idea of an IUD, then you are still more likely to be happy with an Implanon than a short-acting option.

Preventing dissatisfaction with contraception is key. Given failure rates with IUDs are clearly the lowest, they represent the best option for reproductive control and clearly when providers talk about reversible contraception they should be presenting IUDs and the implant as first-line options.

And for the lawmakers? Want to prevent abortion, the answer isn’t laws it’s free, accessible long-acting contraception.


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  1. I haven’t looked at the article, so I’m curious to know what they used as an estimate of IUD failure rate. Because frankly, I suspect our estimates are far too low. Seven months after I got one, I was pregnant. And I’ve met a LOT of women since then who have IUD babies. And here’s the thing about IUDs: as long as they’re intact, you have no way of knowing if they’re failing. If you miss pills, mess up your NuvaRing cycle or break a condom you know it and you can layer on extra contraceptives. Not so with IUDs. I’ve taken to telling people that IUDs are great as long as an unplanned pregnancy wouldn’t be a catastrophe for them, otherwise maybe not so great.

  2. IUDs aren’t for everyone though. Have been seeing younger patients with PID and IUD use. I thought we were over that but it seems to be coming back on special.

  3. Here in the UK LARCs have been recommended ahead of short term options for at least the last decade. It’s been held up as best practice both for the benefits to patients and in terms of cost/efficiency.

    It’s just a shame that women in the U.S. cannot have their contraception provided free of charge. The cost of devices/medications would be offset several times over by the savings incurred by service users experiencing fewer unwanted pregnancies and their aftermath.

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