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Three-year continuation of reversible contraception.
Am J Obstet Gynecol 2015; 213(5):662.e1-8AJ

Abstract

OBJECTIVE

The objective of this analysis was to estimate the 3-year continuation rates of long-acting reversible contraceptive (LARC) methods and to compare these rates to non-LARC methods.

STUDY DESIGN

The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study that followed 9256 participants with telephone surveys at 3 and 6 months, then every 6 months for 2-3 years. We estimated 3-year continuation rates of baseline methods that were chosen at enrollment. The LARC methods include the 52-mg levonorgestrel intrauterine device; the copper intrauterine device, and the subdermal implant). These were then compared to rates to non-LARC hormonal methods (depot medroxyprogesterone acetate, oral contraceptive pills, contraceptive patch, and vaginal ring). Eligibility criteria for this analysis included participants who started their baseline chosen method by the 3-month survey. Participants who discontinued their method to attempt conception were censored. We used a Cox proportional hazard model to adjust for confounding and to estimate the hazard ratio for risk of discontinuation.

RESULTS

Our analytic sample consisted of 4708 CHOICE participants who met inclusion criteria. Three-year continuation rates were 69.8% for users of the levonorgestrel intrauterine device, 69.7% for copper intrauterine device users, and 56.2% for implant users. At 3 years, continuation was 67.2% among LARC users and 31.0% among non-LARC users (P < .001). After adjustment for age, race, education, socioeconomic status, parity, and history of sexually transmitted infection, the hazard ratio for risk of discontinuation was 3-fold higher among non-LARC method users than LARC users (adjusted hazard ratio, 3.08; 95% confidence interval, 2.80-3.39).

CONCLUSION

Three-year continuation of the 2 intrauterine devices approached 70%. Continuation of LARC methods was significantly higher than non-LARC methods.

Authors+Show Affiliations

Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO.Divisions of Family Planning and Clinical Research, Department of Obstetrics and Gynecology, Washington University School of Medicine in St. Louis, St. Louis, MO. Electronic address: peipertj@wustl.edu.

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26259905

Citation

Diedrich, Justin T., et al. "Three-year Continuation of Reversible Contraception." American Journal of Obstetrics and Gynecology, vol. 213, no. 5, 2015, pp. 662.e1-8.
Diedrich JT, Zhao Q, Madden T, et al. Three-year continuation of reversible contraception. Am J Obstet Gynecol. 2015;213(5):662.e1-8.
Diedrich, J. T., Zhao, Q., Madden, T., Secura, G. M., & Peipert, J. F. (2015). Three-year continuation of reversible contraception. American Journal of Obstetrics and Gynecology, 213(5), pp. 662.e1-8. doi:10.1016/j.ajog.2015.08.001.
Diedrich JT, et al. Three-year Continuation of Reversible Contraception. Am J Obstet Gynecol. 2015;213(5):662.e1-8. PubMed PMID: 26259905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three-year continuation of reversible contraception. AU - Diedrich,Justin T, AU - Zhao,Qiuhong, AU - Madden,Tessa, AU - Secura,Gina M, AU - Peipert,Jeffrey F, Y1 - 2015/08/07/ PY - 2015/04/27/received PY - 2015/07/20/revised PY - 2015/08/02/accepted PY - 2015/8/12/entrez PY - 2015/8/12/pubmed PY - 2016/4/8/medline KW - continuation KW - contraception KW - intrauterine device KW - long-acting reversible contraception KW - subdermal implant SP - 662.e1 EP - 8 JF - American journal of obstetrics and gynecology JO - Am. J. Obstet. Gynecol. VL - 213 IS - 5 N2 - OBJECTIVE: The objective of this analysis was to estimate the 3-year continuation rates of long-acting reversible contraceptive (LARC) methods and to compare these rates to non-LARC methods. STUDY DESIGN: The Contraceptive CHOICE Project (CHOICE) was a prospective cohort study that followed 9256 participants with telephone surveys at 3 and 6 months, then every 6 months for 2-3 years. We estimated 3-year continuation rates of baseline methods that were chosen at enrollment. The LARC methods include the 52-mg levonorgestrel intrauterine device; the copper intrauterine device, and the subdermal implant). These were then compared to rates to non-LARC hormonal methods (depot medroxyprogesterone acetate, oral contraceptive pills, contraceptive patch, and vaginal ring). Eligibility criteria for this analysis included participants who started their baseline chosen method by the 3-month survey. Participants who discontinued their method to attempt conception were censored. We used a Cox proportional hazard model to adjust for confounding and to estimate the hazard ratio for risk of discontinuation. RESULTS: Our analytic sample consisted of 4708 CHOICE participants who met inclusion criteria. Three-year continuation rates were 69.8% for users of the levonorgestrel intrauterine device, 69.7% for copper intrauterine device users, and 56.2% for implant users. At 3 years, continuation was 67.2% among LARC users and 31.0% among non-LARC users (P < .001). After adjustment for age, race, education, socioeconomic status, parity, and history of sexually transmitted infection, the hazard ratio for risk of discontinuation was 3-fold higher among non-LARC method users than LARC users (adjusted hazard ratio, 3.08; 95% confidence interval, 2.80-3.39). CONCLUSION: Three-year continuation of the 2 intrauterine devices approached 70%. Continuation of LARC methods was significantly higher than non-LARC methods. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/26259905/Three_year_continuation_of_reversible_contraception_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9378(15)00852-2 DB - PRIME DP - Unbound Medicine ER -