Research
Gynecology
Three-year continuation of reversible contraception

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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.

Section snippets

Materials and Methods

In 2007, the Contraceptive CHOICE Project (CHOICE) began recruiting women for a prospective observational cohort study. The goal of the study was to reduce the unintended pregnancy rate in the St. Louis, MO, area by promoting the most effective methods of contraception and eliminating the cost barrier to all forms of contraception. The methods have been reported in detail16 but are described briefly below. The Human Research Protection Office at Washington University in St. Louis approved the

Results

Of 9256 CHOICE participants, the first 5090 were observed for 3 years. In this cohort, 382 women were excluded because they did not start their chosen baseline method by the 3-month survey. There were a total of 4708 participants (92%) who were observed for 3 years and were included in this analysis. A flow diagram of included participants is shown in Figure 1. There were 185 women (4%) who were censored because of discontinuation for desire to conceive or pregnancy.

Demographic and reproductive

Comment

Continuation rates for LARC methods at 1, 2, and 3 years are significantly higher than non-LARC methods. After adjustment for confounding variables, the choice of a shorter-acting method and younger age were associated with increased discontinuation.1, 4, 18, 19 Teens 14–19 years of age were more likely to discontinue than women of ≥20 years old. However, of those adolescents who chose LARC methods, more than one-half were still using their method at 3 years compared with one-fifth of

References (21)

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Cited by (0)

The Contraceptive CHOICE Project is funded by an anonymous foundation. This publication also was supported by Washington University Institute of Clinical and Translational Sciences grant number UL1 TR000448 from the National Center for Advancing Translational Sciences and award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health.

J.F.P. receives research funding/support from Bayer, Teva, and Merck and serves on advisory boards for Teva Pharmaceuticals and MicroCHIPs; T.M. serves on an advisory board for Bayer Healthcare Pharmaceuticals and a data safety monitoring board for phase 4 safety studies of Bayer contraceptive products; the remaining authors report no conflict of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Cite this article as: Diedrich JT, Zhao Q, Madden T, et al. Three-year continuation of reversible contraception. Am J Obstet Gynecol 2015;213:662.e1-8.

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