September 27th, 2020

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Rate of and Reason for Discontinuation of Levonorgestrel 13.5 mg Intrauterine System as Compared to Levonorgestrel 52 mg Intrauterine System and Subsequent Contraceptive Choice at an Academic Medical Center
Authors:  Adela G. Cope, M.D., Amy L. Weaver, M.S., and Petra M. Casey, M.D.
  OBJECTIVE: To compare the rates of and reasons for discontinuation of levonorgestrel (LNG) 52 mg intrauterine system (IUS) and LNG 13.5 mg IUS.

STUDY DESIGN: In this retrospective cohort study, 81 premenopausal women aged 13–55 who underwent LNG 13.5 mg IUS insertion and 345 women who underwent LNG 52 mg IUS insertion from 1/1/2013 to 12/31/2015 were identified. Baseline characteristics, symptom concerns, discontinuation rates, and subsequent contraception were compared.

RESULTS: Women with LNG 13.5 mg IUS were significantly younger (mean age, 25.8 vs. 30.3 years), more likely to be nulliparous (87.7% vs. 28.0%), less likely to have previously used long-acting reversible contraception (12.3% vs. 35.4%), and had lower mean body mass index (25.1 vs. 27.1 kg/m2). In women with contact within 24 months, 54.8% (40/73) of women with LNG 13.5 mg IUS expressed symptom concerns, as compared to 60.1% (157/261) of women with LNG 52 mg IUS (p=0.41). By 24 months the cumulative incidence of discontinuation for symptom-related concerns was 20.4% (95% CI 9.8–31.0%) and 13.9% (95% CI 9.5–18.3%) among women with LNG 13.5 mg IUS and LNG 52 mg IUS, respectively, taking into account other reasons for discontinuation.

CONCLUSION: While a lower proportion of LNG 13.5 mg IUS users expressed symptom concerns, the discontinuation rate due to symptom-related concerns by 24 months was higher in this group, though not significant statistically.
Keywords:  contraception, intrauterine devices, levonorgestrel, long-acting reversible contraception
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