Expanding the Use of Intrauterine Contraception

Summary and Comment |
June 22, 2016

Expanding the Use of Intrauterine Contraception

  1. Eleanor Bimla Schwarz, MD, MS

Efficacy of 52-mg LNG-IUD persisted for 7 years.

  1. Eleanor Bimla Schwarz, MD, MS

Use of intrauterine contraception is rising in the U.S., but uptake would be further improved with more information about the available options. In a 7-year international study evaluating the safety and efficacy of the 52-mg levonorgestrel-releasing intrauterine device (LNG-IUD; marketed in the U.S. as Mirena and Liletta) compared with the copper IUD (TCu380A), WHO researchers randomized 1884 users to the LNG-IUD and 1871 users to the TCu380A (mean overall age, 30). During each year of follow-up, the 52-mg LNG-IUD was more effective than the TCu380A. Although only 398 LNG-IUD users completed 7 years of follow-up, no pregnancies were reported between years 5 and 7, producing a cumulative failure rate of 0.53% at 7 years (compared with 0.12% in the first year of use).

In a second international study, industry-supported investigators followed 303 teens (mean age, 16) for 12 months after placement of a 13.5-mg LNG-IUD (marketed in the U.S. as Skyla). No new or unexpected safety events were noted, and no pregnancies occurred. Cervical dilation was required to enable IUD placement in 29% of participants.

Comment

Given that placement is the most challenging aspect of intrauterine contraceptive use, the option of using a 52-mg LNG-IUD for 7 years is wonderful. Although the 13.5-mg LNG-IUD has been marketed to nulliparous women, I find that placing the 52-mg LNG-IUD (which is almost 4 times as effective) is no more difficult in such women. Given teens' greater risk for undesired pregnancy, I encourage those who are interested in intrauterine contraception to start with a 52-mg LNG-IUD.

Editor Disclosures at Time of Publication

  • Disclosures for Eleanor Bimla Schwarz, MD, MS at time of publication Grant / Research support Office of Adolescent Health Editorial boards Contraception; Journal of General Internal Medicine

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