Birth Control That Really Works

Summary and Comment |
May 24, 2012

Birth Control That Really Works

  1. Eleanor Bimla Schwarz, MD, MS

In the Contraceptive CHOICE project, IUDs and implants were 20 times more effective than pills, patches, or rings.

  1. Eleanor Bimla Schwarz, MD, MS

Despite their proven safety, intrauterine devices (IUDs) and implants are used by only a small fraction of U.S. women and even fewer adolescents. To compare the effectiveness of IUDs, implants, and depot medroxyprogesterone acetate (DMPA) with other commonly prescribed contraceptives, prospectively collected data were analyzed from 7486 participants in the Contraceptive CHOICE project, in which they received free contraceptives of their choosing.

Cumulative contraceptive failure rates among participants who used combined hormonal contraception (CHC; pills, patches, or rings) were 4.8%, 7.8%, and 9.4% during years 1, 2, and 3, respectively. Among women using IUDs or implants, these rates were 0.3%, 0.6%, and 0.9% (P<0.001); rates were similarly low among women who returned to receive all DMPA injections (but only 43% of women who started DMPA were using it 1 year later [JW Womens Health May 12 2011]). The adjusted hazard ratio for unintended pregnancy in CHC users compared with IUD or implant users was 21.8. Unintended pregnancy rates in women younger than 21 were similar to those for older participants when IUDs or implants were used, but were twice those for older participants when CHC was used.


These findings highlight the need to ensure that young women are informed about and have access to intrauterine devices and contraceptive implants. Women are more likely to be very satisfied with these methods, and therefore are more apt to continue using them.


Reader Comments (1)

Duna Miller

Very painful - I was very sorry I had one and could hardly wait to have it removed. I don't agree that it's a good choice for a young woman.

Competing interests: None declared

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