A three-year comparative study of continuation rates, bleeding patterns and satisfaction in Australian women using a subdermal contraceptive implant or progestogen releasing-intrauterine system

Abstract

Background Long-acting reversible contraceptive methods (LARCs) are safe, highly effective, readily reversible, and require no action on the part of the user following insertion. Early discontinuation may put women at increased risk of unintended pregnancy.

Methods Following insertion of a progestogen-only subdermal implant or intrauterine system (IUS) at Family Planning NSW, women 18 years and older completed a questionnaire about their choice. At 6 weeks, 6, 12, 24 and 36 months by telephone or online they completed a questionnaire about bleeding patterns, side effects, satisfaction, and reasons for discontinuation.

Results Two hundred IUS users and 149 implant users were enrolled. The former were generally older, married or in a de-facto relationship, and had children. Forty-seven percent of implant users discontinued within three years compared to 27% of IUS users (p = 0.002). In the first two years amenorrhoea was more frequent in implant users. Frequent bleeding/spotting was more prevalent in the first year of IUS use but over time was twice as prevalent in implant users. Infrequent bleeding/spotting was more common in IUS users.

Conclusion Both devices are highly effective and acceptable cost-effective methods. While LARCs should be promoted to women of all ages seeking contraception, early discontinuation due to unacceptable bleeding highlights the need for pre-insertion counselling.

KEYWORDS:

• Long-acting reversible contraceptive
• Implant
• Intrauterine system
• Continuation rates
• Bleeding patterns

ACKNOWLEDGEMENTS

Our sincerest thanks to our research staff Rachael Harrop, RN, and Dr Lina Safro for their assiduous follow-up of the women who participated in this survey. Without their efforts there would be no results to report.

Declaration of interest: Edith Weisberg has provided expert opinion for MSD and Bayer HealthCare, has obtained research funding for investigator-initiated research from both companies, and has been supported to attend conferences by Bayer HealthCare. Deborah Bateson has provided expert opinion for MSD, Bayer HealthCare and Pfizer as part of her role as Medical Director at Family Planning NSW, and has been supported to attend conferences by MSD and Bayer HealthCare. Family Planning NSW provides Implanon NXT training for MSD and has received an educational grant from Bayer HealthCare to set up an IUD insertion training programme. The authors alone are responsible for the content and the writing of the paper.