Long-term continuation and satisfaction of IUDs
Awarded 2013
Complex Family Planning Fellowship Research
Justin Diedrich, MD
Washington University in St. Louis

Highly effective, long-acting reversible contraceptive (LARC) methods have the potential to decrease unintended pregnancies and reduce health disparities. These include the copper-containing intrauterine device (Cu-IUD) and the levonorgestrel-containing IUD (LNG-IUD). The LUCID Study (long-term utilization and continuation of intrauterine devices) sought to describe long-term continuation of the LNG- and Cu-IUD at 48 and 60 months. Given the improved bleeding profile associated with the LNG-IUD, our hypothesis was that women choosing the LNG-IUD would have higher long-term continuation than those using the Cu-IUD at 48 months.
Study methods
This was a prospective cohort study of women who received an IUD through the Contraceptive CHOICE Project (CHOICE). Our primary outcome was continuation at 48 months. We randomly selected women who had either LNG- or Cu-IUDs inserted between January 2008 and June 2009 and contacted them by telephone. Once contacted and consented, they were asked if they were still using their IUD. Women who reported discontinuation of the IUD were asked for reasons why and subsequent contraceptive use. Factors associated with discontinuing the IUD were identified.
Important findings
At 48 months there was no statistically significant difference in continuation between LNG- (62.0%) and Cu-IUD users (64.2%).  Continuation at 48 months was highest among women over 29 years of age at insertion (LNG-IUD 71.4%; Cu-IUD 77.1%). Women under 24 years of age had the lowest 48-month continuation (LNG-IUD 55.4% and Cu-IUD 53.2%). Demographic characteristics, baseline menstrual bleeding, and pregnancy history were not associated with discontinuation.
Summary statement
IUD continuation remains high (> 60%) at 48 months with no difference between Cu- and LNG-IUDs. The data provided by this study can be used for future cost-effectiveness analyses. Given the high rate of long-term continuation, IUDs remain an excellent option for long-acting contraception.

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