Efficacy, reproductive priorities predict discontinuation of contraception in teens
Discontinuation of long-acting reversible contraception (LARC) among teens appears to be uncommon and is mostly influenced by contraceptive efficacy in relation to their reproductive values and preferences, according to a recent study.
The study included 775 young women who were made to complete surveys before and after initiation of LARC. Those with intrauterine devices (IUD; n=385; median age, 22 years) or contraceptive implants (n=390; median age 19 years) were included in the analysis. The endpoint was contraceptive discontinuation before 30 months of use.
Among those who were not lost to follow-up, rates of 30-month discontinuation were comparable between those who received levonorgestrel and copper IUDs (35.6 percent vs 38.6 percent; p=0.65). IUD initiators were significantly less likely to discontinue use by 24 (31.5 percent vs 39.6 percent; p=0.03) and 30 (36.3 vs 45.4 percent; p=0.02) months, relative to their implant counterparts.
Kaplan-Meier curves showed that IUD users continued contraceptive use for a mean of 733 days, higher than that in implant initiators (697 days).
The most common reason for IUD discontinuation was pain, which was reported by 27.0 percent of participants. This was followed by bleeding (20.9 percent), malposition or expulsion (15.7 percent), and the desire for pregnancy (7.9 percent). Other reasons accounted for 17.4 percent of discontinuations.
In terms of implant discontinuation, bleeding was the most frequent cause, cited by almost half of participants (49.3 percent). Weight change (12.9 percent), mood changes (10.0 percent) and the desire for pregnancy (9.0 percent) were among the other common reasons for discontinuation.