Researchers and clinicians have long known that copper intrauterine devices (IUDs) work well for emergency contraception. But few were concerned to study the feasibility of using hormonal IUDs for the same purpose.
Now, in a first-of-its-kind study, University of Utah Health scientists found that hormonal IUDs compared to copper IUDs for use as emergency contraceptives. The researchers say the finding supports the addition of hormonal IUDs to conventional emergency contraception options. They conclude that the use of hormonal IUDs could have significant effects on emergency contraception, including menstrual reduction and cramping associated with copper IUDs.
The study appears in the journal Jan. 28 den New England Journal of Medicine.
“These findings support the use of hormonal IUDs as a safe and viable option for women trying to prevent pregnancy up to five days after intercourse,” says David Turok, MD , MPH, lead author of the study and associate professor in the Department of Obstetrics and Gynecology at U of U Health. ”As an emergency prevention device, it appears to be no worse than a copper IUD and is far superior. than the pill the next morning. “
He said, “And, unlike emergency contraceptive pills, hormonal IUDs can continue to provide highly effective contraception for up to seven years.”
The risk of weight gain after using morning pills is about 2%, Turok says. In comparison, the 0.1% risk for pregnancy with copper IUDs is much lower. In this study, the risk with hormonal IUDs was 0.3% and statistically less effective than the copper IUD.
Every hormonal IUD approved in the US contains a synthetic version of the hormone progesterone called levonorgestrel (LNG). This study used the Liletta IUD; Mirena, another type of hormonal IUD, uses the same amount of LNG as Liletta.
When people are offered both hormonal and copper IUDs, they more often choose the LNG IUD. However, unlike copper IUDs, the use of LNG IUDs as an emergency emergency device has been little studied. As a result, very few medical providers have used LNG IUDs for this purpose.
To address this issue, U of U Health researchers decided to test the efficacy of LNG IUDs against copper IUDs. Over three years beginning in August 2016, they employed more than 700 people, ages 18 to 35, seeking emergency contraception at six Utah Planned parenting clinics.
All participants had unprotected relationships at least once in the previous five days. In addition, they had regular menstrual cycles, knew the date of their last menstrual period, had a negative urine pregnancy test, wanted to prevent pregnancy for at least a year, and they were interested in using an IUD. Participants were randomly assigned to receive an LNG or copper IUD. One month later, none of the 321 participants received a heavy copper IUD. Pregnancy occurred in just one of the 317 participants who received LNG IUDn.
“While I assumed that the hormonal IUD would work for emergency contraception, I was surprised that it worked just as well as the copper IUD,” said Lori Gawron, MD, MPH, co. -author author and assistant professor in the Department of Obstetrics and Gynecology at U of U Health. “This finding is encouraging because it will give people more options for both emergency and ongoing contraception and reduce barriers to the same-day IUD setting when patients want one.”
Turok adds that this research supports giving IUDs to those who want one at any time in the menstrual cycle, regardless of the unprotected relationship they have had since. short, giving women more opportunity to intervene than conventional medical recommendations.
The researchers received urine pregnancy tests from about 93% of the participants. They did not rule out pregnancy in the remaining 7% based on study information and clinical reports. Among other study limitations, although participants were unaware of which device they had received in the first month of use, the nurses who sent it knew what device was inserted in each patient. That is because of significant differences in the appearance of these IUDs.
The last new method of emergency contraception was approved for use by the Food and Drug Administration almost 15 years ago. According to the researchers, LNG IUDs may be an attractive option because they are widely used and are already FDA approved for use as birth control.
“This is all about increasing access and choice for people,” Turok says. “It’s about supporting their ability to live the life they want and having meaningful sexual relationships in ways that are unrelated to pregnancy. “
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In addition to Dr. Turok and Dr. Gawron, Alexandra Gero, Rebecca Simmons, Jennifer Kaiser, Gregory Stoddard, Corrine Sexsmith, and Jessica Sanders of the University of Utah Health contributed to this study.
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