Motives Behind Early Discontinuation of Long-Acting Reversible Contraception [18O]

INTRODUCTION: Long-acting reversible contraception (LARC) has been shown to reduce rates of unintended pregnancy and abortion, but is often discontinued prematurely due to side effects. The objective of this study is to investigate reasons for discontinuation of different LARC methods. METHODS: Retrospective review of electronic medical records documenting IUD and implant insertions for 278 women from March 2011–June 2014 was performed. Time to removal (TTR) and reason for removal was determined. Statistical analysis was performed using Kaplan-Meier survival analysis, log-rank tests, and Kruskal Wallis test. RESULTS: Levonorgestrel IUD had a median TTR of 2.6 years compared to copper IUD (1.5 years) and progestin implant (1.4 years), though statistical significance was not reached. Most common reason for method removal was device malposition or expulsion (30%) followed by complaints of pain (dysmenorrhea, pelvic pain, or dyspareunia; 26%) and irregular or heavy bleeding (18%). The copper IUD is associated with the highest rates of removal for all reasons - pain, bleeding, or malposition/expulsion compared to other LARC methods (P=.02). Those with removal due to malposition/expulsion had the lowest mean age (23.1 years; P=.01) and shortest median TTR (0.31 years; P=.003) compared to the other removal groups. Those with bleeding complaints had a shorter TTR than those with removal due to pain. CONCLUSION: Levonorgestrel IUD appears to have the longest median time to removal and lower rates of removal for pain, bleeding, or malposition/expulsion. Younger patients are more likely to experience LARC removal due to device malposition/expulsion.