Comparison of copper intrauterine device with levonorgestrel-bearing intrauterine system for post-abortion contraception

Family planning and nutrition: systematic review of the effects of family planning on nutritional status of adolescent girls and women of reproductive age

INTRODUCTION

Contraceptive use may affect women's nutritional status through birth spacing, parity, age at first birth, menstruation changes, and increased income. To inform the integration of family planning with nutrition interventions, we synthesised evidence linking the use of family planning to nutritional outcomes in women of reproductive age (15-49 years) and adolescents (10-19 years) in low- and middle-income countries (LMICs).

METHODS

We searched PubMed, Embase, Web of Science and Cochrane Library for randomised controlled trials (RCTs), cluster RCTs, non-randomised trials and cohort studies published from 2000 onwards. Family planning exposure included any contraception type with no restrictions by comparison arms. Outcomes were maternal anthropometry and iron-status indicators. Random effects meta-analyses were done for comparisons with a minimum of three studies sharing intervention arms, outcomes and study design. Risk of bias and certainty of evidence were assessed.

RESULTS

Of 20 097 publications, 99 were eligible for inclusion, covering 29 outcomes and 23 interventions (eg, oral contraception, intrauterine devices (IUD)). In 28 instances, at least three studies matched on intervention arms, outcomes and study design. Meta-analysis of RCTs showed that users of hormonal IUDs had significantly higher haemoglobin than oral contraceptive users (four studies; mean difference=1.25 g/dL; 95% CI: 0.38, 2.12; certainty=very low). Users of any hormonal contraceptive had a small reduction in body mass index (BMI) compared with non-contraceptive controls (seven studies; mean difference=-0.28 kg/m2; 95% CI: -0.52 to -0.04; certainty=low); however, most samples were women with polycystic ovarian syndrome. Other relationships were very uncertain and not statistically significant.

CONCLUSION

Evidence is weak suggesting that hormonal IUDs increase haemoglobin compared with oral contraceptives and that any hormonal contraceptive use reduces BMI. Hormonal IUDs likely limit blood loss from menstruation, allowing for higher haemoglobin than oral contraceptives. Mechanisms for lower BMI after hormonal contraceptive use remain unclear. More robust evidence is necessary to guide policy.

PROSPERO REGISTRATION NUMBER

This review was registered prospectively with the International Prospective Register of Systematic Review (PROSPERO ID: CD42023400069).

Contraception with levonorgestrel-releasing intrauterine system versus copper intrauterine device: a meta-analysis of randomized controlled trials

BACKGROUND

Globally, approximately 19.4% of women of reproductive age use intrauterine contraception, encompassing both copper intrauterine devices (Cu-IUDs) and levonorgestrel intrauterine devices (LNG-IUDs). Despite current guidelines endorsing intrauterine contraception as a primary method, there remains debate regarding device selection. Notably, the lack of data regarding reasons for discontinuation has limited previous meta-analyses. This study aims to comprehensively evaluate the potential differences between intrauterine devices using available multinational data, thereby providing a basis for global policy and healthcare services.

METHODS

We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library for primary studies published from inception to January 13, 2024, with no language or geographic restrictions. The study was registered on PROSPERO (CRD42024496400). We included only randomized controlled trials comparing Cu-IUDs and LNG-IUDs. Data extraction was independently conducted by two reviewers, with unresolved discrepancies referred to a third senior reviewer for consultation. The primary outcome was pregnancy, with secondary outcomes encompassing continuation, reasons for discontinuation, expulsion, satisfaction, and other adverse events. Data were synthesized using a random-effects model. Risk of bias was evaluated with the Cochrane Collaboration's tool, and evidence quality was assessed using the GRADE framework.

FINDINGS

An analysis of 20 trials showed that compared to Cu-IUDs, LNG-IUDs were associated with lower risks of pregnancy (Risk Ratio 0.22, 95% confidence interval 0.12-0.39), ectopic pregnancy (RR 0.12, 95% CI 0.03-0.47), discontinuation due to increased bleeding (RR 0.49, 95% CI 0.28-0.85), increased bleeding (RR 0.42, 95% CI 0.25-0.7), heavy bleeding (RR 0.41, 95% CI 0.22-0.75), and dysmenorrhea (RR 0.41, 95% CI 0.34-0.48), but they carried a higher risk of discontinuation due to amenorrhea (RR 21.05, 95% CI 8.83-50.00). When comparing LNG (52 mg) IUD with copper (380 mm2) IUD, The LNG-IUD showed a lower risk of discontinuation due to increased bleeding (RR 0.68, 95% CI 0.55-0.58) and dysmenorrhea (RR 0.42, 95% CI 0.34-0.53), but a higher risk of discontinuation due to bleeding issues (RR 2.83, 95% CI 2.47-3.25) and amenorrhea (RR 5.92, 95% CI 2.81-12.49). There were no significant differences between the two terms of continuation, expulsion, non-medical reasons for discontinuation, satisfaction, and other adverse outcomes.

INTERPRETATION

LNG-IUDs and Cu-IUDs are both highly effective contraceptive methods. Compared to Cu-IUDs, LNG-IUDs were associated with a lower risk of pregnancy and adverse reactions. However, LNG-IUDs carry a higher risk of amenorrhea. When recommending contraceptive methods, healthcare providers should fully inform patients of these potential risks and consider patient preferences.

FUNDING

The research was funded by Hunan Provincial Natural Foundation of China (2021JJ30040), the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University (2021KFJJ06), and the National Natural Science Foundation of China (No. 81672225).

Bleeding pattern difference between levonorgestrel intrauterine system and copper intrauterine devices inserted immediately post-abortion: a multicenter, prospective, observational cohort study in Chinese women

BACKGROUND

To describe the bleeding pattern (primary outcome), side effects, treatment satisfaction and 6 month continuity rates associated with the 52 mg levonorgestrel intrauterine system (LNG-IUS) and the copper intrauterine device (Cu-IUD) inserted immediately after abortion.

METHODS

This multicenter, prospective, observational cohort study enrolled healthy women (aged ≥18 years) inserted with LNG-IUS or Cu-IUD immediately after first-trimester surgical abortion and followed up to 6 months. Bleeding pattern was obtained through daily patient bleeding diaries.

RESULTS

From 2013 to 2014, we enrolled 512 women (LNG-IUS = 312 [median age: 32.0 years] and Cu-IUD = 200 [median age: 30.0 years]) from nine Chinese centers. LNG-IUS resulted in a significantly lower number of bleeding/spotting days in the second 90 day reference period compared with Cu-IUD (median 14.5 vs. 18.0 days, p < .0001). Amenorrhea rate (no bleeding/spotting day in the second 90 day reference period) and no menstrual bleeding rate (absence of bleeding days in the second 90 day reference period) were significantly higher in LNG-IUS compared to Cu-IUD (13.9% vs. 0% and 39.5% vs. 0%; p < .001 for all). No dysmenorrhea was higher at the last follow-up in LNG-IUS users than Cu-IUD users (81.2% vs. 76%; p = .0047). Both treatments had a high satisfaction rate among women at both the follow-up visits, and the majority of them continued with the treatment. The rates of adverse events (e.g. oligomenorrhea, amenorrhea) in the LNG-IUS and Cu-IUD groups were 77.2% and 44.5% (p < .0001), respectively.

CONCLUSION

LNG-IUS post-abortion shows better bleeding patterns, and reduced dysmenorrhea and bleeding amount, but with a similar safety profile compared with Cu-IUD. ClinicalTrials.gov identifier: NCT01958684.

[Post-abortion contraception]

OBJECTIVE

To establish guidelines of the French National College of Gynecologists and Obstetricians about post-abortion contraception.

MATERIALS AND METHODS

A systematic review of the literature about post-abortion contraception was performed on Medline and Cochrane Database between 1978 and March 2016. The guidelines of the French and foreign scientific societies were also consulted.

RESULTS AND DISCUSSION

After an abortion, if the woman wishes to use a contraception, it should be started as soon as possible because of the very early ovulation resumption. The contraception choice must be done in accordance with the woman's expectations and lifestyle. The contraindications of each contraception must be respected. The long-acting reversible contraception, intra-uterine device (IUD) and implant, could be preferred (grade C) as the efficacy is not dependent on compliance. Thus, they could better prevent repeat abortion (LE3). In case of surgical abortion, IUD should be proposed and inserted immediately after the procedure (grade A), as well as the implant (grade B). In case of medical abortion, the implant can be inserted from the day of mifépristone, the IUD after an ultrasound examination confirming the success of the abortion (no continuing pregnancy or retained sac) (grade C).