Levonorgestrel IUD noninferior to copper IUDs as emergency contraception

Levonorgestrel intrauterine devices were noninferior to copper IUDs as emergency contraception, according to research published in the New England Journal of Medicine.

“Researchers and clinicians have long known that copper IUDs work extremely well for emergency contraception,” David K. Turok, MD, associate professor in the department of obstetrics and gynecology at the University of Utah, told Healio Primary Care. “However, the hormonal IUD (levonorgestrel 52 mg IUD) has distinct characteristics that many people prefer.”

For instance, he said that levonorgestrel IUDs reduce cramping and menstrual bleeding.

“Until now, we did not know if the levonorgestrel IUD worked for emergency contraception. Now we know,” Turok continued. “In a first-of-its-kind study, our team at the University of Utah Health and Planned Parenthood Association of Utah found that hormonal IUDs were comparable to copper IUDs for use as emergency contraceptives.”

To evaluate the effectiveness of both IUDs as an emergency contraceptive, Turok and colleagues conducted a randomized noninferiority trial of women seeking emergency contraceptives after at least one instance of unprotected intercourse in the last 5 days who agreed to an IUD placement. Women aged 18 to 35 years from six clinics in Utah were enrolled in the study from August 2016 through December 2019.

Participants had negative results on urine pregnancy tests prior to IUD placement, and those included in the study were randomly assigned to receive levonorgestrel or copper IUDs. The researchers scheduled 1-month follow-up visits after IUD placement and gave women home pregnancy tests to use the day before the appointment.

Participants were sent follow-up surveys at 3 months and 6 months, and the researchers reviewed electronic health record data to assess pregnancy status and IUD use during follow-up. Women received $10 gift cards for completing follow-up surveys and a $30 gift card for attending their follow-up appointments.

A total of 317 women were randomly assigned to receive levonorgestrel IUDs and 356 women were assigned to copper IUDs. Among them, 290 women who received levonorgestrel IUDs and 300 women who received copper IUDs had results from a 1-month urine pregnancy test.

In a modified intention-to-treat and per-protocol analyses, Turok and colleagues found that the levonorgestrel group had a pregnancy rate of 1 in 317 (0.3%; 95% CI, 0.01 to 1.7). For women in the copper IUD group, the pregnancy rate was 0 in 321 (0%; 95% CI, 0 to 1.1).

In both analyses, the between-group absolute difference was 0.3 percentage points (95% CI, 0.9 to 1.8).

Among participants, 5.4% of those in the levonorgestrel IUD group and 4.9% of those in the copper IUD group sought medical care for adverse events after IUD placement.

The results suggest that levonorgestrel IUD was noninferior to copper IUDs as an emergency contraceptive after unprotected intercourse within the last 5 days, according to the researchers.

Turok said physicians should begin offering this levonorgestrel IUD as an emergency contraception, and that both PCPs and patients should be aware of this as an option for emergency contraception.

“When a new contraceptive option becomes available, the interplay between patient requests and provider knowledge will advance care for all,” he said. “The next phase of research on this topic is investigating ways to communicate that the hormonal IUD is an effective emergency contraception option to people considering using emergency contraception and educating providers to improve care by providing this service.”