#308 Can It Stay or Must It Go? Extended Use of Intrauterine Devices
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- One systematic review:1
- Levonorgestrel (LNG) IUD 52 mg (Mirena™): 4 cohort studies, 2089 participants:
- Health Canada approved duration: 5 years.2
- Years 6 & 7:
- 0.02 pregnancies per 100 person-years (95% CI 0–0.29).
- Expulsion and infection rates: ~0-3%.
- Bleeding/pain leading to discontinuation 0.2 to 6.2%.
- No data on devices with other levonorgestrel dosages.
- Copper-T380A IUD: 2 cohort studies, 473 participants:
- Health Canada approved duration: 10 years.3
- Years 11 & 12:
- No pregnancies reported (95% CI 0–0.8 pregnancies per 100 person-years).
- Expulsion rate ~1%.
- No infections or perforations (reported in one study).
- Bleeding/pain leading to discontinuation 1-5%.
- An earlier systematic review4 found similar results.
- Levonorgestrel (LNG) IUD 52 mg (Mirena™): 4 cohort studies, 2089 participants:
- Limitations:
- No randomized controlled trials were identified. Evidence presented is from relatively small observational studies.
- Most studies were in parous participants.
- Statements from the Society of Obstetricians and Gynecologists of Canada (SOGC) and the American College of Obstetricians and Gynecologists (ACOG) are consistent with these findings.5,6
- SOGC: “Intrauterine contraception (IUC) may be safely continued beyond its approved duration of use.” Removal or replacement may be deferred for up to 12 months.
- ACOG: “Data indicate that the copper IUD, [and] the LNG-20 IUD… are all effective beyond their FDA-approved durations of use.”
- Average annual rates during first five (LNG) or ten (copper-T380A) years of use7:
- Pregnancy: ~0.1% (LNG), ~0.4% (copper-T380A).
- Expulsion and infection rates: ~0.06-1% (LNG), ~0.02-1.5% (copper-T380A).
- Discontinuation due to bleeding or pain: ~7% (LNG), ~3% (copper-T380A).
- IUD cost is ~$350 (LNG 52mg) or ~$78 (copper-T380A).8
some replacement deferral is reasonable
interesting
informative
iud’s are effective beyond their expiatory date.