LARC users have highest rates of contraception continuation at 24-months

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1. The continuation rate for long acting reversible contraception (LARCs) at 2 years was 77%. 

2. Women who used LARCs were less likely to discontinue their method at 2 years compared with non-LARC users. 

Evidence Rating Level: 2 (Good)            

Study Rundown: This large, prospective trial found that women who chose LARC methods, such as IUDs or implants, were less likely to discontinue their contraception at 2 years compared to those who chose non-LARC methods, such as OCPs, rings, and patches. Overall continuation rates for IUDs were 77-79%, compared with only 38-43% for non-LARC methods.

This is one of the first studies to examine the continuation rates of both LARC and non-LARC methods for >1year. A limitation is heavy promotion of LARCs, which may confer higher rates of continuation in women who continued to participate in the study and may make results less generalizable to a non-study population. Future studies might repeat results in a population-based cohort.

Click to read the study in Obstetrics & Gynecology

Relevant Reading: Effectiveness of Long-Acting Reversible Contraception

Study author, Jeffrey F. Peipert, M.D., Ph.D., talks to 2 Minute Medicine: Department of Obstetrics & Gynecology, Division of Clinical Research, at the Washington University in St. Louis School of Medicine, St. Louis, MO

“This paper demonstrates that the continuation rate for LARC methods at 2 years are high (69-79%) and far exceed continuation of non-LARC methods such as the pill, patch, ring, and DMPA (38-43%). The 24-month continuation rate was slightly lower for teens, but the main difference noted in continuation is between LARC and non-LARC methods.  At 24-months, 67% of teens were still using their LARC method compared to 42% of teens selecting non-LARC methods.”

In-Depth [prospective cohort study]: This study analyzed 24 months of follow-up from 6,153 participants of the CHOICE Project, an observational study that provides no-cost contraception and promotes long-acting reversible contraception (LARCs: IUDs and implants) to women in St. Louis. The primary outcome, continuation of the initial contraceptive method at 24 months, was compared between contraceptive methods (IUDs, implants, DMPA, OCPs, ring, patch).

The 24-month continuation rate for LARC users was 77%, compared with 41% for non-LARC users. When adjusted for potential confounders, such as education, income, and parity, LARC users were less likely to discontinue their contraception method than non-LARC users (HR=0.29, 95% CI 0.26-0.32). Rates of continuation for the levonorgestrel and copper IUDs were 79% and 77% and 69% for the implant, while rates of continuation of non-LARC methods were much lower, ranging from 38-43%. 

By Maren Shapiro and Leah Hawkins, MD, MPH

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