Acceptability and continued use of the contraceptive implant (Implanon) compared to others contraceptive methods in the Brazilian public sector
- Conditions
- ContraceptionZ00-Z99
- Registration Number
- RBR-7gqgjm
- Lead Sponsor
- Hospital da Mulher Professor Doutor José Aristodemo Pinotti - Centro de Atenção Integral à Saúde da Mulher - CAISM/ Unicamp
- Brief Summary
Introduction: Long-acting reversible contraceptives (LARC), including the copper-bearing intrauterine device (IUD) (TCu380A), the levonorgestrel-releasing intrauterine system (LNG-IUS), and the etonogestrel-releasing subdermal implant (ENG), are the most effective reversible contraceptives, with the advantage of being convenient and highly desired by users, low cost and requiring a single action to start use. These characteristics compare favorably with other short-acting methods (SARC) that include: combined pills, injectables or vaginal rings that depend on the user, which increases the risk of method failure. Due to the lack of studies comparing LARC and SARC in Brazil, we carried out this study with the following objectives. Objectives: To compare the acceptability rate and discontinuation rates between the etonogestrel (ENG)-releasing implant (Implanon), copper intrauterine device (TCu380A IUD), the levonorgestrel-releasing intrauterine system (LNG-IUS) and short-term methods up to two years after insertion. Methods: We carried out a prospective cohort study at the University of Campinas, SP, Brazil. The study was approved by the university ethics committee (CAAE: 00340818.7.0000.5404). We included women aged 18 to 43 who attended the family planning clinic looking for a contraceptive method between July 2019 and August 2020. All women received counseling about different contraceptive methods and signed a consent form. Additionally, participants were followed up every 3 months until 24 months after insertion. Satisfaction and reasons for discontinuation were assessed. The Kaplan-Meier test was used for survival analysis and the log-rank test for curve comparisons. The significance level was 5%. Results: We included 1222 women in the study, 251 in the SARC group (patches, 165; vaginal ring, 47; monthly injectables, 22; and birth control pills, 17) and 971 in the LARC group (LNG-IUS, 414; implant, 358; and IUD copper, 199). Up to two years, 211/251 (84.1%) discontinued in the SARC group and 242/971 (24.9%) in the LARC group. Among LARC users, there was a significantly greater difference in discontinuation rate for the copper IUD, 80/199 (40.2%) compared to the implant 88/358 (24.6%) and the LNG-IUD 74/ 414 (17.9%); [p<0.001]. Personal reasons were the main reason for discontinuation among SARC users. Abnormal uterine bleeding (AUB) as a cause for discontinuation was higher among ENG implant and TCu380A IUD users, and expulsion was significantly higher for the TCu380A IUD compared with the 52 mg levonorgestrel IUD. The pregnancy rate was 1.2% in the SARC group and for LARC it ranged from 0.5% to 1.0% for the implant and the TCu380A IUD, respectively. Satisfaction rates were high in the SARC (88.9%) and LARC (86.1%) groups. Conclusion When LARC and SARC were offered free of charge, there was greater uptake of LARC and a lower dropout rate than SARC. Both groups had high levels of satisfaction.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Terminated
- Sex
- Female
- Target Recruitment
- Not specified
Women between the ages of 18 and 40; Literacy; New Implanon acceptors; TCu380A IUDs; SIU-LNG and short-term methods like combined pill, injectable and vaginal ring
history of tromboembolism; uterine malformations; blood hipertension; diabetes
Study & Design
- Study Type
- Observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method
- Secondary Outcome Measures
Name Time Method