BACKGROUND AND PURPOSE:

• Ti et al. (AJOG, 2020) assessed whether extended use of copper (Cu) and levonorgestrel (LNG) IUDs is safe and effective

METHODS:

• Systematic review and meta-analysis (from inception through June 2019)
• Data sources
  • PubMed | Embase | Cumulative Index to Nursing and Allied Health Literature | Global Index Medicus
• Study inclusion criteria
  • RCTs, cohort (comparative and noncomparative) studies, and case-control studies
  • Women using modern T380A copper or levonorgestrel IUDs (52 mg, 18.5 mg, and 13.5 mg) past their approved duration date
• Data analysis
  • Study quality was assessed for risk of bias, precision, and external validity
  • Pooled pregnancy rate during the first 2 years of extended use for each intrauterine device type was calculated
• Primary outcome
  • Pregnancy among extended use cohort
• Safety outcomes
  • Adverse events: Expulsion | Displacement | Perforation | Infection
  • Side effects: Bleeding and pain sufficient to require discontinuation during extended use time frame

RESULTS:

• 6 studies were included
  • Levonorgestrel IUD (52 mg): 4 studies (approved for 5 years)
    • Studies were assessed as good-to-poor-quality | 2098 women were included
  • T380A copper IUD: 2 studies (approved for 10 years)
    • Studies were assessed as good-to-fair-quality | 245 women were included

Primary Outcome: Pregnancy

• Levonorgestrel IUD
  • Pooled pregnancy rates
    • Year 6: 0.02 per 100 person-years (95% CI, 0.00 to 0.45)
    • Year 7: 0.03 per 100 person-years (95% CI, 0.00 to 0.71)
    • Years 6 and 7 combined: 0.02 per 100 person-years (95% CI, 0.00 to 0.29)
  • Adverse events or discontinuation during extended period
    • Annual rates: 0 to 3.7 per 100 participants
• Copper IUD
  • Pooled pregnancy rates
    • Years 11 and 12
      • 0.0 per 100 person-years (95% CI, 0.0 to 0.8)
  • Adverse events or discontinuation during extended period
    • Annual rates: 0 to 4.6 per 100 participants

CONCLUSION:

• Pregnancy rates and adverse outcomes during 2 years of extended levonorgestrel or copper IUD use are similar to those seen during approved length of use
• The authors caution that the data were limited in quality and quantity, and that these results may not be generalizable to all IUD users
• The appropriate RCT design to answer the question posed in this study would be to randomize patients as they come to the end of approved length of use to either retention or a new IUD
• However, the authors also state that  

…absent more definitive research, clinicians can help patients balance the existing data with individual concerns and circumstances, including the patient’s medical history, access to care, and the potential impact of IUD failure

Learn More – Primary Sources:

Effectiveness and safety of extending intrauterine device duration: a systematic review

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