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RAPID EC Trial Results: Levonorgestrel vs Copper IUD for Emergency Contraception

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BACKGROUND AND PURPOSE:

  • Currently, clinicians only offer copper intrauterine devices (IUDs) for emergency contraception
  • Guidelines recommend oral emergency contraception for women with a levonorgestrel IUD who have had recent, unprotected intercourse
  • Turok et al. (NEJM, 2021) assessed the 1 month pregnancy risk with the levonorgestrel IUD vs copper IUD for emergency contraception

METHODS:

  • Multicenter, randomized, participant-blind, noninferiority trial
  • Participants
    • Women who sought emergency contraception after at least one episode of unprotected intercourse within the 5 days before presentation and agreed to placement of an IUD
  • Intervention
    • Levonorgestrel 52-mg IUD
    • Copper T380A IUD
  • Primary outcome
    • Positive urine pregnancy test 1-month after IUD insertion
      • If unavailable, pregnancy status was determined using survey and health record data
    • Non-inferiority margin was calculated at 2.5 percentage points

RESULTS:

  • Levonorgestrel IUD: 317 women | Copper IUD: 321 women
  • 1-month pregnancy tests obtained in 92.5% of participants
    • Levonorgestrel IUD: 290
    • Copper IUD: 300
  • Pregnancy rates
    • Levonorgestrel IUD: 0.3% (95% CI, 0.01 to 1.7)
    • Copper IUD: 0% (95% CI, 0 to 1.1)
  • The levonorgestrel IUD was noninferior to the copper IUD at preventing pregnancy
    • Between-group absolute difference in both analyses: 0.3 percentage points (95% CI, −0.9 to 1.8)
    • Result was the same for intention to treat and per-protocol analyses
  • Adverse events that resulted in participants seeking medical care in the first month after IUD placement
    • Levonorgestrel IUD: 5.2% of participants
    • Copper IUD: 4.9% of participants
    • Absolute risk difference in total events between the groups: −0.2 (95% CI, −3.6 to 3.3)

CONCLUSION:

  • The levonorgestrel IUD was noninferior to the copper IUD for emergency contraception
  • In addition, the authors state

Unlike the case with oral levonorgestrel, the efficacy of the levonorgestrel IUD for emergency contraception does not appear to be affected by higher body-mass index

Since the IUD also provides ongoing contraception, it avoids the delayed initiation of ongoing contraception that is recommended when ulipristal acetate is used for emergency contraception 

Learn More – Primary Sources:

Levonorgestrel vs. Copper Intrauterine Devices for Emergency Contraception

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Related ObG Topics:

Emergency Contraception: What, When and How?
Emergency Contraception: What’s your Best Option?
Expert Opinion: Over-the-Counter Contraceptives for Adolescents
Can Copper and Levonorgestrel IUD Use Be Safely Extended?

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