Effectiveness of Long-Acting Reversible Contraception

Datos Bibliográficos

ID23385683
AutoresBrooke Winner (Washington University in St. Louis), Jeffrey F Peipert (0000-0002-8546-1943, Washington University in St. Louis), Qiuhong Zhao (0000-0003-3449-8954, Washington University in St. Louis), Christina Buckel (Washington University in St. Louis), Tessa Madden (0000-0001-9455-1943, Washington University in St. Louis), Jenifer E Allsworth (0000-0001-6559-8638, Washington University in St. Louis), Gina M Secura (Washington University in St. Louis)
Año2012
Volumen366
Número21
Páginas1998-2007
Fecha de publicación2012-05-24
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaNew England Journal of Medicine (JOURNAL)
Identificadores de la revistaISSN: 0028-4793 • E-ISSN: 1533-4406
EditorialMassachusetts Medical Society (PUBLISHER • US)
DOI10.1056/nejmoa1110855
PMID22621627
OpenAlexW2140871293
IdiomaEN
Citas recibidas62
Referencias citadas13

BACKGROUND: The rate of unintended pregnancy in the United States is much higher than in other developed nations. Approximately half of unintended pregnancies are due to contraceptive failure, largely owing to inconsistent or incorrect use. METHODS: We designed a large prospective cohort study to promote the use of long-acting reversible contraceptive methods as a means of reducing unintended pregnancies in our region. Participants were provided with reversible contraception of their choice at no cost. We compared the rate of failure of long-acting reversible contraception (intrauterine devices [IUDs] and implants) with other commonly prescribed contraceptive methods (oral contraceptive pills, transdermal patch, contraceptive vaginal ring, and depot medroxyprogesterone acetate [DMPA] injection) in the overall cohort and in groups stratified according to age (less than 21 years of age vs. 21 years or older). RESULTS: Among the 7486 participants included in this analysis, we identified 334 unintended pregnancies. The contraceptive failure rate among participants using pills, patch, or ring was 4.55 per 100 participant-years, as compared with 0.27 among participants using long-acting reversible contraception (hazard ratio after adjustment for age, educational level, and history with respect to unintended pregnancy, 21.8; 95% confidence interval, 13.7 to 34.9). Among participants who used pills, patch, or ring, those who were less than 21 years of age had a risk of unintended pregnancy that was almost twice as high as the risk among older participants. Rates of unintended pregnancy were similarly low among participants using DMPA injection and those using an IUD or implant, regardless of age. CONCLUSIONS: The effectiveness of long-acting reversible contraception is superior to that of contraceptive pills, patch, or ring and is not altered in adolescents and young women. (Funded by the Susan Thompson Buffet Foundation.).

Cohort · Cohort study · Confidence interval · Environmental health · Estrogen · Family planning · Gynecology · Hazard ratio · Intrauterine device · Long-acting reversible contraception · Medroxyprogesterone acetate · Obstetrics · Pill · Population · Pregnancy · Prospective cohort study · Research methodology · Unintended pregnancy · Vaginal ring · Global Maternal and Child Health · Internal Medicine · Medicine · Reproductive Health and Contraception · Reproductive tract infections research · Surgery