Immediate versus delayed initiation of the levonorgestrel-releasing intrauterine systemfollowing medical termination of pregnancy-1year continuation rates: a randomised controlled trial

ObjectiveTo assess the 1-year continuation rates and new pregnancies following immediate versus delayed insertion of the levonorgestrel-releasing intrauterine system (LNG-IUS) after medical termination of pregnancy (MTOP) up to 20weeks of gestation. DesignA randomised controlled trial. SettingHelsinki University Hospital, Finland, January 2013 to December 2014. PopulationA total of 267 women requesting MTOP and planning LNG-IUS for post-MTOP contraception. MethodsInsertion of LNG-IUS occurred immediately (0-3days) or after a delay (2-4weeks) following MTOP. Follow-up visits were at 3months and 1year after MTOP. Main outcome measuresLNG-IUS use at 1year after MTOP. ResultsWomen were randomised to immediate (n=134) or delayed (n=133) insertion of the LNG-IUS, and 133 and 131 were analysed; 127 (95.5%) women received immediate insertion and 111 (84.7%) women had delayed insertion of the LNG-IUS (risk ratio [RR] 1.13, 95% CI 1.04-1.22). The verified numbers of women continuing the LNG-IUS use at 1year were 83 (62.4%) and 52 (39.7%) (RR 1.57, 95% CI 1.23-2.02). The numbers of new pregnancies were 6 (4.5%) and 16 (12.2%) (RR 0.37, 95% CI 0.15-0.91), and numbers of subsequent TOPswere 4 (3.0%) and 5 (3.8%) (RR 0.79, 95% CI 0.22-2.87). ConclusionsImmediate insertion of the LNG-IUS following MTOP resulted in higher 1-year continuation rates compared with delayed insertion. In addition, those receiving immediate insertion demonstrated a decreased new pregnancy rate, but no difference in the numbers of another TOP. Tweetable abstractImmediate LNG-IUS insertion after MTOP results in a higher 1-year continuation compared with delayed insertion. Tweetable abstract Immediate LNG-IUS insertion after MTOP results in a higher 1-year continuation compared with delayed insertion.