Table 3.
Complications, failure, and discontinuation: ENG implant vs LNG-IUS
| Outcomes | Age 15–19 years | Age 20–24 | Age 25–44 | ||||||
|---|---|---|---|---|---|---|---|---|---|
| N (column %) | OR (95% CI)c | N (column %) | OR (95% CI)c | N (column %) | OR (95% CI)c | ||||
| ENG implant |
LNG-IUS | ENG implant |
LNG- IUS |
ENG implant |
LNG-IUS | ||||
| Total N | 2,388 | 2,204 | n/a | 2,014 | 8,988 | n/a | 2,972 | 68,728 | n/a |
| Outcomea | |||||||||
| Dysparuniab | 20 (0.8) | 36 (1.6) | 0.51 (0.29, 0.88) | 29 (1.4) | 180 (2.0) | 0.72 (0.48, 1.06) | 45 (1.5) | 821 (1.2) | 1.27 (0.94, 1.72) |
| Dysmenorrhea | 59 (2.5) | 62 (2.8) | 0.88 (0.61, 1.26) | 25 (1.2) | 191 (2.1) | 0.58 (0.38, 0.88) | 44 (1.5) | 1,008 (1.5) | 1.01 (0.75, 1.37) |
| Premenstrual tension | 3 (0.1) | 6 (0.3) | 0.46 (0.12, 1.85) | 5 (0.2) | 36 (0.4) | 0.62 (0.24, 1.58) | 10 (0.3) | 467 (0.7) | 0.49 (0.26, 0.92) |
| Excessive or frequent menstruation | 101 (4.2) | 74 (3.4) | 1.27 (0.94, 1.73) | 80 (4.0) | 233 (2.6) | 1.55 (1.20, 2.01) | 132 (4.4) | 2,561 (3.7) | 1.20 (1.00, 1.44) |
| Dysfunctional or functional uterine hemorrhage | 122 (5.1) | 97 (4.4) | 1.17 (0.89, 1.54) | 92 (4.6) | 343 (3.8) | 1.21 (0.95, 1.53) | 132 (4.4) | 2,494 (3.6) | 1.24 (1.03, 1.48) |
| Postcoital bleeding | 6 (0.3) | 9 (0.4) | 0.61 (0.22, 1.73) | 13 (0.6) | 47 (0.5) | 1.24 (0.67, 2.29) | 8 (0.3) | 209 (0.3) | 0.89 (0.44, 1.80) |
| Endometrial hyperplasia | 0 (0.0) | 2 (0.1) | n/a | 0 (0.0) | 5 (0.1) | n/a | 5 (0.2) | 65 (0.1) | 1.78 (0.72–4.42) |
| Metrorrhagia | 68 (2.8) | 36 (1.6) | 1.77 (1.17, 2.66) | 45 (2.2) | 136 (1.5) | 1.49 (1.06, 2.09) | 65 (2.2) | 1,156 (1.7) | 1.31 (1.02, 1.68) |
| Irregular menstrual cycle | 178 (7.5) | 124 (5.6) | 1.35 (1.07, 1.71) | 151 (7.5) | 445 (5.0) | 1.56 (1.29, 1.88) | 165 (5.6) | 3,012 (4.4) | 1.28 (1.09, 1.51) |
| Absence of menstruation | 81 (3.4) | 75 (3.4) | 1.00 (0.72, 1.37) | 58 (2.9) | 261 (2.9) | 0.99 (0.74, 1.32) | 61 (2.1) | 1,277 (1.9) | 1.11 (0.85, 1.44) |
| Scanty or infrequent menstruation | 2 (0.1) | 8 (0.4) | 0.23 (0.05, 1.09) | 7 (0.3) | 26 (0.3) | 1.20 (0.52, 2.77) | 3 (0.1) | 172 (0.3) | 0.40 (0.13, 1.26) |
| Pelvic inflammatory disease | 1 (0.0) | 4 (0.2) | 0.23 (0.03, 2.06) | 1 (0.0) | 14 (0.2) | 0.32 (0.04, 2.42) | 2 (0.1) | 41 (0.1) | 1.13 (0.27, 4.67) |
| Inflammatory disease of the uterus except cervix | 2 (0.1) | 10 (0.5) | 0.18 (0.04, 0.84) | 1 (0.0) | 45 (0.5) | 0.10 (0.01, 0.72) | 3 (0.1) | 188 (0.3) | 0.37 (0.12, 1.15) |
| Cervicitis and endocervicitisb | 30 (1.3) | 45 (2.0) | 0.61 (0.38, 0.97) | 53 (2.6) | 206 (2.3) | 1.15 (0.85, 1.56) | 64 (2.2) | 1,003 (1.5) | 1.49 (1.15, 1.92) |
| Ectopic Pregnancy | 1 (0.0) | 1 (0.0) | 0.92 (0.06, 14.8) | 1 (0.0) | 8 (0.1) | 0.56 (0.07, 4.46) | 0 (0.0) | 36 (0.1) | n/a |
| Abnormal pregnancy or spontaneous abortion | 7 (0.3) | 5 (0.2) | 1.29 (0.41, 4.08) | 10 (0.5) | 20 (0.2) | 2.24 (1.05, 4.79) | 8 (0.3) | 121 (0.2) | 1.53 (0.75, 3.13) |
| Normal pregnancyb | 14 (0.6) | 32 (1.5) | 0.40 (0.21, 0.75) | 18 (0.9) | 118 (1.3) | 0.68 (0.41, 1.12) | 28 (0.9) | 561 (0.8) | 1.16 (0.79, 1.69) |
| Hematoma of upper arm | 0 (0.0) | n/a | 0 (0.0) | n/a | 0 (0.0) | n/a | |||
| Removal within 1 yearb | 295 (12.4) | 257 (11.7) | 1.07 (0.89, 1.28) | 305 (15.1) | 1,152 (12.8) | 1.21 (1.06, 1.39) | 493 (16.6) | 8,102 (11.8) | 1.49 (1.35, 1.64) |
Classification of each complication was determined by the presence of an International Classification of Diseases, 9th revision (ICD-9) corresponding with each complication, including: dysparunia (625.0), dysmenorrhea (625.3), premenstrual tension syndrome (625.4), excessive or frequent menstruation-which also includes menorrhagia and menometrorrhagia (626.2), dysfunctional or functional uterine hemorrhage NOS (626.2), post coital bleeding (626.7), endometrial hyperplasia (621.3, 621.30–621.39), metrorrhagia (626.6), irregular menstrual cycle (626.4), absence of menstruation (626.0), scanty or infrequent menstruation, including oligomenorrhea (626.1), pelvic inflammatory disease (614.0–614.2),inflammatory disease of the uterus except cervix (615, 615.0, 615.1, 615.9), Cervicitis and endocervicitis (616.0), ectopic pregnancy (633.10, 633.11, 633.20, 633.21, 633.80, 633.81, 633.90, 633.91, 761.4), molar pregnancy, abnormal products of conception, missed abortion, spontaneous abortion (630–634, 634.0, 634.00–634.02, 634.1, 634.10–634.12, 634.2, 634.20–634.22, 634.3,634.30, 634.31, 634.4, 634.40–634.42, 634.5, 634.50–634.52, 634.6, 634.60–634.62, 634.7, 634.70–634.72, 634.8, 634.80–634.82, 634.9, 634.90–634.92), normal pregnancy (V22, V22.0, V22.1, V22.2), hematoma of upper arm (23930, 23931), or removal within 1 year (IUD: 97.71, V25.12, V25.13 + Current Procedural Terminology (CPT) code 58301 or 58562, ENG implant: CPT codes 11976, 11982).
Significant interaction of age and contraceptive method were found in Dysparunia, Cervititis/endocervicitis, Normal pregnancy and Removal within 1 year (P values were 0.005, 0.004, 0.01 and 0.002, respectively).
OR (95% CI): Odds ratio (95% confidence interval) of having the specified complication for women with ENG implant vs. those for women with LNG-IUS insertion.
Bolded values indicate significant results (p<0.05).
ENG implant=subdermal etonogestrel implant
LNG-IUS=levonorgestrel intrauterine system