Sydney School of Medicine (Central Clinical School) Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
Royal Prince Alfred Hospital, Sydney Local Area Health Service, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2021 Jun;61(3):448-453. doi: 10.1111/ajo.13319. Epub 2021 Feb 18.
The Australian Contraceptive ChOice pRoject (ACCORd) aimed to assess the impact of a complex general practice intervention on the uptake of long-acting reversible contraceptives (LARC).
Using survey data from enrolled women, we aimed to compare the ongoing use and satisfaction of women who chose one of the hormonal LARC methods including the levonorgestrel intrauterine system (LNG-IUS) or levonorgestrel implant compared to the oral contraceptive pill (OCP).
We used the data from participants' baseline, six and 12-month surveys to identify new users of implants, LNG-IUS or OCP. We included demographic information, ongoing use of the contraceptive method, reasons for dissatisfaction and discontinuation and experience of side-effects. Proportions were compared using χ tests.
Of the 740 women enrolled in ACCORd, 176 started using a hormonal LARC or OCP in the study's first six months with 76 using the IUS (43%), 60 the implant (34%) and 40 (23%) the OCP. Twelve-month continuation rates for the LNG-IUS, implant and OCP were 93, 83 and 65% respectively (P < 0.001). Satisfaction was highest among the LNG-IUS users; 86% were very/somewhat satisfied compared to 75% of implant users and 61% of OCP users (P < 0.001). Main reasons for method dissatisfaction were irregular bleeding and mood changes which were similar for all methods.
This study provides further evidence that hormonal LARC methods have higher continuation and satisfaction rates compared to the OCP with similar side-effects. Since hormonal LARC methods have the highest contraceptive efficacy, these should be offered first-line to women.
澳大利亚避孕选择项目（ACCORd）旨在评估一项综合全科医学干预措施对长效可逆避孕方法（LARC）使用率的影响。
我们使用纳入女性的调查数据，旨在比较选择其中一种激素 LARC 方法（包括左炔诺孕酮宫内节育系统[LNG-IUS]或左炔诺孕酮埋植剂）与口服避孕药（OCP）的女性的持续使用和满意度。
我们使用参与者基线、6 个月和 12 个月调查的数据来确定植入物、LNG-IUS 或 OCP 的新使用者。我们纳入了人口统计学信息、避孕方法的持续使用情况、不满和停药的原因以及副作用的经历。使用 χ 检验比较比例。
在 ACCORd 纳入的 740 名女性中，176 名在研究的前 6 个月开始使用激素 LARC 或 OCP，其中 76 名使用 IUS（43%）、60 名使用植入剂（34%）和 40 名（23%）使用 OCP。LNG-IUS、植入剂和 OCP 的 12 个月续用率分别为 93%、83%和 65%（P<0.001）。LNG-IUS 用户的满意度最高；86%的人非常/有些满意，而植入剂用户的满意度为 75%，OCP 用户的满意度为 61%（P<0.001）。方法不满意的主要原因是不规则出血和情绪变化，所有方法都存在类似的情况。
这项研究进一步证明，与 OCP 相比，激素 LARC 方法具有更高的续用率和满意度，且副作用相似。由于激素 LARC 方法具有最高的避孕效果，因此应优先向女性提供这些方法。
