University of Utah School of Medicine, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States.
University of Utah School of Medicine, Department of Obstetrics and Gynecology, Salt Lake City, UT, United States.
Contraception. 2021 Nov;104(5):561-566. doi: 10.1016/j.contraception.2021.06.011. Epub 2021 Jun 21.
This study assessed the timing, frequency, use of backup method and 1-month pregnancy rates among individuals who had an intrauterine device (IUD) placed as emergency contraception and reported intercourse within 7 days post-placement.
In this secondary analysis of a randomized control trial of IUDs for emergency contraception, 518 individuals reporting unprotected intercourse in the preceding 5 days had a 52 mg levonorgestrel intrauterine system (IUS) or 380 mm copper IUD placed outside the first week of their menstrual cycle. All participants were advised to use backup contraception for 7 days. We assessed pregnancy status 1 month after placement by urine testing or, when not available, by survey responses and electronic health record review. Participants reported whether their first sexual activity after device placement occurred within 7 days of their placement, the frequency of intercourse and whether they used backup contraception.
Rapid return to sexual activity was common and use of backup contraception was rare, regardless of type of IUD placed. Of participants who resumed penile-vaginal intercourse in the first month, most (286/446, 64.1%) participants reported intercourse within 7 days of IUD placement; only 16.4% (74/446) used condoms or withdrawal. No pregnancies occurred among users of the levonorgestrel IUS who reported intercourse within 7 days of placement (0/138, 0.0%, 95% CI 0.0%, 2.6%) nor among users of the 380mm copper IUD (0/148, 0.0%, 95% CI 0.0%, 2.5%).
Pregnancy rates are low after placement of an IUD for emergency contraception, even among the many who resume intercourse within days following IUD placement without use of backup contraception.
Clinical guidelines should facilitate access to contraception, including elimination of unnecessary recommendations for backup contraception or abstinence in the 7 days following 52 mg levonorgestrel intrauterine system.
本研究评估了因 7 天内发生无保护性行为而将宫内节育器（IUD）作为紧急避孕措施的人群中，IUD 放置后发生性行为的时间、频率、使用后备方法以及 1 个月的妊娠率。
在一项关于紧急避孕用 IUD 的随机对照试验的二次分析中，518 名在过去 5 天内发生无保护性行为的个体，在其月经周期的第一周之外放置了 52mg 左炔诺孕酮宫内节育系统（LNG-IUS）或 380mm 铜 IUD。所有参与者均被建议在 7 天内使用后备避孕方法。我们通过尿液检测或在无法进行尿液检测时通过调查回复和电子健康记录审查，在放置后 1 个月评估妊娠状况。参与者报告其放置后首次发生性行为的时间是否在放置后 7 天内，性交频率以及是否使用后备避孕方法。
无论放置哪种 IUD，快速恢复性行为的情况都很常见，且使用后备避孕方法的情况很少见。在第一个月恢复阴茎阴道性交的参与者中，大多数（286/446，64.1%）报告在放置 IUD 后 7 天内发生了性行为；只有 16.4%（74/446）使用了避孕套或体外排精。在放置后 7 天内发生性行为的 LNG-IUS 使用者中未发生妊娠（0/138，0.0%，95%CI 0.0%，2.6%），380mm 铜 IUD 使用者中也未发生妊娠（0/148，0.0%，95%CI 0.0%，2.5%）。
即使在许多人在放置 IUD 后几天内没有使用后备避孕方法就恢复性行为的情况下，紧急避孕放置 IUD 后的妊娠率也很低。
临床指南应促进避孕方法的获得，包括消除对 52mg 左炔诺孕酮宫内节育系统放置后 7 天内使用后备避孕方法或禁欲的不必要建议。
