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HONOLULU – The risk of unintended pregnancy was 84% lower with use of levonorgestrel-releasing intrauterine devices than with copper intrauterine devices, according to an analysis of secondary outcomes in a prospective international cohort study of 61,448 women.
EURAS-IUD (the European Active Surveillance Study for Intrauterine Devices) reported its primary outcome in early 2014, showing very low and similar uterine perforation rates in women receiving either levonorgestrel-releasing IUDs or copper IUDs for the first time.
Among secondary outcomes, the levonorgestrel-releasing IUD (Mirena) was associated with a significantly lower risk of unintended pregnancy than were copper IUDs, after adjustment for the influence of age, body mass index, and parity, Dr. Klaas Heinemann Jr. and his associates reported at the annual meeting of the American Society for Reproductive Medicine.
The risk of ectopic pregnancy also was lower with the Mirena than with copper IUDs, showing a 74% decrease in the likelihood of ectopic pregnancy after adjustment for the effects of age, body mass index, and parity, said
Dr. Heinemann of the Berlin Center for Epidemiology and Health Research.
Rates of unintended or ectopic pregnancies were very low in both groups.
Among the 43,078 women receiving the Mirena, follow-up information on 41,001 women aged 18-50 years provided data on 44,633 women-years of observation. Among the 18,370 women receiving copper IUDs, follow-up information on 17,323 women aged 18-50 years provided data on 17,703 women-years of observation.
The 26 contraceptive failures on the Mirena included 13 in women with unrecognized expulsion of the IUD and 1 with a dislocated IUD. The 92 contraceptive failures on copper IUDs included 16 women with unrecognized expulsion of the IUD and 26 with a dislocated IUD.
On the Pearl Index of contraception effectiveness (the number of unintended pregnancies divided by 100 women-years), the Mirena rated 0.06 and copper IUDs rated 0.52, Dr. Heinemann reported. Pregnancy incidence rates were less than 0.08/100 women-years with the Mirena and less than 0.56/100 women-years with copper IUDs.
The lower pregnancy rate with the Mirena was present in all age groups, he added.
Seven confirmed ectopic pregnancies in the Mirena group and 14 in the copper IUD group produced incidence rates of less than 0.05/100 women-years with the Mirena and less than 0.10/100 women-years with copper IUDs.
The 70% of women who received the Mirena tended to be older (mean age, 37 years) than those who got copper IUDs (mean age, 33 years). The women who got the Mirena also were less likely to have delivered a child within the prior year (20%) or to be breast-feeding at the time of insertion (9%), compared with women who got copper IUDs (29% and 15%, respectively).
The research was funded by Bayer, which markets Mirena. Dr. Heinemann is a former employee of Bayer Schering Pharma.
On Twitter @sherryboschert
All contraceptives, particularly IUDs, are very effective. Keep in mind that this is one study that showed a difference between the two IUDs. I don’t think any other studies in the past, in the years that both IUDs have been on the market, have shown this type of phenomenon.
This study was sponsored by a pharmaceutical company. I think you have to take any industry-sponsored results with a grain of salt if they show major differences. My reading of this study is that there are differences, but the differences are much lower than any complications or problems with pregnancy in and of itself, without a contraceptive agent.
The way I would spin this for any prospective patient is that all IUDs, both the levonorgestrel-releasing IUD and the copper IUD, are great methods of contraception. Pregnancy rates are low overall and the risk of ectopic pregnancy is low.
The Pearl Index was below 1, which is good. The Pearl Index for the copper IUD was higher than reported in previous studies. That’s a little unusual.
It’s hard to take a lot from this study other than to say these are two very good methods of contraception. I’m awaiting the full paper before I would be too concerned about changing prescribing habits. If you are a Mirena prescriber, continue to be a Mirena prescriber. I don’t think there’s anything alarming here, although it’s a little surprising because it does go against what’s been shown in previous studies.
Dr. Michael A. Thomas is professor of ob.gyn. and chief of the division of reproductive endocrinology and infertility at the University of Cincinnati. He gave these remarks in an interview. Dr. Thomas has been an adviser to Teva Pharmaceutical Industries, which markets copper IUDs, and has participated in clinical trials that helped bring the Mirena IUD to market.
All contraceptives, particularly IUDs, are very effective. Keep in mind that this is one study that showed a difference between the two IUDs. I don’t think any other studies in the past, in the years that both IUDs have been on the market, have shown this type of phenomenon.
This study was sponsored by a pharmaceutical company. I think you have to take any industry-sponsored results with a grain of salt if they show major differences. My reading of this study is that there are differences, but the differences are much lower than any complications or problems with pregnancy in and of itself, without a contraceptive agent.
The way I would spin this for any prospective patient is that all IUDs, both the levonorgestrel-releasing IUD and the copper IUD, are great methods of contraception. Pregnancy rates are low overall and the risk of ectopic pregnancy is low.
The Pearl Index was below 1, which is good. The Pearl Index for the copper IUD was higher than reported in previous studies. That’s a little unusual.
It’s hard to take a lot from this study other than to say these are two very good methods of contraception. I’m awaiting the full paper before I would be too concerned about changing prescribing habits. If you are a Mirena prescriber, continue to be a Mirena prescriber. I don’t think there’s anything alarming here, although it’s a little surprising because it does go against what’s been shown in previous studies.
Dr. Michael A. Thomas is professor of ob.gyn. and chief of the division of reproductive endocrinology and infertility at the University of Cincinnati. He gave these remarks in an interview. Dr. Thomas has been an adviser to Teva Pharmaceutical Industries, which markets copper IUDs, and has participated in clinical trials that helped bring the Mirena IUD to market.
All contraceptives, particularly IUDs, are very effective. Keep in mind that this is one study that showed a difference between the two IUDs. I don’t think any other studies in the past, in the years that both IUDs have been on the market, have shown this type of phenomenon.
This study was sponsored by a pharmaceutical company. I think you have to take any industry-sponsored results with a grain of salt if they show major differences. My reading of this study is that there are differences, but the differences are much lower than any complications or problems with pregnancy in and of itself, without a contraceptive agent.
The way I would spin this for any prospective patient is that all IUDs, both the levonorgestrel-releasing IUD and the copper IUD, are great methods of contraception. Pregnancy rates are low overall and the risk of ectopic pregnancy is low.
The Pearl Index was below 1, which is good. The Pearl Index for the copper IUD was higher than reported in previous studies. That’s a little unusual.
It’s hard to take a lot from this study other than to say these are two very good methods of contraception. I’m awaiting the full paper before I would be too concerned about changing prescribing habits. If you are a Mirena prescriber, continue to be a Mirena prescriber. I don’t think there’s anything alarming here, although it’s a little surprising because it does go against what’s been shown in previous studies.
Dr. Michael A. Thomas is professor of ob.gyn. and chief of the division of reproductive endocrinology and infertility at the University of Cincinnati. He gave these remarks in an interview. Dr. Thomas has been an adviser to Teva Pharmaceutical Industries, which markets copper IUDs, and has participated in clinical trials that helped bring the Mirena IUD to market.
HONOLULU – The risk of unintended pregnancy was 84% lower with use of levonorgestrel-releasing intrauterine devices than with copper intrauterine devices, according to an analysis of secondary outcomes in a prospective international cohort study of 61,448 women.
EURAS-IUD (the European Active Surveillance Study for Intrauterine Devices) reported its primary outcome in early 2014, showing very low and similar uterine perforation rates in women receiving either levonorgestrel-releasing IUDs or copper IUDs for the first time.
Among secondary outcomes, the levonorgestrel-releasing IUD (Mirena) was associated with a significantly lower risk of unintended pregnancy than were copper IUDs, after adjustment for the influence of age, body mass index, and parity, Dr. Klaas Heinemann Jr. and his associates reported at the annual meeting of the American Society for Reproductive Medicine.
The risk of ectopic pregnancy also was lower with the Mirena than with copper IUDs, showing a 74% decrease in the likelihood of ectopic pregnancy after adjustment for the effects of age, body mass index, and parity, said
Dr. Heinemann of the Berlin Center for Epidemiology and Health Research.
Rates of unintended or ectopic pregnancies were very low in both groups.
Among the 43,078 women receiving the Mirena, follow-up information on 41,001 women aged 18-50 years provided data on 44,633 women-years of observation. Among the 18,370 women receiving copper IUDs, follow-up information on 17,323 women aged 18-50 years provided data on 17,703 women-years of observation.
The 26 contraceptive failures on the Mirena included 13 in women with unrecognized expulsion of the IUD and 1 with a dislocated IUD. The 92 contraceptive failures on copper IUDs included 16 women with unrecognized expulsion of the IUD and 26 with a dislocated IUD.
On the Pearl Index of contraception effectiveness (the number of unintended pregnancies divided by 100 women-years), the Mirena rated 0.06 and copper IUDs rated 0.52, Dr. Heinemann reported. Pregnancy incidence rates were less than 0.08/100 women-years with the Mirena and less than 0.56/100 women-years with copper IUDs.
The lower pregnancy rate with the Mirena was present in all age groups, he added.
Seven confirmed ectopic pregnancies in the Mirena group and 14 in the copper IUD group produced incidence rates of less than 0.05/100 women-years with the Mirena and less than 0.10/100 women-years with copper IUDs.
The 70% of women who received the Mirena tended to be older (mean age, 37 years) than those who got copper IUDs (mean age, 33 years). The women who got the Mirena also were less likely to have delivered a child within the prior year (20%) or to be breast-feeding at the time of insertion (9%), compared with women who got copper IUDs (29% and 15%, respectively).
The research was funded by Bayer, which markets Mirena. Dr. Heinemann is a former employee of Bayer Schering Pharma.
On Twitter @sherryboschert
HONOLULU – The risk of unintended pregnancy was 84% lower with use of levonorgestrel-releasing intrauterine devices than with copper intrauterine devices, according to an analysis of secondary outcomes in a prospective international cohort study of 61,448 women.
EURAS-IUD (the European Active Surveillance Study for Intrauterine Devices) reported its primary outcome in early 2014, showing very low and similar uterine perforation rates in women receiving either levonorgestrel-releasing IUDs or copper IUDs for the first time.
Among secondary outcomes, the levonorgestrel-releasing IUD (Mirena) was associated with a significantly lower risk of unintended pregnancy than were copper IUDs, after adjustment for the influence of age, body mass index, and parity, Dr. Klaas Heinemann Jr. and his associates reported at the annual meeting of the American Society for Reproductive Medicine.
The risk of ectopic pregnancy also was lower with the Mirena than with copper IUDs, showing a 74% decrease in the likelihood of ectopic pregnancy after adjustment for the effects of age, body mass index, and parity, said
Dr. Heinemann of the Berlin Center for Epidemiology and Health Research.
Rates of unintended or ectopic pregnancies were very low in both groups.
Among the 43,078 women receiving the Mirena, follow-up information on 41,001 women aged 18-50 years provided data on 44,633 women-years of observation. Among the 18,370 women receiving copper IUDs, follow-up information on 17,323 women aged 18-50 years provided data on 17,703 women-years of observation.
The 26 contraceptive failures on the Mirena included 13 in women with unrecognized expulsion of the IUD and 1 with a dislocated IUD. The 92 contraceptive failures on copper IUDs included 16 women with unrecognized expulsion of the IUD and 26 with a dislocated IUD.
On the Pearl Index of contraception effectiveness (the number of unintended pregnancies divided by 100 women-years), the Mirena rated 0.06 and copper IUDs rated 0.52, Dr. Heinemann reported. Pregnancy incidence rates were less than 0.08/100 women-years with the Mirena and less than 0.56/100 women-years with copper IUDs.
The lower pregnancy rate with the Mirena was present in all age groups, he added.
Seven confirmed ectopic pregnancies in the Mirena group and 14 in the copper IUD group produced incidence rates of less than 0.05/100 women-years with the Mirena and less than 0.10/100 women-years with copper IUDs.
The 70% of women who received the Mirena tended to be older (mean age, 37 years) than those who got copper IUDs (mean age, 33 years). The women who got the Mirena also were less likely to have delivered a child within the prior year (20%) or to be breast-feeding at the time of insertion (9%), compared with women who got copper IUDs (29% and 15%, respectively).
The research was funded by Bayer, which markets Mirena. Dr. Heinemann is a former employee of Bayer Schering Pharma.
On Twitter @sherryboschert
AT THE ASRM ANNUAL MEETING
Key clinical point: The adjusted risk of unintended pregnancy was 84% lower with levonorgestrel-releasing IUDs than with copper IUDs.
Major finding: Pregnancy incidence rates were less than 0.08/100 women-years with the Mirena and less than 0.56/100 women-years with copper IUDs.
Data source: Secondary outcomes analysis in a prospective, multinational cohort study of 61,448 women receiving IUDs.
Disclosures: The research was funded by Bayer, which markets Mirena. Dr. Heinemann is a former employee of Bayer Schering Pharma.
